title: Preventing rehospitalization through effective home health nursing care.
authors.affiliation: VNA of El Paso, Inc., El Paso, Texas 79902-1433, USA. smvas@sbcglobal.net
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vasquez
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration; D000359:Aftercare / Q000458:organization & administration; D000368:Aged; D019090:Case Management; D003152:Community Health Nursing / Q000458:organization & administration*; D001026:Coronary Artery Bypass / Q000534:rehabilitation; D019468:Disease Management; D004282:Documentation; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D006278:Medicare / Q000458:organization & administration*; D024802:Nurse's Role; D009730:Nursing Assessment; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010347:Patient Care Planning; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data; D019338:Polypharmacy; D012052:Reimbursement, Incentive / Q000458:organization & administration*; D017216:Telemedicine; D017749:Total Quality Management / Q000458:organization & administration; D014481:United States