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Chronic Care Management

The Chronic Care Management (CCM) program is able to address those patients that may have used Home Health or Hospice as well as the dedication SRMC has to our community and our patients. With CCM:

  • Patients can receive end-of-life symptom control through their primary provider. This practice is already in place for those end-of-life patients that have chosen not to have hospice care for a variety of reasons, such as continuing treatment for a cure.
  • An interdisciplinary team of professionals including the provider, nurses, outpatient services, a social worker, case management, address the physical and social needs by coordinating care. Home visits can be made by the provider when appropriate.
  • Nurses make routine calls to patients and their families to see if any new symptoms or needs arise and relay this information to their primary provider. All CCM nursing staff are experienced in end-of-life care.
  • If symptoms or pain are unmanageable at home, they may be admitted as an inpatient to the hospital, placed on observation status, swing bed, or admitted to a nursing home. Further guidance from the Physicians Clinic, Walk-in Clinic, or ER are needed.

Additional support provided includes:

  • 24/7 support
  • Patient education
  • Transportation for SRMC established patients in need to attend clinic and outpatient service visits at SRMC

Click to see how Chronic Care compares to Home Health and Hospice services.

To learn more about the Chronic Care Management program, call the SRMC Physicians Clinic at 308.254.5544.