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Improving Care Transitions of Older Adults Syllabus
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RNCT

Improving Care Transitions of Older Adults

Learning Outcomes

As a result of participating in this learning activity the learner will be able to:

  • Demonstrate knowledge of how to decrease hospitalizations or re-hospitalizations of older adults in home care related to issues of care transitions as evidenced by passing the final exam with a score of 80% or higher at the at the end of the on-line learning activity.

Description
Hospitalization or re-hospitalization continues to be an issue for older adults. One of the factors influencing the older adults ability to return to home safely is the effective transition of care between facilities and home care. This program will focus on the role of the clinician in managing the care transition process to reduce issues in care issues that increase the risk of complications and the need to return to the hospital.
Delivery

This is a self-paced course with knowledge check activities. These non-graded activities allow you to check your understanding of the lesson objectives before proceeding on in the course. At the end of the course, you will be required to take the final exam. You must score 80% or higher to pass the course and obtain a certificate of completion.

Objectives
  • Identify concerns in care of the elderly population
  • Define transitions of care
  • Define care coordination
  • Identify barriers to successful transitions
  • Describe critical elements of successful transitions
  • Describe action plan for home health providers
Contact Time

1 Contact Hour: based on 60 minute contact hour

Estimated Time

The estimated time for completion for this activity is 1.2 hour(s).

Intended Audience

This course is designed to meet the continuing education requirements of health care professionals such as Licensed Practical Nurses, Registered Nurses, Physical Therapists, Speech Therapists, Occupational Therapists and Social Workers.

Course Planning Team

Kathy L. Richie, RN, BSN; Kristi Kiehne; MBA; Jeanette Mefford, RN, BSN, MPH, HCS-D, Beth Schoenfeld, RN, MSN, CCP

Approvals
HLC - Higher Learning Commission
Rochester Community and Technical College is fully accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools.
HLC Institution ID:1399
CABRN Professional - CABRN California Board of Registered Nursing
Rochester Community & Technical College: Provider approved by the California Board of Registered Nursing, Provider # 18166, for the stated contact hours in the syllabus of this course.
The named licensee must retain this Certificate of Completion for a minimum of four (4) years.
Disclosure Statements:

Commercial Support: No commercial support was accepted for the development of this course.

Bias: This course provides a balanced view of therapeutic options and is free of commercial bias for or against any product or commercial entity. Use of generic names is always considered before using trade names. Consequently, if trade names are necessary, when available, trade names from several companies will be used. RCTC and the course planning team do not endorse any products or drugs that may be mentioned in this course.

Author Updating

Beth Schoenfeld - RN MSN CCP

Beth is a Registered Nurse, with a Masters in Nursing with a clinical focus in Gerontology from the University of Evansville in Indiana. The majority of Beth's nursing career has been in home health care, working in both education and administration. Beth is also certified as a Chronic Disease Professional Health Coach (CCP) and has developed this program.

Author Originating

Jeanette Mefford - RN BSN MPH HCS-D

Jeanette Mefford is a home care consultant with more than 30 years of experience in administrative and clinical management and leadership. Through this experience, she has gained extensive knowledge and experience in federal as well as state regulation and compliance requirements, OASIS and Prospective Payor System. She is a recognized a leader in education and training seminars in Minnesota as well as nationally.

Links
Naylor, MD. 2004;9(6): 1-4 (PubMed)
Dr. Carla Parry PhD and MSW, Eric A. Coleman MD and MPH, Jodi D. Smith ND and GNP, Janet Frank DrPH and Andrew M. Kramer MD (2003) Home Health Services Quarterly, 22:3, 1-17, DOI: 10, 1300/J027v22n03_01
Department of Veterans Affairs Coordinated Transitional Care (C-TraC) program Toolkit © Copyright Eric A. Coleman, MD Denver, Colorado
Sevin C, Evdokimoff M, Sobolewski S, Taylor J, Rutherford P, Coleman EA.
Institute for Healthcare Improvement June 2013 Cambridge, MA WWW.IHI.org
Home Health Quality Improvement (HHQI) 2014 http://www.homehealthquality.org
Copyright

Materials used in connection with this course may be subject to copyright protection. Retention of the materials for longer than the class term, unauthorized further dissemination of the materials, or use of copyrighted materials in any way other than intended for this class is prohibited by Copyright and Teach Act laws.

Acknowledgment

This course was developed with Rochester Community and Technical College's Continuing Education and Workforce Development Division located in Rochester Minnesota. <br><br> Development was supported by the US Department of Health and Human Services - Health Resources and Services Administration (HRSA); Minnesota Geriatric Education Center (MAGEC) Grant # UB4HP19196; Subaward Grant # P001768405; Director: Robert L. Kane, MD.

Code
RNCT
Category
Professional Health