Enhancing Care Coordination
This focus area will walk you through the decisions and steps needed to optimize care coordination for your cardiac rehabilitation (CR) patients.
Effective care coordination (CC) is a proven strategy for increasing patient participation. Care coordinators begin to work with patients during their hospital stays or shortly after discharge. They educate patients about the benefits of CR and help them enroll in CR programs. Care coordinators can also be extremely helpful in identifying specific barriers to enrollment faced by traditionally underserved populations and possible strategies for addressing them. Care coordinators can be hospital staff or volunteers such as "patient ambassadors."
The combination of care coordination with automatic referral can boost CR referral to 86%, and enrollment to almost 74%.
This set of training materials can help you:
- Understand the broad reach of CC
- Evaluate your catchment area
- Redesign and refine CC workflow processes
- Address patient needs and concerns
- Learn more about CC staffing options
Consolidated Curriculum for Enhancing Care Coordination
This curriculum combines the content from four of the original TAKEheart on-line virtual trainings into:
- a single slide deck that can be customized by users for their own educational or training purposes
- a consolidated implementation guide that provides detailed actionable guidance for implementing the strategies described in the PPT presentation
- a comprehensive resource guide with links to supplemental tools and a comprehensive reference list.
BEFORE YOU BEGIN: Read the USER'S GUIDE (PDF, 416 KB) to learn about how to get the most of out of these materials.
Review the original TAKEheart trainings and webinars that help establish or enhance a care coordination system.
Original TAKEheart Training Modules
The consolidated curriculum for Enhancing Care Coordination is a streamlined and restructured set of training materials drawn from three training modules that were originally presented live to a group of hospitals working in real time to implement strategies to increase patient participation in CR.
Hospitals wishing to take a deeper dive into one or more of the topics covered in the consolidated curriculum can view recordings of the expert-led trainings and download the accompanying presentation slides and implementation guides from these three training modules:
- Training Module 6: Laying the Groundwork for Care Coordination
- Training Module 8: Implementing Effective Care Coordination
- Training Module 9: Engaging and Empowering Patients and Families for Success in Cardiac Rehabilitation
Related Webinars From the TAKEheart Learning Community
TAKEheart Learning Community webinars, held between 2020–2022, featured discussions among CR experts and CR champions from diverse hospitals on wide-ranging strategies for improving CR program operations and addressing patient needs. Recorded versions of these webinars as well as the accompanying slides and event summaries are available for download.
Learning Community webinars relating to the topics covered in the Enhancing Care Coordination training curriculum include:
- Practical Methods for Improving Care Coordination for Cardiac Rehab Patients
- Improving Support for Women Who Need Cardiac Rehabilitation
- Enhancing Care for Heart Failure Patients in Your Cardiac Rehab Program
Practical Methods for Improving Care Coordination for Cardiac Rehab Patients
- Hicham Skali, M.D., MSc, TAKEheart Principal Investigator, Associate Director of the Cardiac Rehabilitation Program at Brigham and Women’s Hospital, Division of Cardiovascular Medicine (Moderator)
- Kathe Briggs, CEP, MS, Director of Cardiac and Pulmonary Rehabilitation Services, East Alabama Medical Center, (EAMC)
- Stacey Greenway, MA, Director of Cardiovascular Disease Management programs at Vidant Medical Center
- Virginia Morris, OTR/L, MIPH, FACHE, Director of Rehabilitation and Cardiopulmonary Rehab at MedStar Southern Maryland Hospital Center and MedStar St. Mary’s Hospital
This Learning Community webinar shares care coordination improvement successes, challenges, and lessons learned and offers practical advice for other programs seeking to improve their own care coordination activities.
Video: Practical Methods for Improving Care Coordination for Cardiac Rehab Patients (1:00:16)
Slides: Practical Methods for Improving Care Coordination for Cardiac Rehabilitation Patients (PDF, 943 KB)
Improving Support for Women Who Need Cardiac Rehabilitation
- Hicham Skali, MD, MSc, TAKEheart Principal Investigator, Associate Director of the Cardiac Rehabilitation Program at Brigham and Women's Hospital, Division of Cardiovascular Medicine (Moderator)
- Haley Stolp, MPH, IHRC, Inc., Million Hearts®, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (Moderator)
- Annie DeVelasco, RN, WomenHeart Champion, Cardiac Rehabilitation Graduate
- Janna Myrick, Cardiac Rehabilitation Graduate
This Learning Community webinar explores and shares insights with peers and offers practical ideas from a panel of CR program leaders, patients, and researchers focused on improving outcomes for women in cardiac rehabilitation.
Video: Improving Support for Women That Need Cardiac Rehabilitation (48:51)
Slides: Affinity Group: Improving Support for Women That Need Cardiac Rehabilitation (PDF, 890 KB)
Event Summary: Affinity Group Details: Improving Support for Women that Need Cardiac Rehabilitation (PDF, 394 KB)
Enhancing Care for Heart Failure Patients in Your Cardiac Rehab Program
- Hicham Skali, MD, MSc, TAKEheart Principal Investigator, Associate Director of the Cardiac Rehabilitation Program at Brigham and Women's Hospital, Division of Cardiovascular Medicine (Moderator)
- Steven Keteyian, PhD, Director Preventive Cardiology Unit at Henry Ford Hospital
- Michelle Young, MSN, APN-BC, Adult Nurse Practitioner in the Cardiovascular Division at Brigham and Women's Hospital
- Daniel Forman, MD, Cardiologist at UPMC Presbyterian and UPMC East
This Learning Community webinar provides evidence-based insights and practical solutions to help programs improve recruitment and care of heart failure patients.
Video: Enhancing Care for Heart Failure Patients in Your Cardiac Rehabilitation Program (59:22)
Slides: TAKEheart Affinity Group: Enhancing Care for Heart Failure Patients in Cardiac Rehabilitation (PDF, 899 KB)
