About the Book
Table of Contents:
PART 1 THEORETICAL CONCEPTS 1 Chronic illness Paul Shelton, EdD, Cheryl Schraeder, RN, PhD, FAAN, Michael K. Berkes, BS, MSW Candidate, and Benjamin Ronk, BA 2 Overview Cheryl Schraeder, RN, PhD, FAAN, Paul Shelton, EdD, Linda Fahey, RN, MSN, Krista L. Jones, DNP, MSN, ACHN, RN, and Carrie Berger, BA, MSW Candidate 3 Promising practices in acute/primary care Randall S. Brown, PhD, Arkadipta Ghosh, PhD, Cheryl Schraeder, RN, PhD, FAAN, and Paul Shelton, EdD 4 Promising practices in integrated care Patricia J. Volland, MSW, MBA, and Mary E. Wright 5 Intervention components Cheryl Schraeder, RN, PhD, FAAN, Cherie P. Brunker, MD, Ida Hess, MSN, FNP-BC, Beth A. Hale, PhD, RN, Carrie Berger, BA, MSW Candidate, and Valerie Waldschmidt, BSE 6 Evaluation methods Robert Newcomer, PhD, and L. Gail Dobell, PhD 7 Health information technology David A. Dorr, MD, MS and Molly M. King, BA 8 Financing and payment Julianne R. Howell, PhD, Robert Berenson, MD, and Patricia J. Volland, MSW, MBA 9 Education of the interdisciplinary team Emma Barker, MSW, Patricia J. Volland, MSW, MBA, and Mary E. Wright PART 2 PROMISING PRACTICES SECTION 1 PRIMARY CARE MODELS 10 Coordination of care by guided care interdisciplinary teams Chad Boult, MD, MPH, MBA, Carol Groves, RN, MPA, and Tracy Novak, MHS 11 Care management plus Cherie P. Brunker, MD, David A. Dorr, MD, MS, and Adam B. Wilcox, PhD 12 Medicare coordinated care Angela M. Gerolamo, PhD, APRN, BC, Jennifer Schore, MSW, MS, Randall S. Brown, PhD, and Cheryl Schraeder, RN, PhD, FAAN SECTION 2 TRANSITIONAL CARE MODELS 13 The care transitions intervention Susan Rosenbek, RN, MS, and Eric A. Coleman, MD, MPH 14 Enhanced Discharge Planning Program at Rush University Medical Center Anthony J. Perry, MD, Robyn L. Golden, LCSW, Madeleine Rooney, MSW, LCSW, and Gayle E. Shier, MSW SECTION 3 INTEGRATED MODELS 15 Summa Health System and Area Agency on Aging Geriatric Evaluation Project Kyle R. Allen, DO, AGFS, Joseph L. Ruby, BA, MA, Susan Hazelett, RN, MS, Carolyn Holder, MSN, RN, GCNS-BC, Sandee Ferguson, RN, BBA, MS, Fellow, and Phyllis Yoders, RN, BSN 16 Program of All-Inclusive Care for the Elderly (PACE) Brenda Sulick, PhD, and Christine van Reenen, PhD \ SECTION 4 MEDICAID MODELS 17 Introduction to Medicaid care management Allison Hamblin, MSPH, and Stephen A. Somers, PhD 18 The Aetna Integrated Care Management Model: a managed Medicaid paradigm Robert M. Atkins, MD, MPH, and Mark E. Douglas, JD, MSN, RN 19 King County Care Partners: a community based chronic care management system for Medicaid clients with co-occurring medical, mental, and substance abuse disorders Daniel S. Lessler, MD, MHA, Antoinette Krupski, PhD, and Meg Cristofalo, MSW, MPA 20 Predictive Risk Intelligence SysteM (PRISM): a decision-support tool for coordinating care for complex Medicaid clients Beverly J. Court, MHA, PhD, David Mancuso, PhD, Chad Zhu, MS, and Antoinette Krupski, PhD 21 High-risk patients in a complex health system: coordinating and managing care 361 Maria C. Raven, MD, MPH, MSc 22 The SoonerCare Health Management Program Carolyn J. Reconnu, RN, BSN, CCM, and Mike Herndon, DO SECTION 5 PRACTICE CHANGE 23 Introduction: practice change fellows initiatives Eric A. Coleman, MD, MPH, and Nancy Whitelaw, PhD 24 Interdisciplinary care of chronically ill adults: communities of care for people living with congestive heart failure in the rural setting Lee Greer, MD, MBA 25 Collaborative care treatment of late-life depression: development of a depression support service Eran D. Metzger, MD 26 Geriatric Telemedicine: supporting interdisciplinary care Daniel A. Reece, MSW, LCSW 27 Integrated Patient-Centered Care: the I-PiCC pilot Karyn Rizzo, RN, CHPN, GCNS SECTION 6 MEDICARE MANAGED CARE 28 Longitudinal care management: High risk care management Chandra L. Torgerson, RN, BSN, MS, and Lynda Hedstrom, MSN, APRN, NP-C SECTION 7 INTERNATIONAL CARE COORDINATION 29 The experiences in the Republic of Korea Weon-seob Yoo, PhD, MPH, MD, and Joo-bong Park Oh, MN, MS, PsyD, RN
About the Author :
Cheryl Schraeder, RN, Ph.D., FAAN is currently Clinical Associate Professor and also Director of Policy and Practice Initiatives, Institute for Healthcare Innovation, at the College of Nursing at the University of Illinois in Chicago, IL. Dr. Schraeder has been the project director/ principle investigator for governmental health care agencies and private foundation demonstrations and projects with vulnerable populations. Paul S. Shelton, EdD is currently Senior Research Specialist at the Institute for Healthcare Innovation at the College of Nursing at the University of Illinois in Chicago, IL. Dr. Shelton has extensive experience in working with governmental health care agencies and private foundations in primary care management demonstrations.
