Chronic Care Model Essay

Duscuss the impact of the ACA and the IMPACT act on long term care arcross the continuum of care.

In the UK, reports show that heart failure has been affecting up to 2% of the population, over 900,000 people are living with heart failure, with 63,000 new cases being diagnosed each year (BHF, 2015). It costs the NHS £625 million per year, as a result of the high portion of emergency admissions, readmission and long length of inpatient stay (NHS Improvement, 2010). DH (2000) confirmed that Heart failure accounts for all cardiac admissions and the readmission rate can be as high as 50% within 3 months; also, it further estimated 50% readmission might be preventable. Unfortunately, Heart Failure can’t be cured, but early

Transitional care management includes services provided to patients whose medical problems require moderate or high complexity medical decision making during their transition from inpatient care to an outpatient setting. Transitional care for heart failure includes a collaborative effort by all health providers to ensure that the patient outcomes are improved. Key components of a transitional care plan for a heart failure patient includes identifying and assessing caregivers to determine their needs for education and support, integrating caregivers into the patient’s healthcare team, and bridging communications between patients, caregivers, and providers. Implementation of transitional care in a hospital setting should include comprehensive discharge planning, home visits, structured telephone support, scheduled follow up visits, and additional printed and online education and disease management information. In a meta-analysis of transitional care interventions to assess the efficacy, comparative effectiveness of transitional care interventions that reduce readmission and mortality rates for adults hospitalized with HF, concluded that home-visiting, multidisciplinary heart failure clinic interventions, and structured telephone support reduced heart failure specific readmission and mortality, and that these interventions should receive the greatest consideration by

Patient-centered care refers to the view that patients and their family members are partners in developing a care plan. This stems from the belief that the patient is in control and that the care provided is rooted in respect that addresses the patient’s personal needs and values (Barnsteiner & Sherwood, 2012). Creating a partnership with a patient that allows them to grasp the goals and methods of their plan of care and includes them in the decision-making process can prevent errors from occurring. This gives the patient the opportunity to correct any

Hospital readmissions are potentially harmful, costly and often times an avoidable event. Between the provisions set forth under the Affordable Care Act and the penalties authorized by the Centers of Medicare and Medicaid Services, hospitals are forced to shift their focus towards the development of strategies to reduce and prevent avoidable hospital readmissions related to heart failure. It is estimated that of the 6 million individuals within the United States diagnosed with heart failure, 1 million of them are hospitalized each year with a primary diagnosis of heart failure, accounting for $17 billion dollars of Medicare expenditures (Sales et al, 2013). What is worse is the death rate associated with heart failure each year, accounting

Providing patients diagnosed with Congestive Heart Failure effective teaching can eliminate reoccurring hospitalizations. Patients are discharged with CHF and readmitted within 30 days. The information provided will examine the process of enhancing patient knowledge and provide additional resources essential for effective health care management. Research evidence provides data that proves patients who are diagnosed with CHF needs a variety of health care needs during admission and after discharge. The proposal will display an evaluation plan, implementation plan and a dissemination of the

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) core measures in relation to Heart Failure (HF) was examined using empirical-based nursing research. Findings suggest that lack of understanding by nurses contributes significantly to the privation of core measure implementation. A significant number of Americans suffer from HF, so patient quality of care assessment was necessitated. Identifying factors were: nurse-patient education resulting in follow-up appointments, left ventricular performance or left ventricular systolic (LVS) function, treatment medications, and smoking cessation programs. Nurses provide an important role in the education of patients with HF. The Nurse is integral in providing documentation in relation to LVS. Nurses play an important role in the administration of HF medication. Smoking, a major cause of HF, requires special nursing intervention. Nursing results in improved quality of care if HF core measures are implemented properly. Additionally, Orem’s universal requisites are fundamental in the nursing process.

Congestive heart failure is a growing chronic condition in the United States that accounts for over one million hospitalizations and is responsible for 27% of patients with heart failure on Medicare are readmitted with 30 days of discharge (Hines, Yu & Randall, 2010). The intensity of the disease process poses a financial strain on both the patient and the payers, especially Medicare, as 10 per 1000 population are 65 years or older and therefore a Medicare beneficiary (Mozaffarian et al., 2015). Consequently, in order to gain control over this chronic disease and its cost burden, the government and policy makers have shifted the responsibility to the health care facilities through the creation of policies that affect hospital reimbursement based on readmission rates. As a member of the quality team at my facility, the Hospital Readmissions Reduction Program deeply impacts my practice and encourages the hospital as a whole to focus on improving multidisciplinary collaboration in pursuit of quality patient care, resulting in better outcomes and decreased readmissions.

Each year the number of readmissions of the heart failure patient within 30 days of discharge has grown. The Medicare division in relation with the Affordable Care Act is reducing the amount of money they are willing to pay for readmissions to the hospital. Hospitals are now more than ever looking for ways to reduce the number of readmissions to the hospital for the heart failure patient. The purpose of this paper is take a look at a program designed with to reduce the readmission rates of one hospital to reduce the number of readmission through improved education and follow up of the heart failure patient.

According to the Centers for Disease Control and Prevention (CDC) there are an estimated 5.1 million adults suffering from heart failure (2013). As the prevalence of heart failure continues to rise, one out of every nine deaths occur as a result of this chronic condition. Studies conducted at Yale found in Medicare age patients with heart failure, there is a median 30-day mortality rate of 11.1% and 5-year rate of approximately 50% (Alspach, 2014). According to Desai & Stevenson (2012), rising costs of care are in direct correlation to the number of hospital admissions related to a primary diagnosis of heart failure especially among adults age 65 years or older. The national rate for readmissions within 30 days is approximately 24.7%, consequently having

The authors of this article explore the importance of and latest advances in transitions of care programs for patients with Heart Failure (HF). The authors paint a clear picture about the scope of the problem and go on to discuss some of the most well-known and researched transitions of care interventions in current practice. Although many of these interventions have been successful, the authors report fact that programs vary in organizational framework, team composition, and program focus. Programs are also noted to differ based on population size and care

Drug and Alcohol Treatment in America has been based on the Medical Model of Treatment. According to Wikipedia, the medical model of addiction is rooted in the philosophy that addiction is a disease and has biological, neurological, genetic, and environmental sources of origin. Treatment includes potential detox with a 28 day or more stay at a residential treatment facility. The continuum of care can include an additional 28 days at the partial hospitalization level, followed by another 6 weeks of Intensive Outpatient.

The authors indicate that the intention of all these new systems/strategies is to increase the available programs for sustaining self-management. Another purpose is the establishment and employment of a series of interferences that make use of new media to amplify evidence-based strategies of patient intervention and assessment that previously have occurred within the medical setting rather than the everyday environments in ways that are complimentary to the age, lifestyle and cultural setting of a patient. The basis for the new interference is that

A great amount of time, money and resource is devoted to improving the transition to home from hospital in the heart failure patient (Qaddoura, Ashoori, Kabali, Thabane, Haynes, Connolly & Spall, 2015). With extensive research available on heart failure and readmission, this study will focus on four main categories. This four category approach allows the clinician to best formulate and prepare for practice in the outpatient setting. The four categories will include various articles based upon evidenced based practice approaches with ultimate goal of reducing admission by implementing successful outpatient care. The four categories are as follows: Frequent monitoring or reporting to the PCP; Medication and Diet compliance; Predictors of

The purpose of this essay is to provide a review of the models which are Chronic Care Model and Patient-Centered Medical Home Model. Also to provide how both achieve quality and safety and add as much information on how both models benefit in providing care to the patients.