Disease Management
What is it?HeartWell is an innovative health improvement initiative to decrease the incidence of cardiovascular disease, one individual at a time. A team of registered nurses conducts health screenings, one-on-one risk factor modification counseling, chronic disease support groups and community…
What is it?The Better Breathers Club, launched in January 2014, offers education on topics related to lung disease and lung health. Monthly meetings promote skills that enable patients with chronic lung disease to better manage their conditions while also allowing members to give and receive…
What is it?The diabetes initiative was formed as a pilot program with the goal of improving the quality of care for the growing diabetic population in Sussex County. The program was implemented in 10 primary care practices, and educated providers regarding current evidence-based practices for…
What is it?Developed by MedStar Health, Hair, Heart and Health (HHH) is a community-based program that seeks to reduce risk for cardiovascular disease among African-American men. Barbershops serve as a community venue, offering screenings for high blood pressure and diabetes. The program trains…
What is it?In 2010, the University of Charleston School of Pharmacy began offering a rural rotation site for their third- and fourth-year student pharmacists and pharmacy residents. These students and the instructor meet face to face with patients who have been referred to the program for a…
What is it?An innovative partnership with East Stroudsburg University of Pennsylvania and Wilkes University trains a select group of volunteer students to act as health coaches for patients with chronic illness. The students – who visit patients at home – are trained to recognize signs that a…
What is it?The Community Health Team (CHT) is a multidisciplinary team that works with providers to improve health outcomes with free services to all patients. Team members include nurses, dietitians, a diabetes educator, social workers, substance abuse and tobacco cessation counselors, exercise/…
What is it?For more than 15 years, Circle Home, Inc. has provided “walk-in” health clinics conveniently located at 20 different senior centers, senior housing and community agencies. Services include checks for blood pressure, weight and blood glucose levels, wellness coaching and staff who listen…
What is it?The Asthma Action Team is a multidisciplinary, multilingual, familycentered program within the Center for Pediatric Medicine (CPM), the largest primary care outpatient clinic of its kind in South Carolina. Through significant collaboration with a diverse network of partners, the team…
What is it?For the last 16 years, North Mississippi Medical Center (NMMC) has hosted the annual Live Well Health Fair. During this event, NMMC and other community organizations partner to offer free seasonal flu shots and free health screenings for anxiety, blood pressure, glaucoma, depression,…