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

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    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 Delivering a Care Coordination Project

    Greetings, everyone! I am Student Name, and I am excited to share insights on a care coordination project targeting chronic care patients, with a focus on planning and presentation. In this presentation, my role is that of a Care Coordinator Project Manager, and I will explore a comprehensive strategy to effectively organize and coordinate patient care.

    Purpose of the Care Coordination Plan

    The objective of introducing a care coordination plan for chronic care patients is to streamline patient care practices and related activities efficiently. The plan aims to facilitate the seamless coordination of crucial medical information among healthcare professionals, mitigating misunderstandings and preventing adverse events. A successful care coordination plan is designed to enhance the quality of care, implement assurance plans for patient management, monitor their conditions, and bolster support through the development of efficient information systems.

    Vision for Interagency Collaboration

    Efficient organization and coordination of care for chronic care patients are paramount for effective condition management, improved patient experiences, satisfaction, and outcomes. The primary care coordination approach, as advocated by Welkin (2022), involves an integrated, patient-centered strategy that collaborates with patients and their families to address specific needs. This collaborative effort establishes accountability, develops proactive care plans, connects with community resources, highlights patient needs and goals, and supports self-management objectives. Leadership roles are integral to fostering teamwork and reducing healthcare inefficiencies by enhancing information exchange, symptom reporting, and arranging necessary equipment for patients.

    Given that chronic care patients often grapple with unresolved health concerns, interagency collaboration is crucial. Psychologists, nurses, chronic care specialists, psychiatrists, and patients must collaborate to address the unique challenges faced by chronic patients. Collaboration with psychologists and psychiatrists is especially essential considering the potential trauma and distress associated with treatment procedures. The vision assumes that chronic care treatments are costly, causing significant distress to patients of all ages and backgrounds. Areas of uncertainty include the required skills for nursing staff to enhance collaboration and communication.

    Identifying Participating Organizations

    Various organizations actively contribute to the care of chronic patients to enhance their outcomes. The National Association of Chronic Disease Directors (NACDD) brings together approximately 7,000 chronic disease professionals across the US to advocate, educate, and provide technical assistance for the health protection of chronic care patients through primary and secondary prevention efforts.

    The Worldwide Hospice Palliative Care Alliance, established in 2008, aims to meet the needs of chronic care patients and alleviate the challenges they face, ranging from economic to psychological distress. The inter-professional care coordination team I propose comprises nurses, nursing leaders, chronic care specialists, insurance providers, psychologists, psychiatrists, and pharmacists.

    Determining Resources

    Efficiently determining and utilizing appropriate resources for chronic care is essential. Economic costs for chronic illnesses must be assessed, considering that 90% of the nation’s $4.1 trillion healthcare expenditures annually are allocated to chronic illnesses. Heart diseases, cancer, and diabetes account for significant costs to healthcare systems. Preventive measures, such as those supported by the CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) funds, can help reduce these costs.

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

    Additionally, the American Chronic Pain Association and Accountable Care Organization (ACO) provide financial incentives for improved care outcomes, promoting affordable and quality care. Utilizing these resources aids patients in managing chronic illnesses and pain. The financial aid from such programs can be integrated into care coordination plans to provide support to patients. Chronic care staffing is another crucial resource, emphasizing not only the quantity but also the training and dedication of staff resources. The assumption is that the coordinated care plan developed will be eligible for patient funding programs. Areas of uncertainty revolve around the impact of these funding programs on patient outcomes.

    Project Milestones

    Establishing an efficient care plan is crucial for improving the quality of life for chronic patients. The care coordination team, consisting of chronic specialists, nurses, patients, doctors, and hospital management, will collaborate to enhance health literacy, support better self-management, and assess patients’ progress for continuous improvement. Results will be evaluated through patient satisfaction surveys or questionnaires, allowing for ongoing refinement of the care coordination plan until all issues are minimized. The anticipated outcomes include enhanced patient knowledge of their illness, increased confidence in self-management, reduced patient distress through improved collaboration and communication, and the successful identification of resources for utilization.

    Presentation to Decision-Makers

    Implementing a successful healthcare coordination plan for chronic care patients requires enhanced communication, collaboration, and the efficient utilization of resources. Each milestone will be achieved through careful planning to maximize patient satisfaction. Engaging different organizations for funding is essential to alleviate financial distress among patients. The plan’s implementation should be periodically evaluated through surveys to measure program quality.

    Conclusion

    In this project, we have delved into the challenges faced by chronic care patients dealing with lifelong diseases. The proposed care coordination plan aims to organize medical information, streamline care, and enhance health literacy for improved 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/

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

    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

    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/