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www.atlanticare.org3x1cYouhavehelpedmeunderstandthatbeingdiagnosedwithdiabetesdoesnotmeanIcannotcontinuetoenjoyeatingoutwithfriends.x1dx1cYouprovideduswithcontactsforcommunityresourcesandwewereabletofindthecareourmomneededtobeabletostayinherhomeof50years.x1dPatientsandphysiciansalikearerespondingwithgreatenthusiasmtoanovelmodelofpatientcarerecentlyintroducedinAtlantiCarePhysicianGroupx19sprimarycareofficesandatselectprivateinternalmedicineandfamilymedicinepracticesinourcommunity.AtlantiCareisattheforefrontofimplementingthisemergingx1cmulti-diseasechroniccaremodelx1dwhichisdesignedspecificallyforpeoplewhoarelivingwithlong-termorcomplexhealthconditions.UnderthismodelAtlantiCarehasestablishedateamofnursecaremanagerswhoserveaspersonalhealthcoachesandhealthcareadvocatesforpatientswithdiabetescancerhighbloodpressurehighcholesterolheartconditionsdiseasesoftherespiratorysystemsuchasasthmaorchronicobstructivepulmonarydiseasearthritissleepapneaandmore.AllourcaremanagersareexperiencedregisterednurseswhohavecompletedthespecializedPopulationCareCoordinatorTrainingProgramdevelopedbytheDukeUniversitySchoolofNursingandRutgersCollegeofNursing.Eachcaremanagerworksinclosecollaborationwiththephysiciansnursesandothermembersoftheprimarycareteamtomakesurepatientsarereceivingthesupportandresourcestheyneedwhentheyneedthem.x1cHavinganillnessorsuddenhealtheventcanbeaveryfrighteningandoverwhelmingexperienceinsomeonex19slife.Thereisgreatsatisfactioninknowingyoucanhelpguideapersonthroughthesedifficulttimes.Asnurseswehavetheinnatedesiretohelptocaretomakethingsbetterforanotherhumanbeing.Ifwewantpeopletotakeownershipoftheirhealthweneedtobreakdownthebarriersandhelpthem.Beinganursecaremanagerisjustanotherchanneltodothatx1dsaysChristeenCornellRNBSNCCMdirectorofClinicalTransformationAtlantiCareHealthEngagement.Cornellworkscloselywithourteamofcaremanagerstoensurethehighestlevelsofpatientsatisfactionwiththeprogram.Patient-CenteredCareIsOurPriorityAtlantiCarex19snursecaremanagershaveauniqueanddiverseroleintheprimarycareoffice.Someoftheirday-to-dayresponsibilitiesincludeMeetingindividuallywithpatientstodeveloppersonalizedplansofcareandhelpingpatientssetrealisticandappropriategoalstoimprovetheirhealthandwell-beingAnsweringquestionsandprovidinghealtheducationtohelppatientsunderstandtheirdiagnoseshowtotaketheirmedicinesandhowtomanagethesymptomsoftheirdiseasesaswellasotherconcernsConnectingpatientswithhealthy-livingandsupportive-careresourceswithinAtlantiCareandinthecommunityCoordinatingfollow-upcareandsharingtestresultsandotherpertinentmedicalinformationwithreferringphysiciansandspecialistsOverseeingthetransitionofcareparticularlydischargeforpatientshospitalizedatAtlantiCareRegionalMedicalCenterorthosewhorequiretransfertoaskillednursingorrehabilitationfacilityx1cAttheendofthedaythesatisfactioncomesinknowingthatwerelievedsomeofthestressesassociatedwithillnessandhospitalization.Wewantpatientsandtheirfamiliestofocusontheirhealthnotworryaboutmakingthenextappointmentorwhethertheirhospitalrecordswillgetbacktotheirphysicians.Thereisalsogreatsatisfactioninsettinggoalswithapatienttoimprovehisorherhealthandworkingtogethertoachievethosegoals.Wetrulybelievethatpatientsarethecenterofourworkx1dsaysCornell.NurseCareManagersPioneeringaNewApproachtoPrimaryCareIunderstandhowandwhyIneedtoreadfoodlabels.Itisnotworkanymoreitisawayoflifeforme.