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> enhanced care management
enhanced care management
Assessment and Planning Section
Conduct comprehensive initial assessment of patient's health status
Identify patient's goals and preferences for care
Develop individualized care plan with input from patient and interdisciplinary team
Coordination of Care Section
Facilitate communication between all providers involved in patient's care
Ensure seamless transitions between care settings
Monitor and follow up on referrals to specialists or other services
Medication Management Section
Review patient's medication list for accuracy and appropriateness
Educate patient on proper medication administration and potential side effects
Monitor patient's adherence to medication regimen and address any barriers
Health Promotion and Education Section
Provide patient with information on healthy lifestyle choices and preventive care measures
Encourage patient to engage in self-management activities
Offer resources for support and assistance with behavior change
Monitoring and Evaluation Section
Regularly assess patient's progress towards goals and adjust care plan as needed
Document all interactions and interventions in patient's medical record
Seek feedback from patient and family members on care management process
Follow-up and Continuity of Care Section
Schedule regular follow-up appointments to monitor patient's health status
Coordinate care transitions between different providers or care settings
Ensure patient has access to necessary resources and support services
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