Specialization in home care: a cardiopulmonary model.

The Visiting Nurse Service of Rochester and Monroe County, Inc. has developed an innovative method of clinical practice to meet the needs of patients after acute episodes of heart or lung disease. The cardiopulmonary program has a multidisciplinary approach, focusing on disease management through physical assessment, symptom management, diagnostic testing, and rehabilitation via progressive activity tolerance. The program has been successful in either preventing or increasing the length of time between hospital admissions, and has increased the agency's referral base, improved staff job satisfaction, and reduced turnover.