Supporting Members to Avoid Hospital Readmission and Treatment (SMART): A Value Based Approach to Chronic Care Management

To elevate the role of the home health aide in the discharge planning process to ensure patients can successfully manage their symptoms at home following a hospital stay and reducing their chances of being readmitted within thirty (30) days.

Training address these conditions:

  • Heart Failure
  • Diabetes
  • Hypertension
  • Asthma/COPD
  • Behavioral Health: Depression and Alzheimer’s Disease
...

To elevate the role of the home health aide in the discharge planning process to ensure patients can successfully manage their symptoms at home following a hospital stay and reducing their chances of being readmitted within thirty (30) days.

Training address these conditions:

  • Heart Failure
  • Diabetes
  • Hypertension
  • Asthma/COPD
  • Behavioral Health: Depression and Alzheimer’s Disease
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