Designed for the Unique Needs
of Homecare Providers

This site provides homecare clinicians with access to chronic care management models, best practices and downloadable resources for homecare patients.

Heart Failure
Nutrition
Exercise
Monitoring
Medications
Problem Solving
Coping
Risk Reduction
 Assess 
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Evaluate 
Hypertension and Angina
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"The body of knowledge that serves as the rationale for nursing practice determines the areas of specialty to develop as well as the manner in which that knowledge is organized, tested and applied." -Carper, 1978
level 2

Heart Failure > Risk Reduction > Assess

Assess

Address reducing risk factors for re-admission at each visit in the form of an individualized self-care action plan.
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Other factors to address are cardiovascular risk factors, age appropriate health screenings and immunizations need to be addressed.
Heart Failure Self-Assessment - Level 3 (doc) - Aug 1st, 2010
Patient questionaire to assess patient's understanding of his/her condition

Decision Support Tool: Heart Failure - Level 2 (doc) - Aug 1st, 2010
This decision support tool was developed to help improve home health patient and agency outcomes by supporting standardized and evidence-based practice. This material is provided by the Quality Insights of Pennsylvania, the Medicare Quality Improvement Organization for Pennsylvania.

Estimate of 10-Year Risk for Coronary Heart Disease - Level 1 (Web Page) - Aug 1st, 2010
Charts with point system to assess 10-year risk.

Reference Card from the 7th Report of the Joint National Committee on Prevention- Level 1 (pdf) - Aug 1st, 2010
Tool that assists the clinician with identifying risks and evaluating hypertension.

Six Minute Walk Assessment - Level 2 (pdf) - Aug 1st, 2010
Objective tool done on admission and discharge. Measures distance while ambulating over a six minute time period. Patient is closely monitored during walk for physiological changes.

Dehydration Risk Assessment - Level 2 (doc) - Aug 1st, 2010
A dehydration assessment tool

Therapy Fall Risk Evaluation Form - Level 3 (doc) - Aug 1st, 2010
Form for evaluating fall risk

Assessing Risk for Hospital Re-admission- Level 1 (News Article) - Oct 23rd, 2007
 Patients at risk for re-admission after initial diagnosis for HF include the following: 70 years old or greater Newly diagnosed with HF Hospitalizations for any reason in the last 5 years Social isolation HF related to acute MI or uncontrolled HTN History of alcohol abuse HF with...

 


Levels of evidence
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Level 1
Systematic reviews and repeated studies, thoroughly researched.
Level 2
Experimental (Single or Quasi experimental study) and non-experimental (Exploratory or qualitative study).
Level 3
Recommendations of respected, experienced homecare authorities.
Level 4
Not Recommended.



The development of the hypertension and chronic stable angina project was made possible by a grant from the New York State Attorney General on behalf of the Attorneys General of all 50 states, DC and Puerto Rico from litigation settlement funds to benefit the healthcare needs of consumers with high blood pressure and angina. Original funding for the site was provided in part by US Congress and CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.