NURS FPX 4050 Assessment 4 Final Care Coordination Plan

Final Care Coordination Plan

The provision of care coordination in the Preliminary Care Coordination Plan is the outcome of all healthcare professionals, caregivers, and stakeholders who collaborate to provide merited care. The care coordination plan is built on the current concept of patient-centered care that draws best practices and emerging standards in care coordination (National Academies of Sciences, Engineering, and Medicine, 2020). NURS FPX 4050 Assessment 4 Final Care Coordination Plan: In this way, a client-centered approach is the basic principle on which this document relies to address the client’s overall health status, needs, and goal setting, as well as provide either the long-term or specific intervention that is correspondent (Agency for Healthcare Research and Quality, 2019). The relationship between patient and nursing demands personalized care, inclining towards individual’s perspectives, experiences, and beliefs, as well as showing the importance of collaboration and communication by all involved people.

Patient-Centered Health Interventions and Timelines

To tackle the healthcare challenge of deprived communities with limited access, our patient-centered interventions focus on inclusivity and collaboration along with the utilization of existing community resources. Firstly, we plan to eliminate transportation barriers by working with local transportation services to subsidize trip tickets or provide free shuttle services for healthcare appointments (Ray et al., 2020). This project, scheduled to be carried out within the next three months, will guarantee a reach of health facilities even in the presence of any logistical challenges. As well as this, we are realizing the importance of having the clinic hours extended and improving the appointment scheduling systems to decrease the waiting time and increase the convenience of patients. Within the following six months, we plan to put in place extended hours and conduct regular reviews of the scheduling systems for optimization every three months.

In addition, we support the policy changes including Medicaid expansion that are aimed at widening the insurance coverage and increasing the financial affordability of healthcare services (Artiga et al., 2021). The implementation of these activities will start in the next six months, with consistent policy changes’ effect tracking and patients’ access. Furthermore, we are dedicated to implementing cultural competence programs for healthcare professionals and staff members to build trust and engagement among patient populations. We will develop and launch these courses within the next 6 months boasting of annual sessions to refresh cultural competency.

NURS FPX 4050 Assessment 4: Ethical Decisions in Designing Patient-Centered Health Interventions

Designing patient-centered health interventions, ethical factors have to be paid strong attention to and the interests of humans to be respected at every step of their care. Compassionate decision-making guided by literature and ethics leads to the creation of interventions that put patient welfare first, promoting healthy cultural diversity, gaining informed consent, being transparent and accountable. Literature stresses moral principle to deal with inequalities in care provision, paying special attention to populations, which might be deprived of healthcare services, with reference to implementation of such actions as fairness and social justice (Artiga et al., 2021; National Academies of Sciences, Engineering, and Medicine, 2020). Also, clinicians must incorporate cultural competency into interventions so as to ensure that different ethical/religious preferences and values are factored in (Agency for Healthcare Research and Quality, 2019; Lewin Group, 2020). Ethical decision-making also shows the value of obtaining informed consent from patients and developing the principles of honesty and dialog for trust. Additionally, the interventions should emphasize on beneficence and nonmaleficence, preventing the adverse effects of the interventions to patients ( National Academies of Sciences, Engineering, and Medicine, 2020; Artiga et al, 2021). NURS FPX 4050 Assessment 4 Final Care Coordination Plan: Another aspect of ethical reflection is resource allocation, which enables interventions to achieve ethically correct outcomes and enhance the shared community well-being (Schooley, 2019; Lewin Group, 2020). Incorporating ethical factors in the design of patient-focused health interventions enables us to maintain ethical standards, while the provision of top-notch, culture-sensitive healthcare services to underserved communities is ensured. Eternal ethical evaluation and reflection are perquisite to avoid inadvertent deviation of interventions from ethical principles and to stay on the course of the equal provision of healthcare services.

Relevant Health Policy Implications

The designed care coordination plan evolves several major health policy implication that need to be given so much significance in the policy process in order to ensure seamless coordination and continuity of care. Primary among the policy initiatives to be embraced is the support for the Medicaid expansion to widen opportunities, hence it minimizes financial constraints towards access to healthcare more especially for the concerned group (Artiga et al., 2021). Whether they undergo health maintenance or chronic disease care, telehealth technology should be integrated into mainstream healthcare systems by policies that ensure reimbursement parity and overcome regulatory hurdles to provide equitable access to care, even in remote areas (Ray et al., 2020). On the other side, policy measures like culture competency training for healthcare professionals can generate improved patient-centered care that is heterogeneous to patients of different backgrounds (Office of Health Services Research and Policy, 2019). Moreover, it is also vital for the government to promote for adequate financing and support for community health centers since these centers are the backbone of providing the primary healthcare services to the unserved in the society, requiring policies to be enacted on the coming up of more health facility workforce and also expanding the space (Shi et al., 2020). Furthermore, policy procedures must adapt to improve socioeconomic factors that leads to health sector fairness. This consists of granting subsidies and getting cooperation from the other sectors such as the transportation and providing of affordable housing. In consequence, social determinants screening procedures must be integrated into health care systems (National Academies of Sciences, Engineering, and Medicine, 2020). By adhering to these health policy implications, civil servants can become a part of national health care system implementation start, where health care will be addressed to each person as a simple issue, and all people will have an equal opportunity to use it.

Priorities that a Care Coordinator would Establish

Care coordination is an ongoing interaction when presenting a care coordination plan to a patient and family member. During this process, the care coordinator would ensure to give emphasis on certain key aspects which would then be altered by evidence-based practice. The core of this process is patient centered goal setting. The patient preferences and health goals are valued and part of the care plan that is agreed upon by both parties (National Academies of Sciences, Engineering, and Medicine, 2020). The plan will be developed by matching targeted activities with the patient’s goals. This way, the more personalized and effective care is achieved. Furthermore, continuous education of the patient and their closed ones on their condition and alternative treatment options will play a key role in the support of their active participation in treatment decision-making. The coordinator will use educational materials and resources based on evidence, to meet the patient’ health literacy level, learning approach and understanding, as such to increase engagement (Ray, et al., 2020). Our purpose is to also alleviate medication management concerns and enhance therapy to make it evidence-based by making sure medicine is being taken and monitoring a possible bad effect. In addition, the coordinator will emphasize on the process of making sure everything is settled down regarding care coordination between the different people who are involved in the treatment of the patient, use of evidence based care continuity methods for communication enhancement (Artiga et al., 2021). Establishing social determinants of health that the patient encounters and which have to be overcome is also an important step to take; however, referrals to community resources should be provided, where they should be evidence-based and proven to solve problems of social determinants correctly. To sum up, an appropriate system for ongoing performance tracking and data collection should be instituted, which takes into account validated outcomes and calls for any necessary adjustments as the plan is being implemented. This makes sure that the patient care delivery system is continuously improved accordingly. The care coordinator accomplishes this through open discussions with patients designed to deliver evidence-based and personalized care. This improves the care quality, efficiency, and effectiveness, which will eventually translate to improved health status for the patient.

Using Literature on Evaluation as a Guide

The gap between learning sessions’ content and evidence-based criteria is filled once evaluative information is compared against the best practices recommended in such documents as “Healthy People 2030.” Methods of evaluation such as Kirkpatrick’s Four-Level Model and the RE-AIM framework, which are highly structured approaches to assess interventions comprehensively at any level, have been recommended (Braithwaite et al., 2017; Glasgow et al., 1999). Through the use of these models, educators can systematically plan their learning sessions’ content and they can identify the areas that need improvement The alignment with Healthy People 2030, the national health objectives framework, is a key aspect for the teaching sessions to have proper actions that target the national health priorities adequately. The contents of the educational session can be tailored to the objectives of Healthy People 2030 which target care coordination, health equity, social determinants of health, and access to health care (U.S. Department of Health & Human Services, 2020). It is a must to revise the lessons that are based on the evaluation outputs to help to improve the effectiveness of teaching sessions. When evaluation results show that knowledge acquisition is not adequate or that students barely put in the effort, educators can step in and use evidence-based strategies to deal with issues that emerge in public health and address such priorities. Through introducing evaluation evaluations and stressing intersectoral teaching classes, educators can customize educational interventions to improve health outcomes and facilitate care coordination.

NURS FPX 4050 Assessment 4: Conclusion

The last phase which forms part of the program I am discussing is the Care Coordination Plan that is a specific strategy that deals with contents related to the broad healthcare access and delivery issues. The plan of implementation is directed at enhancing health outcomes while addressing the question of equity in access to healthcare which is created on basis of the principle of patient-centered care, evidence-based intervention, and collaboration amongst great partners like carers, healthcare providers, and community agencies. The basis of the plan is constructed using the acquired best practices and also is culturally competent and appraised the social determinants of health. The plan calls on the necessity of the conditional, where the vulnerable population is taken care of. The plan succeeded in attaining the objectives by the incorporation of interventions that addressed the target directly through transportation aid, policy advocacy and community resource mobilization thus overcoming the limits to care and resulting in improvement of individual and community health outcomes. NURS FPX 4050 Assessment 4 Final Care Coordination Plan: Advancing evaluation, modification and assessment should be key factors in healthcare plan efficiency and capability of adapting to healthcare requirements dynamism. Overall, the Care Coordination Plan summarizes a confidence in a healthcare system that is comprehensive, users friendly, and is personal enough for each gazebo or person.

References

Hannigan, B., Simpson, A., Coffey, M., Barlow, S., & Jones, A. (2018). Care coordination as imagined, care coordination as done: Findings from a cross-national mental health systems study. International Journal of Integrated Care, 18(3). https://doi.org/10.5334/ijic.3978

Jowsey, T., Dennis, S., Yen, L., Mofizul Islam, M., Parkinson, A., & Dawda, P. (2016). Time to manage: Patient strategies for coping with an absence of care coordination and continuity. Sociology of Health & Illness, 38(6), 854–873. https://doi.org/10.1111/1467-9566.12404

Karam, M., Chouinard, M.-C., Poitras, M.-E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing care coordination for patients with complex needs in primary healthcare: A scoping review. International Journal of Integrated Care, 21(1), 1–21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977020/

Palimaru, A. I., McBain, R. K., McDonald, K., Batra, P., & Hunter, S. B. (2021). Perceived care coordination among permanent supportive housing participants: Evidence from a managed care plan in the united states. Health & Social Care in the Community, 29(6). https://doi.org/10.1111/hsc.13348

Schultz, E. M., & McDonald, K. M. (2014). What is care coordination? International Journal of Care Coordination, 17(1-2), 5–24. https://doi.org/10.1177/2053435414540615

Sharma, N., O’Hare, K., O’Connor, K. G., Nehal, U., & Okumura, M. J. (2018). Care coordination and comprehensive electronic health records are associated with increased transition planning activities. Academic Pediatrics, 18(1), 111–118. https://doi.org/10.1016/j.acap.2017.04.005

Explore our Nursing Writing Services for further assistance and resources.