Advanced Preventive Care
Advanced Preventive Care is a system that enables health care providers, specially trained nurses, participants, and families to work together as a team to keep participants healthy. Advanced Preventive Care allows a participant’s team to catch problems early, manage existing chronic and acute conditions, and improve overall quality of life by preventing complications and other negative health outcomes. The heart of Advanced Preventive Care is combining care coordination, disease management, and personalized preventative interventions in long-term, data-driven, and highly reliable programs.
Care coordination relies
on the teamwork between nurses, healthcare providers, and participants
to coordinate and manage the care of a participant's existing
condition(s), especially between multiple doctors and specialists. This
kind of work can range from activities like pill reconciliation - making
sure that participants are not being prescribed double doses of the
same medicines by their different providers - to communication
management - making sure that all the providers working for a
participant (and family) are on the same
page.
Disease management uses disease-specific protocols to ensure that participants get the best evidence-based clinical care for their particular disease(s) and condition(s), and that participants are educated to self-manage the aspects of their condition(s) that they can. While the participant's medical providers take the lead in mapping out a disease management strategy for the participant, our nurse care managers often are essential in helping to successfully implement and provide feedback to refine the medical management plan.
Personalized preventive interventions - like weight management, food and diet education, and exercise classes - slow the progression or even reverse a person's existing condition(s), and prevent new complications and conditions from arising. Group programs for these interventions also offer an additional opportunity to socialize, meet new friends, and gain peer support.
In our system of Advanced Preventive Care, specially trained nurses work with participants to create a sustained, supportive relationship that enables them to combine all these approaches - care coordination, disease management, and personalized preventive interventions - to flexibly respond to changing patient needs over a long period of program engagement. Our system has sometimes been described as "complex care management", "advanced care management", "community-based care management", and other labels, but we think the term Advanced Preventive Care best captures the broad, anticipatory, and proactive nature of our approach.
In our system of Advanced Preventive Care, specially trained nurses work with participants to create a sustained, supportive relationship that enables them to combine all these approaches - care coordination, disease management, and personalized preventive interventions - to flexibly respond to changing patient needs over a long period of program engagement. Our system has sometimes been described as "complex care management", "advanced care management", "community-based care management", and other labels, but we think the term Advanced Preventive Care best captures the broad, anticipatory, and proactive nature of our approach.
Advanced Preventive Care For Chronically Ill Older Adults
Since 2001, we have honed and refined our system of Advanced Preventive Care for chronically ill, older adults through tireless research and development. Advanced Preventive Care is designed to:
Our system of Advanced Preventive Care for chronically ill, older adults integrates dozens of protocols to support the monitoring, assessments, and preventive interventions needed to help achieve these goals. It also strongly emphasizes participant and family health education, lifestyle behavior change, medication management, self-management coaching, nutrition, and physical activity. In a randomized controlled trial, this system was proven to save lives, reduce hospitalizations, and decrease health care costs for higher-risk Medicare beneficiaries. See our Results.
- prevent the onset, or slow the progression, of common chronic diseases - especially heart failure, coronary artery disease, chronic lung disease, depression, and diabetes
- avoid preventable complications associated with chronic conditions and the aging process
- preserve functional independence and mobility
- facilitate advanced care and end of life planning
Our system of Advanced Preventive Care for chronically ill, older adults integrates dozens of protocols to support the monitoring, assessments, and preventive interventions needed to help achieve these goals. It also strongly emphasizes participant and family health education, lifestyle behavior change, medication management, self-management coaching, nutrition, and physical activity. In a randomized controlled trial, this system was proven to save lives, reduce hospitalizations, and decrease health care costs for higher-risk Medicare beneficiaries. See our Results.
Watch the full video below for a sample of the kinds of services included in HQP's system of Advanced Preventive Care for chronically ill older adults.