Patient Recovery Components
From WikiDreams
Contents
Recovery Assessments/Intake
Description Remote or point of service by RN, Social Worker, Recovery Navigator
Recovery Education
Remote or onsite
- Clinical Condition - Personal Care, Understanding Conditions
- Lifestyle Impact - Lifestyle impact that is permanent or during the recovery process
- Treatment Options - Surgery, therapy and care options like medications, palliative care. Decision aids.
- Patient Preference Options - Advanced Directives, authorization of access, advanced beneficiary options, end of life, provider preferences
Recovery Planning
Development of a recovery plan
- Provider Planning Services - CMS has new care transition reimbursement
- Recovery Planning Team - Physician, Social Worker, Recovery Navigator
“Qualified Option” Development
- Treatment Options - With impact – cost, risk, functional, etc.
- Setting Options - With impact – cost, risk, quality of life
Recovery Monitoring
- Physiological, Conditions, Behavioral metrics
- Treatment effectiveness
- Intervention protocols
- Technology setup (wifi, LTE, etc.)
- Personal Emergency Response Systems (PERS)- A single button (i.e., "I've fallen… and I can't get up!" – LifeCall)
Recovery Management
Remote or onsite
- Education
- First level triage, escalate as required
- 24 x 7 support
- Schedule Appointments and rides to services
- Get services, Rx filled, etc.
- Physician, Social Worker, Recovery Navigator
Technology Support
- Remote – troubleshooting, education, training
- Onsite – troubleshooting, education and training
On-site Setting Support
- Onsite Assessments (throw rugs for hip/knee, mold – asthma/COPD, etc.),
- Technology setup (wifi, LTE, etc.)
- Training/Education on use of equipment, taking care of a wound
Recovery Treatment
Surgeries
Procedures & Tests
Medicine
Therapies
Other Treatments
Recovery Activities
Socioeconomic Status
- Insurance Coverage - apply for Medicaid, petition for coverage of treatment
- Employment - Get a new job or help getting back to work
- Education - for new skills or career
Physician Environment & Setting
- Home Remodeling
- Housing Applications - Assisted Living Center, Homeless shelter, adult day care
Patient Preferences
- Establish Patient Preferences
- Recovery Goals
- Recovery Team
- Recovery Plan
- Recovery Monitoring
- Recovery Protocol
Patient Technology Adoption
- Purchase of devices
- Establish Personal Health Record
