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The patient, PCP and the acute care facility by providing a teamwork approach through:
- Continuity of care, by assisting patient reconnect
with their PCP in a timely manner
- Access to a robust network of area
specialists
- Reducing emergency room visits
and re-hospitalizations
- Improving outcomes by
seeing the patient
within 48 hours of discharge to ensure
medical conditions
remain stabilized
- Personalized quality
and professional
care in the home
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- Medical evaluation and follow-up within 48 hours of
patients discharge from hospital
- Post hospitalization medication reconciliation
- Education of the patient and family members on
medications and other wellness factors
Physician recertifications for homebound patients
Utilizing Transitions House Calls improves a patients health
and quality of life. The physician develops a relationship and
understanding of the patient and their care giver. Patients
receive regular care and follow up while reducing
safety risks and travel time.
The Medical Directors are Internal Medicine or Family Practice board certified physicians with extensive knowledge and experience working with older adult patients who may be medically complex due to multiple diagnosis’s that require monitoring.
Our clinic staff includes a team of Board certified physicians, Nurse practitioners and Physician Assistants.
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KELLY SHEA Acute Care Nurse Practitioner since 1997 with a total of 14 years experience in cardiology (including both as a RN and a NP); including open heart/heart and lung transplant ICU at Baylor Dallas; Heart Place Cardiology group following inpatients and outpatients; CHF follow-up patients, post-intervention patients. She graduated in 1992 and received her MSN in 1997, both from UT Arlington. Kelly has been working in the housecalls specialty since 2009 and also serves as an honorary faculty member at UT Arlington School of Nursing. Kelly covers the H-E-B, Watauga, Colleyville, Southlake, Keller, and Grapevine areas in northern Tarrant County. |
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NICOLE SHUTTS Nurse Practitioner since 2002 with experience in Oncology, Palliative Care, and Geriatric Medicine. Her passion for working with adult population was personified when she relocated from Missouri to Texas to work in the housecalls specialty in 2010. Nicole covers the greater east Dallas, Allen, Richardson, Garland, Rowlett, Rockwall, and Mesquite areas. |
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DEBRA FOLDOE Practiced nursing in DFW area since 2000 and is a graduate of UT Arlington for both undergraduate and advanced practice degrees. Her experience includes inpatient and outpatient settings as well as within the health insurance industry. Her nursing expertise includes wound care, diabetes, CHF, COPD, GI, urology, post surgical care, and acute and chronic family care. Debra covers the greater Arlington, Grand Prairie, Irving, Las Colinas, and west Dallas areas.
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MARGARET KOHN Family Nurse Practitioner since 2003. Her nursing experience is in Medical/Surgical where she was charge nurse on a busy unit at Virginia Baptist Hospital Lynchburg, VA. The variety of disease processes managed in the unit provided her with core knowledge that would be expanded further moving from Virginia to TX. Margaret has been working in the Housecalls specialty since 2006. She covers the greater Fort Worth area including Benbrook, Lake Worth, Azle and Weatherford areas. |
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TRACY COOK Adult Nurse Practitioner since 2006. She has over 20 years of nursing experience, 18 of which have been in the home health environment. She began working in the housecalls specialty in 2006. Tracy covers Denton County to include Lewisville, Flower Mound, Frisco and McKinney areas. |
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SHAUNA McCARTHY Adult Nurse Practitioner since 2008. She received her Master’s of Science in Nursing and Bachelor’s degrees from Marian University, Wisconsin. With 21yrs of nursing experience in Internal Medicine, ICU, Cath Lab, Homecare and Nursing Home, including Nurse Director and Educator. Shauna covers the Mansfield, Crowley, Burleson, Cleburne, and Midlothian areas. |
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DAVID RODRIGUEZ Family Nurse Practitioner who completed his undergraduate and graduate work from Texas Woman's University in May 2002. His most recent experience includes more than eight years of private practice gastroenterology, and three years emergency room medicine at Baylor. David recently joined the Housecalls specialty and covers the North Dallas, HP/UP, Carrollton, Coppell, Farmers Branch, Addison, Plano, and Allen areas. |
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