NURS FPX 6618 Assessment 1 Planning and Presenting a Care Coordination Project

Student Name

Capella University

NURS-FPX 6618 Leadership in Care Coordination

Prof. Name

Date

Planning and Presenting a Care Coordination Project

Hello Everyone! I am Student Name, and today I will be presenting on a care coordination project for chronic care patients focusing on presenting and planning. During this presentation, I would consider a comprehensive strategy to coordinate and organize the care for the patients as a Care Coordinator Project Manager.

Purpose of Care Coordination Plan

The purpose of presenting a care coordination plan for chronic care patients is to organize patient care practices and all other activities efficiently. It would also help coordinate the important medical information related to the patients among the professionals avoiding any misunderstandings or adverse events. An effective care coordination plan ensures that the quality of care is being improved and that an assurance plan would manage patients, track their condition, and support them by developing efficient information systems.

Vision for Interagency

Organizing and coordinating care for chronic care patients is essential to effectively help them manage their condition and improve their experience, satisfaction, and outcomes. Primary care coordination is the best approach for a coordinated care plan (Welkin, 2022). This approach would be integrated and patient-centered as it would involve collaborating with the patients and their families with an intervention that would specifically fulfill the patient’s needs (Welkin, 2022).

Accountability would be established, proactive care plans would be developed, community resources would be linked, patients’ needs and goals would be highlighted, and self-management goals would be supported. Leadership roles would also be assigned in this plan to develop teamwork. It would reduce inefficiencies in healthcare with an increased exchange of information about patients’ stay and medications, reporting patients’ symptoms to resolve them, and arranging equipment for patients (Welkin, 2022).

Chronic care patients are usually individuals with unsolvable health concerns. There must be an interagency collaboration among psychologists, nurses, chronic care specialties, psychiatrists, and patients to deal with chronic patients. Collaboration with psychologists and psychiatrists is essential as the patient may be going through a traumatic experience and distress due to the treatment procedures. The assumptions underlying this vision are that the treatments for chronic care are expensive, making the patients suffer a lot of distress and that patients of all ages and backgrounds can face chronic care problems. The areas of uncertainty include the skills the nursing staff would have to practice to enhance collaboration and communication.

Identifying the Organizations

Several organizations are working to participate in caring for chronic patients to improve their outcomes. The National Association of Chronic Disease Directors (NACDD) is an organization consisting of departments that are working to protect the health of chronic care patients through primary and secondary prevention efforts (National Association of Chronic Disease Directors, n.d.). This organization unites about 7,000 chronic disease professionals across the US to advocate, educate, and provide technical assistance.

Another organization is the Worldwide Hospice Palliative Care Alliance, established in 2008 to meet the needs of chronic care patients and minimize the problems faced by these patients (The Worldwide Hospice Palliative Care Alliance, n.d.). These problems can vary from economic distress to psychological distress. My inter-professional care coordination team will comprise nurses, nursing leaders, chronic care specialists, insurance providers, psychologists, psychiatrists, and pharmacists.

Determining the Resource

It is essential to determine the appropriate resources for chronic care and utilize them efficiently. Economic costs would have to be determined for chronic illnesses. 90% of the nation’s $4.1 trillion healthcare expenditures annually are for chronic illnesses (Centers for Disease Control and Prevention, n.d.). Heart diseases cost about $216 billion to the healthcare systems, cancer costs $240 billion, and diabetes $327 billion (Centers for Disease Control and Prevention, n.d.). Preventive measures could help reduce these costs. One of the essential funding programs to financially assist chronic care patients is the CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) funds (Centers for Disease Control and Prevention, n.d.). It helps reduce unhealthy behaviors and prevent chronic diseases for all communities nationwide. Likewise, American Chronic Pain Association provides pain relief to patients facing chronic illnesses.

Accountable Care Organization (ACO) also improves care outcomes with financial incentives and promotes affordable and quality care (Rural Health Information Hub, n.d.). Utilizing these resources helps patients manage their chronic illnesses and pain. The financial aid offered by such programs can be utilized in the care coordination plans to assist the patients and make them feel they are being taken care of. Another essential resource is chronic care staffing which is necessary to treat each patient. The quantity of the staff is not the only important thing, but the staff should also be well trained with time and resources dedicated to training. In addition, the assumption is that the coordinated care plan being developed would be eligible for patient funding programs, and these findings would be enough to help the patients. The areas of uncertainty are the amount of difference these funding programs would make for the patients.

Project Milestones

An efficient care plan must be established to help chronic patients have a better quality of life. Specialists from various fields can collaborate to help patients suffering from various problems that come along with chronic illnesses. The care coordination team will include chronic specialists, nurses, patients, doctors, and hospital management.

The coordination team will help improve health literacy allowing better self-management and assessing patients’ progress to make further improvements. The results from this coordinated care plan will be evaluated by measuring patient satisfaction through surveys or questionnaires. This plan can be further improved till all the errors and problems are minimized. Moreover, this care coordination plan will achieve the milestone of preparing the care plan, gathering the stakeholders or team members, developing a care coordination team, and evaluating results to determine success.

The expected outcomes of this project are the patient will have a better knowledge of their illness and be more confident with self-management. A successful care coordination plan would reduce patient distress with enhanced collaboration and communication among the professionals, the patients, and their families. There should also be a successful short-listing of resources to be utilized.

Presentation of Project to Decision-Makers

For implementing a successful healthcare coordination plan for chronic care patients, there needs to be enhanced communication and collaboration along with short-listing of the most appropriate resources to utilize them efficiently. Every milestone will be achieved through careful planning that increases patient satisfaction. Moreover, different organizations should be contacted for funding to help resolve the financial distress among the patients. The plan’s implementation should be evaluated in allocated periods through surveys to measure the program’s quality.

Conclusion

In this project, chronic care patients suffering from lifelong diseases are discussed. A care coordination plan should be developed to help coordinate medical information related to the patients, to organize care, and improve their health literacy for better healthcare outcomes.

References

Centers for Disease Control and Prevention. (n.d.). Chronic Disease Center Budget and Funding | CDC. https://www.cdc.gov/chronicdisease/budget-funding/index.htm

Centers for Disease Control and Prevention. (n.d.-b). Health and Economic Costs of Chronic Diseases | CDC. https://www.cdc.gov/chronicdisease/about/costs/index.htm

National Association of Chronic Disease Directors. (n.d.). NACDD. https://chronicdisease.org/page/about_nacdd/

Rural Health Information Hub. (n.d.). Rural Health Funding & Opportunities: Chronic disease management – Rural Health Information Hub. https://www.ruralhealthinfo.org/funding/topics/chronic-disease-management

NURS FPX 6618 Assessment 1 Planning and Presenting a Care Coordination Project

The Worldwide Hospice Palliative Care Alliance. (n.d.). https://www.thewhpca.org/

Welkin

. (2022, August 24). Managing Chronic Conditions Through Care Coordination. Welkin Health. https://welkinhealth.com/managing-chronic-conditions-through-care-coordination/

NURS FPX 6618 Assessment 1 Planning and Presenting a Care Coordination Project