title: Physician practice marries DM tools with home care in successful CHF program.
abstract: Find out how a made-to-order CHF program implemented by a physician practice in California married a comprehensive DM package with a home health agency and received a drastic drop in readmissions as a one-year anniversary present.
mesh_terms: D002140:California; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019468:Disease Management; D006333:Heart Failure / Q000451:nursing / Q000628:therapy*; D006699:Home Care Services / Q000458:organization & administration; D006792:House Calls; D006801:Humans; D010343:Patient Admission; D010351:Patient Discharge; D010353:Patient Education as Topic; D016730:Program Development; D015397:Program Evaluation