title: Customized clinical case management for chronically ill patients. Health system sees remarkable results with teams of case managers, physicians, patients.
abstract: Securing excellent care and positive outcomes for seriously ill, high-risk patients requires extraordinary measures. A health system in Georgia is experiencing strong results by taking a team approach to health care with case managers, physicians and patients working together.
authors.forename: L W
authors.initials: LW
authors.lastname: Haldeman
authors.forename: S P
authors.initials: SP
authors.lastname: Read
authors.forename: T
authors.initials: T
authors.lastname: Hart
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D019090:Case Management / Q000458:organization & administration*; D002908:Chronic Disease / Q000628:therapy*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005845:Georgia; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D009722:Nurse Practitioners / Q000193:education; D018570:Risk Assessment