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Care Coordination

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Older Americans are admitted to the hospital more often than any other age group. Then, after they leave the hospital, one in five ends up back within 30 days. Most of the time, this is preventable.

Part of the problem is that people with Medicare often get medical care from many different doctors and don’t know if they are talking with each other. This can lead to care that is not well coordinated and result in unneeded tests and medication errors. We aim to change that.

atom Alliance is working to keep older Americans out of the hospital and improve their care, but we need your help.

Find-A-Community

Here’s what you can do to protect yourself and your loved ones

ATOM_Logo_Device_Transparent-20px-20pxGet Educated

Look through the Resource tabs below for help with how to stay out of the hospital and improve your coordination of care. You can also search our online library.

ATOM_Logo_Device_Transparent-20px-20pxGet Active

Have you filled out a personal health record? Made a living will? Talked about all of your medications with your doctor? These are all tools that have been used by others to improve their use of medications.

Use the tabs to the right to search for specific tools and resources related to this page.

You can also search our comprehensive library of online resources, where you can sort by atom Alliance state, initiative, patient or provider focus or simply type in a keyword for quick access to the tools and resources you need.

atom Alliance Pinterest Board: Hospital Readmissions & Care Coordination
atom Alliance Pinterest Board: Caregivers
Safety after a Stroke
Information from the National Stroke Association on how to stay safe and prevent falls after suffering a stroke
Quality Care Finder
Find and compare doctors, plans, hospitals, suppliers and other providers.
What You Can Do To Prevent Falls
Learn what changes to make to lower your chances of falling.
Safety As You Go from Hospital to Home
Get tips on how to be safe at home after hospital discharge.
National Transitions of Care Coalition
Offers resources for consumers and family caregivers
The Care Transitions Program: Tools for Patients and Caregivers
With funding from the John A. Hartford and Robert Wood Johnson Foundations, the program designed tools to support patients as they make the transition from hospital to home.
Medline Plus: Interactive Health Tutorials
Learn about the symptoms, diagnosis and treatment for a variety of diseases and conditions. Also learn about surgeries, prevention and wellness.
Taking Care of Myself: A Guide for When I Leave the Hospital
Provides information patients need to help them care for themselves when they leave the hospital
I’m a Caregiver
Get resources, stories, and newsletters about taking care of someone with Medicare.
Questions to Ask Your Doctor
Provides lists of questions to ask your doctor before, during and after appointments
Next Step in Care
Provides easy to use guides to help caregivers and healthcare providers work closely to plan and implement smooth transitions for chronically or seriously ill patients
American Bar Association: Commission on Law and Aging
Commission examines a wide range of legal issues affecting older persons, resulting in policy and practice research and development, coordination and collaboration, education (professional and public) and technical assistance
AARP: Caregiving Resource Center
Information, tools and tips for caregivers
Caring Connections
Provides people with information and support when they are planning ahead, caring for a loved one, living with an illness or grieving a loss
End of Life Issues
Page sponsored by the U.S. National Library of Medicine and the National Institutes of Health contains links to useful materials for both patients or caregivers faced with planning end-of-life of care
Eldercare Locator
A public service of the U.S. Administration on Aging connecting you to services for older adults and their families
Health Information in Multiple Languages: MedlinePlus
Offers access to high quality health information for patients in 40 languages; more than 2,500 links to nearly 250 health topics
Kentucky Department for Aging and Independent Living
Patients Like Me is a website for sharing, support and research. Learn from others, connect with people like you and track your health.
The Center for Excellence in Assisted Living
Zone Tool Total Knee Replacement
Zone Tool Total Knee Replacement

Preview: Zone Tool Total Knee Replacement
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758.99 KB | Last Updated: July 20, 2016

Zone Tool Total Hip Replacement
Zone Tool Total Hip Replacement

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727.33 KB | Last Updated: July 20, 2016

Go to the Hospital or Stay Here?
Go to the Hospital or Stay Here?

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421.99 KB | Last Updated: August 20, 2015

Quick Tips When Talking with Your Doctor
Quick Tips When Talking with Your Doctor

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206.40 KB | Last Updated: February 26, 2015

Warning Signs: Blood Clot
Warning Signs: Blood Clot

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262.60 KB | Last Updated: February 6, 2015

Warning Signs: COPD
Warning Signs: COPD

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251.95 KB | Last Updated: February 6, 2015

Warning Signs: Heart Attack
Warning Signs: Heart Attack

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213.73 KB | Last Updated: February 6, 2015

Warning Signs: Heart Failure
Warning Signs: Heart Failure

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245.21 KB | Last Updated: February 6, 2015

Warning Signs: Pneumonia
Warning Signs: Pneumonia

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229.02 KB | Last Updated: August 21, 2015

Checklist for Getting the Right Diagnosis
Checklist for Getting the Right Diagnosis

Preview: Checklist for Getting the Right Diagnosis
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236.74 KB | Last Updated: February 5, 2015

Advancing Excellence: Consumer Fact Sheet for Reducing Hospitalizations
Advancing Excellence: Consumer Fact Sheet for Reducing Hospitalizations

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92.45 KB | Last Updated: August 21, 2015

Your Discharge Planning Checklist
Your Discharge Planning Checklist

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322.83 KB | Last Updated: February 6, 2015

Taking Care of Myself Guide
Taking Care of Myself Guide

Preview: Taking Care of Myself Guide
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775.74 KB | Last Updated: February 6, 2015

Discharge Checklist
Discharge Checklist

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22.52 KB | Last Updated: August 21, 2015

20 Tips to Help Prevent Medical Errors
20 Tips to Help Prevent Medical Errors

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413.95 KB | Last Updated: February 6, 2015

Personal Health Records Help Keep Your Medical Information Handy
Personal Health Records Help Keep Your Medical Information Handy

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483.10 KB | Last Updated: February 6, 2015

Talking with Your Healthcare Provider
Talking with Your Healthcare Provider

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194.42 KB | Last Updated: February 6, 2015

Care Coordination Blog

  • Questions Are The Answer

    Questions Are The Answer

    Questions Are The Answer Help your patients get more involved in their healthcare by asking questions, talking with the healthcare team, and understanding their condition. Research shows that patients who have a good relationship with their healthcare team receive better care and are more satisfied. Patients and families who engage with healthcare providers ask good questions… Read More »
  • How to Be More Confident Talking to Your Doctor

    How to Be More Confident Talking to Your Doctor

    The single-most important way you can stay healthy is to be an active member of your own healthcare team. Read More »
  • Battle the Opioid Overdose Epidemic with Information and Action

    Battle the Opioid Overdose Epidemic with Information and Action

    The United States is in the midst of a prescription opioid overdose epidemic. According to the Centers for Disease Control and Prevention (CDC), 44 people in the United States die every day from prescription opioid overdose and many more become addicted. Read More »

Blog Archive

News Releases

Partners

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Healthcare-Associated Infection Prevention

About one in every 25 patients admitted to a hospital gets an infection.

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Nursing Home Care

There are 1.4 million Americans living in our nation’s 15,600 nursing homes.
 
 

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Drug Safety

Medication errors are a leading cause of preventable harm for people aged 65 and over with Medicare.
 

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