Care Coordination Essay

Berry, L., Rock, B., Houskamp, B., Brueggeman, J., & Tucker, L., (2013). Care coordination for patients with complex health profiles in inpatient and outpatient settings. Mayo Clinic Proceedings, 88(2), 184-94. Retrieved from http://search.proquest.com/docview/1312503895?accountid=34574

One of the aims of the Patient Protection and Affordable Care Act (ACA) of 2010 is improved integration and coordination of services for primary patient care. The patient-centered medical home (PCMH) is one of the approaches by which improvements can be established. The patient-centered medical home model is particularly well-suited for people who have chronic illness. The design of the patient-centered medical home model departs substantively from traditional reimbursement policies, in that, the ACA provides for incentives and resources to enable care coordinators to be directly recognized and compensated for their care coordination work. Care coordinators are most often registered nurses who through their work that aligns with ACA engage in quality improvement work, cost-effectiveness measures, and patient advocacy. To bring the ACA model to a human scale, the authors present a case study of a care coordinator at a patient-centered medical home in rural Maine. The table provided below provides a basic textual analysis of the study as it is published in the professional nursing journal.

1.2 – Assess a child or young person’s development in following areas :- physical, communication, intellectual/ cognitive, social, emotional and behavioural and moral.

Care coordination is an integral part of current health care models, including the Patient Centered Medical Home Model. There are various sources that show the benefit of care coordination efforts in improving

The health care is reforming in a way that care delivery models have been formed and people will be paying for quality of care as a whole (Fairman, Rowe, Hassmiller, & Shalala, 2011). The health care reform law is attempting to balance the system of health care resources in that a balance will be yielded to award care value over the volume of care provided. This reform calls into nurse leadership and the input of nurses who contribute the largest labor to the health care system. Registered nurses are vital in the delivery model of patient centered care system.

Nurses should be full partners, with physicians and other health professionals, in regarding health care in the United States(Institute of Medicine, 2011).Nurses should be full partners because who knows nursing and what nurses need better than a nurses themselves? In care environments, being a full partner involves taking responsibility for identifying problems and areas of waste, devising and implementing a plan for improvement, tracking improvement over time, and making necessary adjustments to realize established goals (Institute of Medicine, 2011).The expense of certain supplies and equipment could be decreased over time if nurses had more say in their environment and resources. On many floors in hospitals, certain supplies are not needed

The hospice regulation states that hospice services must provide consistent care with patient and family 's needs and goals. Another regulation is that the hospice must communicate and integrate according to policies regarding the coordination of care. The RN case manager is responsible for coordinating care and implementing a plan of care for each patient.

As the largest group of health care professionals, nurses hold the key to effective health care system change. Without the nurses and their leadership skills and expertise, we know that the efforts to address the challenges facing the healthcare system will be in vain. So much of what nurses do directly addresses health care reform goals concerning better quality care for more people at a lower cost. Throughout the years nurses have made a tremendous effort to reduce the rates of medical errors,

In the evolving health care environment, a guiding policy and personnel planning is required with respect to the numbers, types and mix of professionals. To overcome the challenges of the existing health care system and practice environment, “nurses need to be well educated, team oriented, adaptable and able to apply competencies relevant to leadership” (The Future of Nursing: Leading Change, Advancing Health, 2011, p. 270). Health care system is complex and has conflicting interests. Nurse helps the patient and family to connect to their social support systems and help to coordinate care and improve patient outcomes. Evidence shows that high quality nursing care can reduce cost

I think coordination or care transition programs would be effective in improving the health outcomes of my patients. I believe all patients want to learn how to take care of themselves and control their own lives. Transitions coaching by home visits and three phone calls would help patients find the support and instruction they need to know that they are playing an important role in their own care. For example, we could help patients with hypertension (HTN) or cerebrovascular accidents (CVA) learn about

Care coordination within health care systems ensures the client of an effective and short stay. Care coordination refers to the coordination between and among professional teams that serve valuable roles involved in providing care to clients. Different disciplines of health care professionals include nursing, medicine, case management, pharmacy, nutrition, social work, and allied health professionals, such as speech therapists and physical therapists. They are found in all health care delivery systems and are extremely effective when the focus is strictly on the needs of the client. Interprofessional teams are valuable because each health care professional has specialized knowledge and skills so that health care plans are determined with

Patients with complex chronic conditions can benefit from nurse-led care coordination in ambulatory care settings in the aspect of reductions in ED visits and hospitalizations. Nurses provide guided-care and facilitate cross setting communication and transition between specialty and primary providers (Haas & Swan, 2014). Nurses support patient decision-making and self-care management. Nurses hear concerns and goals of patients and enhance their engagement in care interventions. Nurses empower patients and families in understanding health care resources and seeking consultation prior to increased severity of the disease (Forbes III, 2014).

to the increasing numbers of people involved and its impact on the whole healthcare. The

Reflecting on the kitchen practice and the placement, there are many activities and works require having good collaboration between different service staffs and health department. Therefore, I understand that good coordination skills are necessary to have better rapport building with the peers and the other staffs in a hospital or aged care setting.

Nurse leaders are aware that today’s health care system has many issues complicating the goal of quality patient care and outcomes for all. Nurse leaders must stay informed and become involved as an advocate influencing changes in policy, laws, and/or regulations that govern the health care system they practice in. At times the advocacy requires a nurse leader to become more involved beyond their immediate level of practice and into the world of politics and policy.