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Managed Care Nursing

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An 80-year-old female has a diagnosis of chronic CHF. She lives with her husband in a small rural community near a local community hospital. She uses her primary care provider for all of her care. Due to complaints of SOB, she has had four trips to the emergency room in the past five months via EMS. One trip resulted in hospital admission.

What would be an ideal resource for this patient to ensure education of the disease process, improve the patient overall health care and reduce costs from ambulance rides to the ER for unnecessary visits?
  1. Disease management program
  2. Pulmonologist referral
  3. Review with the member her EOB
  4. Hospice referral
  5. Home health referral
Explanation
Answer: A - A disease management program would be an ideal resource for a patient to ensure education of disease processes, improve overall health care and reduce costs from EMS and ER.
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