Chronic Care Center Opens in Livingston

Last updated: Dec 27, 2016

What happens when seriously ill patients are ready to leave the hospital but still need acute care from several specialists? How can individuals with multiple chronic conditions that require complex treatments avoid frequent hospitalization?

Summit Medical Group (SMG) is filling the gap in care between the hospital and the doctor’s office by offering its first Chronic Care Center (CCC) in Livingston, New Jersey. When patients are discharged from the hospital, or have several serious medical conditions, they often need intense, multidisciplinary treatment and disease management. These cases require more attention and resources than are possible in an office visit with a primary or specialty care physician.  

 “The CCC transforms treatment for our most complex patients,” says Amina Ahmed, MD, Service Line Chief for Hospital Medicine and Post-Acute Care at SMG. “By offering a high-risk patient care facility, we can bridge the gap for our sickest patients who need intermediate care before they return to their primary care provider or specialist.”

The CCC is different from an urgent care service, which stabilizes very sick patients and sends them to the hospital. Instead, the goal of the CCC is to avoid re-hospitalization and stabilize high-risk patients experiencing an exacerbation of their illness before their condition worsens.   

What types of individuals would benefit from the Chronic Care Center?

  • Patients in transition — those being discharged from the hospital, emergency room, rehabilitation center, or nursing facility who are at high-risk for readmission  
  • Chronically ill patients – individuals with multiple active chronic conditions, such as: chronic obstructive pulmonary disease (COPD), diabetes, chronic kidney disease, dementia, or exacerbation of heart failure.

What type of care is offered?

The CCC is a multidisciplinary treatment center that integrates on-site care management, social work, and clinical pharmacy within the visit to support patient well-being. With a laboratory located on-site, as well as x-ray and imaging, clinicians can identify serious conditions, such as heart failure or pneumonia, early while it is still possible to be treated in the outpatient setting.

What services will be offered?

  • Treatments, such as intravenous (IV) diuretics or steroid therapy
  • Health education and coaching
  • Nutritional counseling
  • Medication therapy management
  • Social work and case management

“Leaving the hospital is a high-risk event for patients. They often have multiple changes in medications and require post-discharge care from several disciplines,” says Dr. Ahmed.  “At the CCC, we can provide everything they need in one coordinated setting.”

Patients receive longer consultations and may be seen multiple times. Upon discharge from the CCC, our nurse care managers and social workers help transfer patients safely back to their primary or specialty care physician.

 “Our goal is to stabilize the patients’ condition, improve their quality of life, and teach them self-management skills they can apply in their home environment,” says Dr. Ahmed.

Who provides care?

  • Hospitalists, advanced practice clinicians, and specialists — develop an individualized treatment plan to manage the patient’s condition.
  • Registered nurses and nursing care managers — provide chronic disease education and facilitate patient follow-up with specialty and primary care.
  • Clinical pharmacists — emphasize medication adherence, review high-risk medication interactions, and help establish “polypharmacy” care plans that use multiple drugs to treat serious medical conditions.  
  • Social workers — support patients and identify social needs, such as medical equipment or transportation, in-home nursing visits, or respite care.
  • Palliative care specialists — help patients that are homebound or require symptom management or advanced care planning.

What are the benefits of the Chronic Care Center?

  • Improve quality of care and reduce costs by providing a time-limited program that complements primary and specialty care. 
  • Avoid preventable hospital admissions and readmissions.

A referral from an SMG hospitalist, primary care physician, specialist, or the Urgent Care Center is required.

Location: 75 E. Northfield Road, Livingston, NJ 07039

Phone:  973-841-4001

Hours of Operation: 9am to 5pm, 7 days per week

Closed: Major holidays only (Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas, and New Year’s Day)

For more information, contact:
Media Relations
[email protected]