Tag Archives: chronic disease management

Home Health

Engaging Seniors to Help Them Age in Place

Editor’s note: This week’s post describes a program that helps frail seniors live healthier for longer at home. “Community Aging in Place — Advancing Better Living for Elders” helps by removing practical barriers to everyday activities so seniors can engage in daily life and health-related activities and safely age in place. Occupational therapists, carpenters and […]


Susan Carr Susan Carr is a medical editor and writer specializing in patient safety and engagement. In addition to curating the EngagingPatients blog, she produces publications for the Betsy Lehman Center in Boston and the Society to Improve Diagnosis in Medicine. Susan lives and works in Lunenburg, Massachusetts.

Susan Carr has 185 post(s) at EngagingPatients.org

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Home Care

Patient Engagement Begins at Home

When I think about patient engagement, I’m usually thinking of patients and caregivers engaged in care plans directed and managed by healthcare professionals. The settings most familiar to me include hospitals, physician practices, and ambulatory care offices, such as physical therapy practices, urgent care facilities, and community clinics. I’m not usually thinking of home care. Patient […]

Chronic Disease Management

An Engaged Patient Takes Control of His CKD Journey

What you need to understand about me is that I’ve lived my entire life outside the box. Active, engaged, creative and in control—that’s me. I was a master builder who worked on centuries-old buildings in and around my hometown of Portland, Oregon. I was the guy people called when a building had a problem no […]


Tom Mitchell Tom Mitchell is a former master builder and a patient mentor for Cricket Health, a developer of scalable healthcare technology services designed to fundamentally transform the care and treatment of people with chronic kidney disease who are at high-risk of progressing to end-stage renal disease.

Tom Mitchell has 1 post(s) at EngagingPatients.org

Patient Perspectives

My Journey With Kidney Failure—From Engaged Patient to Patient Mentor

I was placed on dialysis when I was 30 years old. Before my diagnosis of end-stage renal disease (ESRD) or kidney failure, I had been an active, adventurous world traveler. I spent time in the Middle East, first in the Army, then later as a civilian defense contractor. When I finally rotated back to Kansas […]


Michael Fields Michael Fields is a patient mentor for Cricket Health, a developer of scalable healthcare technology services designed to improve the care and treatment of people with CKD who are at high-risk of progressing to ESRD. A white paper on the use of multi-channel education technology to help patients manage late-stage CKD and ESRD is available here.

Michael Fields has 1 post(s) at EngagingPatients.org

The Transformation of Healthcare

Moving the Needle in Healthcare: A Disruptive Innovation to Reduce Unnecessary Hospitalizations and ER Visits

Any list of the burning issues in healthcare will include skyrocketing costs, utilization (both over and under), lack of access, the ongoing surge in chronic disease, the need for greater patient engagement and better patient experience, lack of effective coordination of care, a healthcare finance system that still rewards incidental and procedural events at the […]


Pamela Greenhouse, VP, Clinical Operations, Wellbridge Health Pamela has 25+ years of leadership experience in healthcare operations, spanning the continuum of care (ambulatory, acute, rehabilitation, home care and long-term care). She joined Wellbridge Health, Inc. (wellbridgehealth.com) in 2016 as Vice-President, Clinical Operations. Wellbridge Health is a care management solutions company, the goal of which is to reduce hospital re-admissions and avoidable ER visits through integrated methods of tele-monitoring and health coaching by social workers and nurses. Ms. Greenhouse has co-authored over 30 papers in peer-reviewed scholarly journals with a focus on improving care delivery, patient centered care, patient engagement, and experienced based design. She has spoken nationally and internationally on these topics, as well. She holds an M.B.A. in Organizational Behavior.

Pamela Greenhouse, VP, Clinical Operations, Wellbridge Health has 11 post(s) at EngagingPatients.org

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Redesigning Patient Care

Integrating Community Support Resources to Treat the Whole Patient

What if doctors prescribed community support resources with lifestyle changes instead of just medicine? What if your referral was to an outside group or program rather than to a specialist? There are many organizations and resources outside of the traditional health system that can act as ambassadors for promoting and maintaining health, and when utilized […]


Jessica Deary Speaker, writer, patient advocate and advisor, Jessica Deary brings a valuable perspective to the topics of patient experience and patient-centered care, having been a patient with a complicated medical condition.She obtained her BA in Business and Economics followed by an MBA and started a small consulting business. Although her initial experience was in strategic management, she was drawn to patient advocacy as a result of her own experiences as a long-standing patient. She obtained formal certification in patient advocacy and continues to expand her knowledge in patient experience and patient- centered care through continuing education. Currently, she is a patient advisor at Penn State Hershey Medical Center and a volunteer in patient care at Holy Spirit Hospital. She and her pug, Maya, volunteer in the pet therapy program at several health systems. She also speaks to both healthcare professionals and patients, and writes on patient experience and patient-centered care related topics.

Jessica Deary has 1 post(s) at EngagingPatients.org

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Chronic Disease Management

Using Gaming to Engage and Drive Behavior Changes in Patients

Today’s chronic disease patient is often inundated with education about his or her condition. Although clinicians and educators have good intentions, and the material provided is robust and thorough, traditional education often fails to drive patients to make needed behavior changes. The Challenge of the Returning Patient Nearly 25% of patients hospitalized with congestive heart […]

Family and Friend Engagement

Personal Support Networks: Reshaping Care Communication

I recently attended a conference on patient engagement where one of the speakers discussed the growth projections of chronic illness in the U.S., describing the dire consequences it will have on our health delivery system if unaddressed. The primary implication was one of scale. For example, how will we as a system respond when confronted […]


John G. King John King is passionate about the transformation of healthcare and believes effective communications are central to enhancing the patient and family experience, improving the coordination of care and empowering people to better manage their health and well-being. As President of Standard Register Healthcare, he's made it the company's mission to help customers standardize and manage communications across the continuum of care, and enable providers and payers to engage the right person with the right information so they can influence behavior and achieve their desired outcomes.

John G. King has 2 post(s) at EngagingPatients.org

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Patient-Centered Care

HERE TO HOME: Effectively Engaging Heart Failure Patients in Their Care

As a Planetree hospital, Griffin Hospital is committed to engaging patients and families with access to information and education. In 2012, we identified a lack of consistent patient disease education with teach-back which contributed to a high readmission rate for Heart Failure. We introduced “HERE TO HOME,” a program to address communication and patient education […]


Kathleen M. Martin, RN, BSN, CCM, CPC-H Kathleen M. Martin, RN, BSN, CCM, CPC-H, has been Vice President of Patient Safety and Care Improvement since 2006 and currently leads the Quality Performance Improvement initiatives for Griffin Hospital, a 160-bed community acute care facility. Prior to this position, Kathleen served as an Assistant Vice President of Case Management and Medical Records since 1983. Kathleen was instrumental in developing the Palliative Care Program in collaboration with the Connecticut Hospice which enables patients to experience patient-centered end of life care. Kathleen currently leads a community collaborative “Gateway To Health” to reduce heart failure readmissions with area skilled facilities and home care agencies. Kathleen also has facilitated bereavement and support groups for the community for the past 25 years. She is a member of CMSA, AAPC and serves on the QA Board of the Connecticut Hospital Association.

Kathleen M. Martin, RN, BSN, CCM, CPC-H has 1 post(s) at EngagingPatients.org

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Patient and Family Engagement

Family Engagement: Combatting Low Literacy, Driving Better Patient Outcomes

This week, I was once again reminded of the prevalence and impact of low health literacy. An article on WashingtonPost.com penned by CVS Caremark pointed to these statistics from the National Institutes of Health (NIH) that looked at the elder segment of the population, age 65 and older: 2/3 of older people are unable to […]