Nurse Care Manager/Care Coordinator Best Practice Sharing

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Charge: Best practice sharing amongst CTC NCMs and Care Coordinators.

(Recommended attendees: nurse care managers; care coordinators from PCMH Kids practices)

 

Meeting Frequency

3rd Tuesday Monthly
8-9:30AM
PCMH-Kids required meeting with pediatric-topic
(Feb, May, Aug, Nov)

Location

301 Metro Centro Blvd 2nd Floor
Warwick, Rhode Island
Click here for directions.

Facilitators

Deb Hurwitz
(Debra.Hurwitz@umassmed.edu) 

Susanne Campbell
(Susanne.Campbell@umassmed.edu)


2017 NCM/CC Meeting Agendas


12/20/16
11/15/16 (Pediatric Focus)
10/18/16 (Cancelled)
9/20/16
8/16/16 (Pediatric Focus)
7/19/16
6/14/16
5/10/16 (Pediatric Focus)
4/12/16
3/8/16
2/9/16
1/12/16

2017 NCM/CC Meeting Minutes


3/21/17
2/21/17
1/17/17

12/20/16
11/15/16 (Pediatric Focus)
10/18/16 (Cancelled)
9/20/16
8/16/16 (Pediatric Focus)
7/19/16
6/14/16
5/10/16 (Pediatric Focus)
4/12/16
3/8/16
2/9/16
1/12/16

2017 NCM/CC Meeting Handouts


Identification and Connecting with High Risk and Transitions of Care Patients
Care Transformation Collaborative of Rhode Island (CTC-RI) Nurse Care Manager/Care Coordinator Faculty Application 
Career Development Opportunity
Implementation Plan: xG Learn Nurse Care Coordinator/Care Coordinator Training 

12/20/16 Panel Discussion
RI Home and Community Care Services to the Elderly Presentation
Transition Presentation bu the RI Department of Health
The Commonwealth Fund Case Study: Care Models for High Need, High Cost Patients
Integrated Care Initiative
Respite Fact Sheet
Kids Connect Fact Sheet
Cedars Family Centers Fact Sheet
CTC High Risk Patient Management Strategy- April 2016
Nursing Assessment Care Plan Documentation Templates
RIQI Shift in Care Project- January 2016
2015 PCMH NCM Learning Collaborative Evaluations

2017 NCM/CC Additonal Resources


Additional NCM/CC Resources can also be found here.

Additional NCM/CC Resources can also be found here.
Municipal Senior Transportation Survey
Hospital Based Delirium Assessment
Depression in Assisted Living
Frailty Presentation by Martha Watson, MS, APRN, GCNS and Christie Bowser, RN-BC
Integra Community Care Network-April 2016
Transitional Care Cut Hospital Readmissions for NC Medicaid Patients with Complex Chronic Conditions
SHARE Approach Flyer
Enhanced Personal Health Care: Care Coordinator's Handbook
Discharge Planning Checklist
PASSoffice


Our Mission

The mission of the Care Transformation Collaborative is to lead the transformation of primary care in Rhode Island in the context of an integrated health care system; and to improve the quality of care, the patient experience of care, the affordability of care, and the health of the populations we serve.