Client Name
Capella University
NURS-FPX6612: Health Care Models Used in Care Coordination
Instructor’s Name
August 2024
Triple Aim Outcome Measures
Slide 2: Hello, my name is —. Today’s presentation will be based on evaluating the care coordination process of Sacred Heart Hospital (SHH) and the design and application of current techniques to improve and enhance the procedure of care coordination so that they can achieve triple-aim outcomes (Kokko, 2022). In this presentation, the stakeholders that are involved in achieving the desired goal will be analyzed to ensure the effectiveness of the triple aim outcome strategies implementation process.
Purpose
Slide 3: The purpose of the presentation is to identify the process of care coordination to understand the changes that need to be made in the improvement process of care coordination for better health and patient outcomes (Storkholm et al., 2019). This presentation will focus on presenting advanced and improved strategies for achieving triple aim outcomes measures to the staff members of Sacred Heart Hospital, including leaders, healthcare professionals, case managers, and care coordinators. The strategy will clarify the importance of healthcare models in achieving the triple aim and how these models help in the evaluation of data based on evidence. In today’s presentation, the role of governmental initiatives in improving the outcomes will also be discussed.
Triple Aim
Slide 4: The framework, the triple aim is developed to improve the standard and health quality available to the patients along with the improvement of the whole system of healthcare (Lacagnina, 2019). This aim is based on three main objectives which are listed below;
Improving the Health of the Population
The first objective focuses on a broader concept of providing health to the whole population as it is their fundamental right to have access to high-quality health and security (Behera & Prasad, 2022). The health of the population refers to the health of the nation as it focuses on designing, developing, and implementing strategies that are useful for providing quality health to everyone. Security of the population means the success of the whole healthcare system operating all over the world (Paul et al., 2023). This objective can be achieved by guiding people regarding chronic diseases and their prevention and making them aware of the health standards that are needed to stay safe. Population health includes the whole population like the culturally diverse people or vulnerable groups.
Enhance Patient Care Experience
Positive patient outcomes and better patient experiences are always the major concerns of all healthcare organizations because keeping the patient safe and healthy is the agenda of the healthcare system (Ferreira et al., 2023). Emerging technologies also increase the demand for high-quality patient experiences due to which organizations are implementing strategies that are useful for generating positive patient outcomes like providing advanced training to the staff for effective patient handling, that is centered towards the well-being and satisfaction of the patient. This objective of the triple aim also focuses on strategies that are beneficial for the patient’s health and effective in improving the patient care experience.
Healthcare Cost Reduction
Cost of the healthcare is always the major concern of people having different financial backgrounds thus reducing the cost so that people around the world can benefit from healthcare facilities is necessary for the success of any healthcare organization (Frazier et al., 2022). Cost management and reduction strategies can be applied that will focus on eliminating wastage, reducing the rate of readmissions, and narrowing the need for extra tests and procedures. Efficient staff with competent abilities can help the whole healthcare system minimize the cost of healthcare for the betterment of the patients and the healthcare organizations.
Relationship Analysis of Health Care Models and Triple Aim
Slide 5: Healthcare models are designed and implemented to generate positive patient feedback by approving the health of high quality and safety for the patients through the main objectives including patient-centered healthcare approaches, improved outcomes of the patient by ensuring patient satisfaction, and quality care for the patients (Connor, 2023). The healthcare models are strongly related to the triple aim as they are also focused on achieving goals that are suitable for all the people in the world including diverse populations and other special groups. The relationship between a few models and the triple aim is given below;
Patient-Centered Medical Home (PCMH)
Slide 6: This model primarily focuses on the approaches that are patient-centered thus giving a lot of attention to the approaches that can enhance patient experience, patient outcome, patient health, and the well-being of the patient (Ginting et al., 2022). It involves the collaboration of interdisciplinary teams to ensure patient safety from all the perspectives of patient medical history including social, psychological, medical, and so on. This model focuses on strengthening the relationship between the patient and the healthcare providers for a better understanding of the health needs of the patients.
PCMH relates to the triple aim by fulfilling the three main objectives including cost reduction through the timely management of diseases and incorporating preventive measures to reduce the risk of health disparities, providing health to the population by effectively treating one patient with competent staff, and improving patient experience by improving the communication and relationship of patient and provider (Ginting et al., 2022). This model also relates to the transitional care model by keeping the smooth transitions between healthcare facilities and with the patient self-management model by educating patients regarding their health conditions.
Transitional Care Model
Slide 7: This model focuses on providing better quality health services to the patient transferring from one healthcare facility to another by assessing the needs of the patient, and communicating with the case managers, care coordinators, and healthcare staff of the destination care (Leithaus et al., 2022). This model ensures that the patient receives complete care at the destination care unit and transfers smoothly with great care to the destination.
This model relates to the triple aim by focusing on quality and positive patient outcomes ensuring improved patient experience. It also focuses on reducing the rate of readmissions by providing extra care and effective instructions to the patients and family members at the time of discharge and preventing health disparities by carefully planning for emergencies with all the useful resources (Leithaus et al., 2022). It also relates to the PCMH model in giving continuous care to the patient and effective monitoring of the patient’s health condition. Concerning the patient self-management model it educates and trains the patients about their further visits, medications, and other regular tests.
Patient Self-Management Model
Slide 8: This model focuses on giving education and training to the patients to take full care of their lives and understand the basic medications and other precautionary measures needed to control their diseases, especially chronic diseases which can be controlled and improved through preventive measures and proper monitoring (Griffin et al., 2019). This model involves patients in the process of making effective decisions regarding their health and encouraging patients to improve and plan self-management for better health results.
This model relates to the triple aim of reducing the cost of hospital management and educating patients to take care of their selves when it is possible (Griffin et al., 2019). It relates to the transitional model by providing guidance and training to the patients to take care of their selves after discharge thus teaching them self-management. It also relates to PCMH by administering more patient-centered approaches involving the decision-making process of healthcare or taking care of their selves.
Contribution of Health Care Model’s Structure to Evaluation of Evidence-Based Data
Slide 9: Healthcare models have a major effect on the evaluation of the quality of the evidence-based data as their purpose is to ensure patients’ enhanced quality of health and for this purpose, they use standard tools and implement strategies that are best suited for the monitoring, and organizing of patient information (Connor, 2023). All the healthcare models gather data from the patients to understand the healthcare needs of the patients and suggest a particular suitable treatment for the patients. The patient-centered medical home focuses on the well-being of the patients thoroughly by regularly monitoring and recognizing the condition of the patient through the data analysis gathered from the patient’s health condition (Ginting et al., 2022). This model primarily focuses on patients therefore the response of patients serves as a strong data evaluation strategy.
The transitional care model involves the smooth and safe transition of patients from one healthcare facility to another and to make the transitions successful the healthcare providers provide complete accurate information about the patient in the documented form to the destination care providers for the efficient care of the patients after transition (Leithaus et al., 2022).. The data of patients is always evaluated by interdisciplinary teams for better decision-making based on evidence. Patient education regarding basic healthcare assistance is also based on evidence-based data which ensures the quality and safety of the patient information.
The self-management model also involves the quality evaluation of evidence-based data by encouraging the patients to monitor their health condition effectively and regularly and manage the data of their health improvements accurately (Griffin et al., 2019). Patients monitoring themselves provide feedback to their health providers which can be used to evaluate the effects of the current management plan provided to the patients
Evidence-Based Data Shaping by Care Coordination
Slide 10: Evidence-based practices have an essential role in improving the health quality and safety provided to patients regarding their particular health condition (Hashish & Alsayed, 2020). Many hospitals and healthcare facilities are incorporating evidence-based practices for the timely recognition and response to deteriorating patient conditions and to reduce the risk of health disparities. Thus the data based on evidence from different sources like patient feedback, self-monitoring, and patient engagement in decision-making helps the nursing and the care coordination staff at a large scale to effectively understand the condition of the patient and provide proper treatment without wasting any time thus ensuring the efficiency of the care provided to the patients (Hashish & Alsayed, 2020).
Moreover, patients are also aware of their health condition which makes it easier for the cruising staff to give healthcare instructions to the patients thus improving the health provider and patient relation with effective communication. The data based on evidence also enhances the collaboration of interdisciplinary teams by providing data to them for their opinions regarding the advanced and improved healthcare assistance to the patients thus ultimately improving the outcomes of the patients.
Governmental Regulatory Initiative and Outcome Measures
Slide 11: The laws and regulations are impactful in generating positive outcomes from the organizations and keeping the order of the system manageable and organized (Errida & Lotfi, 2021). Governmental regulatory initiatives to achieve the triple aim are as follows;
- The Hospital Readmission Reduction Program (HRRP) of the US governmental regulators found fine in the hospitals for the increased number of readmissions thus assisting in reducing the cost of healthcare.
- The Community-Based Transition Program (CBTP) ensures the secure transition of patients without readmissions thus improving the experience of patients and reducing healthcare costs.
- To improve the quality of care in US National Quality Strategy (NQS) framework was developed so that the high standard of care and safety delivered to the patients do not compromise.
- The use of electronic health records is merging due to the advancements in information healthcare technology. Health Information Technology for Economic and Clinical Health (HITECH) ensures that new technologies should be introduced in healthcare systems for better patient outcomes.
Process Improvement Recommendations for a Group of Stakeholders
Slide 12: The care coordination improvement at Sacred Heart Hospital can be done through various recommendations applied to the group of stakeholders. The few recommendations are as follows;
- The designing and implementation of tools that are effective and standardized to improve the communication between the team members need to be done for an improved understanding of the requirements of the patient and the required treatment protocols and procedures.
- The effective use of informational technology related to healthcare can play a major role in improving care coordination at SHH. Emerging health technologies demand new procedures and strategies for better patient outcomes like the electronic record-keeping system.
- The training of care coordinators to be effective and competent in their role of managing a patient with efficiency and proficiency for the generating of enhanced and improved patient outcomes.
NURS FPX 6612 Assessment 1 Conclusion
Slide 13: Triple aim outcomes measures are based on three particular objectives that focus on providing high-quality health care to the patients (Kokko, 2022). These objectives are health to all the population, cost reduction in healthcare systems, and improved experiences of patients regarding healthcare. The different healthcare models are designed and implemented to achieve a triple aim thus promoting the cause of ensuring and promoting high-quality health and care to the patients of any culture and social group. These models gather quality evidence-based data that is useful for the treatment of the patients and the enhancement of patient outcomes through monitored feedback. This evidence-based data is collectively used by healthcare providers to provide efficient health to patients. Government regulators also ensure the maintenance of high-quality health and safety of the patient through different standards and policies.
NURS FPX 6612 Assessment 1 References
Behera, B. K., & Prasad, R. (2022). Primary health-care goal and principles. Healthcare Strategies and Planning for Social Inclusion and Development, 1(1), 221–239. https://doi.org/10.1016/b978-0-323-90446-9.00008-3
Connor, L. (2023). Evidence‐based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews on Evidence-Based Nursing, 20(1), 6–15. https://doi.org/10.1111/wvn.12621
Errida, A., & Lotfi, B. (2021). The determinants of organizational change management success: Literature review and case study. International Journal of Engineering Business Management, 13(1), 1–15. https://doi.org/10.1177/18479790211016273
Ferreira, D. C., Vieira, I., Pedro, M. I., Caldas, P., & Varela, M. (2023). Patient satisfaction with healthcare services and the techniques used for its assessment: A systematic literature review and a bibliometric analysis. Healthcare, 11(5), 639. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10001171/
Frazier, T. L., Lopez, P. M., Islam, N., Wilson, A., Earle, K., Duliepre, N., Zhong, L., Bendik, S., Drackett, E., Manyindo, N., Seidl, L., & Thorpe, L. E. (2022). Addressing financial barriers to health care among people who are low-income and insured in New York City. Journal of Community Health, 48(2). https://doi.org/10.1007/s10900-022-01173-6
Ginting, M. L., Wong, C. H., Lim, Z. Z. B., Choo, R. W. M., Carlsen, S. C., Sum, G., & Vrijhoef, H. J. (2022). A patient-centred medical home care model for community-dwelling older adults in Singapore: A mixed-method study on patient’s care experience. International Journal of Environmental Research and Public Health, 19(8), 4778. https://doi.org/10.3390/ijerph19084778
Griffin, S., Cardenas, V., Williams, K., & Benrimoj, S. I. (2019). Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One, 14(8). https://doi.org/10.1371/journal.pone.0220116
Hashish, E. A., & Alsayed, S. (2020). Evidence-based practice and its relationship to quality improvement: A cross-sectional study among Egyptian nurses. The Open Nursing Journal, 14(1), 254–262. https://doi.org/10.2174/1874434602014010254
Kokko, P. (2022). Improving the value of healthcare systems using the Triple Aim framework: A systematic literature review. Health Policy, 126(4), 302–309. https://doi.org/10.1016/j.healthpol.2022.02.005
Lacagnina, S. (2019). The triple aim plus more. American Journal of Lifestyle Medicine, 13(1), 42–43. https://doi.org/10.1177/1559827618806183
Leithaus, M., Beaulen, A., De Vries, E., Goderis, G., Flamaing, J., Verbeek, H., & Deschodt, M. (2022). Integrated care components in transitional care models from hospital to home for frail older adults: A systematic review. International Journal of Integrated Care, 22(0), 28. https://doi.org/10.5334/ijic.6447
Paul, M., Maglaras, L., Ferrag, M. A., & Almomani, I. (2023). Digitization of healthcare sector: A study on privacy and security concerns. ICT Express, 9(4), 571–588. https://www.sciencedirect.com/science/article/pii/S2405959523000243
Storkholm, M. H., Savage, C., Tessma, M. K., Salvig, J. D., & Mazzocato, P. (2019). Ready for the triple aim? Perspectives on organizational readiness for implementing change from a danish obstetrics and gynecology department. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4319-3