Care Coordination Assignment Essay

Care Coordination Assignment Essay

Care Fragmentation: The Contribution of the Institute of Medicine’s Six Domains of Healthcare Quality in Finding a Solution

Fragmentation of care in the healthcare system of the United States has already been recognized as a major factor in high cost and low quality of healthcare in the country. Care fragmentation is the situation in which each provider concentrates on a small part of the patient’s overall problem and fails to see the whole picture (Frandsen et al., 2015; Kane, 2015). This fragmentation is partly responsible for the unsafe and low quality healthcare witnessed in the country despite its astronomical cost compared to other developed countries. In 1999, for instance, the Institute of Medicine (IOM) published a landmark report titled To Err Is Human. The report shocked many by stating that about 98,000 preventable patient deaths were occurring in the United States as a result of medical errors that can be prevented (Palatnik, 2016). Care Coordination Assignment Essay To overcome and bridge this quality gap, the IOM recommended the implementation of six domains of healthcare quality in its subsequent report in 2001 titled Crossing the Quality Chasm: A New Health System for the 21^st Century (National Academy of Sciences, 2001). These six quality aims are safety, effectiveness, efficiency, timeliness, patient-centeredness, and equitability (AHRQ, 2018; Tzelepis et al., 2015). This paper discusses the problem of care fragmentation, the role of the six domains of healthcare quality by the IOM in reducing the quality problems caused by fragmentation, and the lessons that nursing can learn from a discipline outside the profession.

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Care Fragmentation in the United States Healthcare System

Care fragmentation occurs when different providers and healthcare professionals caring for the same patient treat the patient in their own way without referring to the previous professional’s notes or even what they gave the same patient. In essence, care fragmentation occurs as a result of lack of coordination of care that the same patient is supposed to receive. It is a failure of interprofessional collaboration of epic proportions, because no single person or central authority takes the responsibility of coordinating the patient’s care. The whole healthcare system ends up being driven not by the patient’s interests, but by greed for profits, capitalism, and selfishness with patient information (Frandsen et al., 2015; Kane, 2015). Thus the current challenges with care fragmentation include a lack of care coordination among providers and a lack of openness or collaboration with regard to patient information. An example of a factor that demonstrates this is the current lack of interoperability of the electronic health record (EHR) systems used by different providers. This essentially means that one provider cannot access the previous health records of a patient they are about to treat, hence inevitably fragmenting the care and risking the life of the patient. Care Coordination Assignment Essay

The impact that care fragmentation has on patient outcomes is immense. Many factors can be cited as the result of this issue of care fragmentation. Amongst these are preventable readmissions which increase the cost of healthcare, longer hospital days which also increases the cost of care, psychological and psychosocial problems, and preventable mortality. A patient who has been mismanaged because of fragmented care will need a longer stay in hospital or a readmission. This means that they will spend more money on an already expensive healthcare system just because the initial care was not coordinated. This may lead them to have financial problems generating psychosocial and psychological problems such as depression. Most importantly, the lack of coordination may lead to preventable medical errors such as overdosing and drug interactions. In the end, the patient may die just because their care could not be coordinated and ended up being fragmented (Palatnik, 2016; Frandsen et al., 2015; Kane, 2015).

The Institute of Medicine’s Six Domains of Healthcare Quality and the Role of Nursing in Implementation

As stated in the introduction, after the IOM reported that preventable medical errors were a major cause of preventable patient mortality they recommended what quality healthcare should look like (Palatnik, 2016; Tzelepis et al., 2015; National Academy of Sciences, 2001). They recommended that for healthcare to possess the desired quality, it should be safe, efficient, effective, timely, patient-centered, and equitable (AHRQ, 2018). These six domains or dimensions of healthcare quality are discussed below, demonstrating how the author would meet each dimension:

Safety

Healthcare that is of quality will facilitate the avoidance of harm to patients by the very care that is intended to help them. In care fragmentation, the patient comes with one problem but the fragmented interventions given by different providers because of lack of coordination in care ends up causing them more harm (AHRQ, 2018; Tzelepis et al., 2015).

Timeliness

Healthcare that is timely is quality healthcare. It is healthcare that has zero tolerance for unnecessary delays and waits that end up harming the patient who came to seek care. In fragmented care with no coordination, providers make them wait as they suffer from the problem they had just because the providers cannot liaise with one another professionally (AHRQ, 2018; Tzelepis et al., 2015).

Effectiveness

Quality healthcare is healthcare that is based on evidence-based practice or EBP. This means that in this kind of healthcare system, only those treatments and interventions likely to benefit the patient are used. These are interventions that have proven effectiveness by way of peer-reviewed research into their efficacy (AHRQ, 2018; Tzelepis et al., 2015).

Patient-Centeredness

Healthcare that meets the required quality is culturally competent and responsive to different patient needs of different patients regardless of their race, color, creed, ethnicity, religion, and beliefs. It is healthcare that is respectful and upholds the bioethical principle of autonomy – letting the values of the patient guide all clinical decisions about their care (AHRQ, 2018; Tzelepis et al., 2015). Care Coordination Assignment Essay

Efficiency

Quality healthcare is healthcare that is not wasteful of resources but that uses them efficiently, thereby reducing the cost of healthcare to the patient. These resources include supplies and equipment for which it is the patient who pays (AHRQ, 2018; Tzelepis et al., 2015).

Equitability

Lastly, quality healthcare can be replicated and is not discriminatory based on the patient’s race, gender, age, or socioeconomic status. It is healthcare that upholds social justice and equity in the way that it is offered (AHRQ, 2018; Tzelepis et al., 2015).

The role of nursing in the implementation of these six domains of care quality is that of patient advocacy. Nurses need to be in the forefront in ensuring that patients are treated well and do not suffer while waiting. This may mean taking the initiative to coordinate the patient’s care. Above all, the nurse must not allow the patient to be harmed by fragmentation of care by upholding the bioethical principle of nonmaleficence or primum non nocere (Santhirapala & Moonesinghe, 2016).

Collaboration with a Discipline Outside Nursing

One discipline outside nursing with which collaboration can greatly improve patient outcomes is informatics. The discipline of informatics is concerned with harnessing health information systems to prevent medical and nursing errors as recommended by the IOM in its report titled The Future of Nursing: Leading Change, Advancing Health (Hopper, 2016). Nursing’s collaboration with this discipline has seen the emergence of the nurse informaticist specialist amongst other things. The impact of this collaboration is already being felt in the improvement of patient safety through technological applications such as automated medication dispensing cabinets (ADCs) and bar code medication administration (BCMA). These are already reducing medication errors (Alotaibi & Federico, 2017). Care Coordination Assignment Essay

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Conclusion

The matter of care fragmentation in the US healthcare system has been a source of great suffering for patients. This is because it has resulted in low quality of care experienced by patients who suffer high costs and harm caused by the lack of coordination in care provision. Part of the solution lays in the implementation of the IOM’s six domains or dimensions of quality healthcare. In this, nurses are the frontline champions who must advocate for the patient’s welfare through collaboration with disciplines such as informatics.

References

Agency for Healthcare Research and Quality [AHRQ] (2018). Six domains of health care quality. Retrieved 3 September 2020 from https://www.ahrq.gov/talkingquality/measures/six-domains.html

Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. Doi: https://doi.org/10.15537/smj.2017.12.20631

Frandsen, B.R., Joynt, K.E., Rebitzer, J.B., & Jha, A.K. (2015). Care fragmentation, quality, and costs among chronically ill patients. American Journal of Managed care, 21(5), 355-362. https://www.ajmc.com/view/care-fragmentation-quality-costs-among-chronically-ill-patients

Hooper, V.D. (2016). The Institute of Medicine report on the future of nursing: Where are we 5 years later? Journal of PeriAnesthesia Nursing, 31(5), 367-369. http://dx.doi.org/10.1016/j.jopan.2016.08.013

Kane, J. (December 11, 2015). Fragmentation is behind health care’s biggest problems. Retrieved 3 September 2020 from https://www.kevinmd.com/blog/2015/12/fragmentation-is-behind-health-cares-biggest-problems.html

National Academy of Sciences (2001). Crossing the quality chasm: A new health system for the 21^st century. Retrieved 3 September 2020 from https://www.ncbi.nlm.nih.gov/books/NBK222271/

Palatnik, A. (2016). To err is human. Nursing Critical Care, 11(5), 4. Doi: https://doi.org/10.1097/01.CCN.0000490961.44977.8d

Santhirapala, R., & Moonesinghe, R. (2016). Primum non nocere: Is shared decision-making the answer? Perioperative Medicine, 5(16), 1-5. https://doi.org/10.1186/s13741-016-0042-3  Care Coordination Assignment Essay

Tzelepis, F., Sanson-Fisher, R., Zucca, A., & Fradgley, E. (2015). Measuring the quality of patient-centered care: Why patient-reported measures are critical to reliable assessment. Patient Preference and Adherence, 9, 831-835. https://doi.org/10.2147/ppa.s81975

Purpose: The purpose of this paper is to examine care fragmentation and discuss personal accountability and the importance of interdisciplinary collaboration to deliver healthcare meeting the six aims from The Institute of Medicine (IOM).

 To prepare for writing this paper

4. View the Care Coordination Paper Assignment Overview posted in Blackboard
5. View the video posted in Blackboard on the Institute of Medicine (IOM) aims for care that is: Safe, Effective, Patient-Centered, Timely, Efficient, Equitable.
6. Review the report brief from the IOM’s landmark book Crossing the Quality Chasm (2001) as posted. This is older than 5 years, but was “landmark” information changing the way we deliver care.
7. Review the faculty provided APA resources (formatting tips, USI APA requirements, how to remove extra spaces) posted in Blackboard. Use the APA manual and USI Library for other APA resources. This paper will require the correct use of APA headings

The Key Components of the Paper

Introduction-summarize concepts the paper will discuss and state the purpose of the paper

 Care Fragmentation-Discuss current challenges with care fragmentation and the impact care fragmentation has on patient outcomes

 The IOM and the Role of Nursing- Define the 6 aims recommended by the Institute of Medicine (IOM) to deliver quality care and provide examples of how you personally meet each aim to deliver healthcare that is:  

Safe

Effective

Patient-Centered

Timely

Efficient

Equitable

 Discipline Outside of Nursing- Identify a discipline outside of nursing and analyze how collaboration with this discipline can improve patient outcomes and transitions of care  Care Coordination Assignment Essay

Identify a discipline outside of nursing

Explore the roles and responsibilities of this discipline

Discuss the impact of collaboration

 Conclusion – Summarize major concepts of paper. Synthesize thoughts presented in body of paper and relate these to the introduction.

This paper will give the fundamental concept of care coordination in healthcare. The goal will be to define care coordination as well as outline the elements of care coordination to be used by the healthcare practitioners. Further, this will include evidenced based practice in coordination of care, including communication of care, patient centered care, and the role of the nurse in care coordination.

Concept of Care Coordination

Care coordination has several components that involve the ability of the patient to have access to the desired healthcare service when the need arises.  Effective care coordination requires a thorough examination of the patient to ascertain the specific care required. This implies that experienced health practitioners should be engaged for successful care coordination among the patients with minimal medication errors that poses health risks to the patients (Hong, 2014). Care coordination has several components that include provision of quality medication to the patients for the achievement of the desired health outcome. Care coordination is the practice by the health practitioners for administering treatment to the patient and offering all the support to restore the good health.  Care coordination also involves creating awareness to the individuals on how to prevent contraction of certain diseases to reduce the instances of new infections for long term good health. The health practitioners should also make a follow up to ascertain how the patients are faring on to offer more support for the achievement of the desired health outcome. Care Coordination Assignment Essay

References

El-Alti, L., Sandman, L., & Munthe, C. (2017). person-centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions? Health Care Analysis, 27(1), 45-59. doi:10.1007/s10728-017-0347-5

Hong, C. S. (2014). Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? doi:10.15868/socialsector.25007

 Care Coordination Assignment Essay

 

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