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Success Metric 1: Clinician assesses the patient’s ability to perform self-care (monitoring signs and symptoms, contacting clinicians if deterioration in signs and symptoms occur, and taking medications as prescribed, etc.) and activities of daily living (walking , cooking
TOOLS TO HELP MEET THIS METRIC
AMA Physician Resource Guide to Patient Self-Management
Hartford Institute for Geriatric Nursing Katz Index for Independence in ADLs
Success Metric 2: Clinician provides the patients/caregivers with written and verbal information on their condition that includes education on treatment regimen (self-care plan), including warning signs and when to call their healthcare provider.
TOOLS TO HELP MEET THIS METRIC
H2H Educational Resources to Help Pts Adhere to their HF Self-Care Plans (PDF)
HFSA Tips for Family and Friends on Heart Failure (for caregivers)
Success Metric 3: Clinician communicates in an empathetic, non-judgmental, collaborative manner that establishes and maintains a positive relationship with the patient and caregiver.
TOOLS TO HELP MEET THIS METRIC
H2H Teach Back Checklist (PDF)
Qualidigm Teaching Patients Module
AHRQ Teach Back Method
TMF Nursing Teach Back Cards – Medications
AHRQ Tips for Communicating Clearly
The Joint Commission Hospital Communication Roadmap
Qualidigm Discussing Palliative and End of Life Care
Success Metric 4: Clinician provides the patient/caregiver with community resources for health care.
TOOLS TO HELP MEET THIS METRIC
DHHS Eldercare Locator
How to Create a Meaningful Patient Transportation Guide
Success Metric 5: Patients/Caregivers demonstrate their knowledge of condition-related signs and symptoms (i.e., frequency and severity of symptoms) and management.
TOOLS TO HELP MEET THIS METRIC
AHRQ Teach Back Method
Success Metric 6: Patients/Caregivers participate in developing a self-care plan with their clinician to better manage their condition. (Patients keep a daily log and record symptoms, weight, medications, diet and activities when directed by their clinician).
TOOLS TO HELP MEET THIS METRIC
H2H Educational Resources to Help Pts Adhere to their HF Self-Care Plans (PDF)
Success Metric 7: Patients identify contact name and number if they need to contact their clinician (e.g., about signs and symptoms).
TOOLS TO HELP MEET THIS METRIC
H2H Patient Appointment Card (PDF)
Qualidigm HF Zones Worksheet
Success Metric 8: Patients/Caregivers bring their daily log and medication list to each and every clinic visit.
TOOLS TO HELP MEET THIS METRIC
Medication Adherence Infographic
AMA Healthy Eating Action Plan (PDF)
AMA Physical Activity Action Plan (PDF)
H2H Medication List (PDF)
CardioSmart My Heart Health Plan
NTOCC Medication List
Success Metric 9: Patients/Caregivers discuss challenges or questions about their condition with clinician.
TOOLS TO HELP MEET THIS METRIC
Medication Adherence Infographic
CardioSmart Partnering with Your Doctor
Success Metric 10: Patients/Caregivers are knowledgeable about and use community resources for health care, as needed.
TOOLS TO HELP MEET THIS METRIC
DHHS Eldercare Locator
How to Create a Meaningful Patient Transportation Guide
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