Client Name
Capella University
NURS-FPX6614: Structure and Progress in Care Coordination
Instructor’s Name
August 2024
Disseminating the Evidence Scholarly Video Media Submission
Hi everyone, welcome to today’s video! I am _____, and today I am going to discuss the improved outcomes of the care coordination intervention along with suggestions on how to keep the improvement of the healthcare services increasing. Care coordination has great significance in refining the health status of the patients, improving the patient experience, and implementing useful strategies suitable for the patient and the healthcare organizations (Albertson et al., 2021). These outcomes will be improved continuously by increasing the care coordination efforts along with the involvement of the interdisciplinary teams. This video will be made for a media platform based on a peer review of the different healthcare professionals to integrate these findings into their healthcare strategies for enhanced patient outcomes.
Care Coordination Efforts Related to Clinical Priorities
In older people suffering from type 2 diabetes (P), does the application of telehealth services (I), compared to traditional care services (C), decrease the readmission hospital rates (O), within the four months (T)?
This PICOT question underlines the issues older adults affected by diabetes face and how care coordination efforts can help in resolving these issues effectively (Northwood et al., 2022). Diabetes patients especially elder people have difficulty monitoring their blood glucose levels, accurately managing their medications, staying consistent with the diabetic diet, and acting effectively on the health management plan provided to them (Weinstock et al., 2020). They required frequent consultations about the instructions given to them regarding their health condition.
These problems can create a lot of other challenges like the increase in the rate of hospital readmissions, and ineffective self-management leading to deteriorating conditions. The readmission in the hospitals can badly impact the staff members and the healthcare organizations resulting in poor patient outcomes. These readmissions often occur due to a need for more patient information about the health condition, the inability of the staff to continuously monitor the health condition of the patient, and insufficient care coordination.
Moreover, traditional consultations are often difficult for older adults due to which the implementation of telehealth services will be more effective (Haimi & Edelsburg, 2022). With the use of remote healthcare services, timely care consultation can be provided which helps in preventing health disparities and deteriorating conditions. This technology increases the efficiency of the staff in managing healthcare situations regularly with the proper guidance to the patients regarding any change in medications which will eventually result in advanced well-being of the patients and staff satisfaction.
Analysis of Care Coordination Efforts
The efforts of the care coordinators in ensuring high-quality health facilities for the patients serve a vital function for healthcare organizations (Martinez et al., 2019). The analysis defines the effectiveness of telehealth services and the consequences of traditional healthcare services. The analysis of efforts of coordinated care for diabetic older adults related to clinical priorities is given below.
Continuous Care Coordination
Telehealth services ensure the continuity of the care provided to older adults regarding their diabetes situation to prevent any kind of health disparities (Crossen et al., 2022). Regular monitoring of the health conditions of the patients and timely intervention of the healthcare providers validate that the patient would be safe and that any change in medications or the diabetes management plan can be communicated timely and frequently. This remote facility reduces delays which are very crucial in preventing damaging healthcare scenarios while the traditional healthcare intervention is more vulnerable to delays due to staff shortage or burnout.
Education and Involvement of Patients
Telehealth facility allows the patient to effectively monitor their help conditions from the comfort of their home through the proper education regarding the assessment and identification of their health signs and following effectively the healthcare management plans (Anderson et al., 2022). However, in the traditional method, self-management has no significance which results in a lack of knowledge in the patients regarding their diagnosis and treatment. This insufficient information results in poor health management and ineffective communication with the staff members.
Remote Monitoring and Sharing of Information
The efficiency of the treatment can be determined through the fact that how fast the response was provided to the patients concerning their deteriorating health condition (Brookes & Baker, 2021). More delays lead to severe health issues which can often result in great damage thus monitoring the deteriorating conditions remotely provides early intervention to ensure the safety and high-quality health of the patients. However, in traditional healthcare treatment, these delays are normal and often result in unmanageable health losses.
Collaboration of Interdisciplinary Teams
Interdisciplinary team collaboration serves as a fundamental purpose of improved patient experience and enhanced health outcomes (Davidson et al., 2022). Telehealth services through remote connection allow all the members from different disciplines to collectively analyze the patient situation and provide solutions based on their mutual expertise which will eventually produce positive clinical results and optimized patient health status. In traditional diagnosis, this collaboration can not be possible due to the unavailability of the healthcare professional or lack of support.
Change in Practice Related to Services and Resources
The implementation of telehealth services to effectively monitor the health conditions of older adults having diabetes type 2 acts as a key factor in improving patient experience and increasing treatment success (Lee et al., 2019). Telehealth services ensure the health of the population by providing timely solutions to health issues along with a continuous assessment of the health needs of the patient.
Most of the health damages occur due to the delay in the treatment process whereas through remote monitoring these delays can be prevented at a large scale and more advanced tools and technologies can be integrated to secure patients and guarantee high-quality health and care (Haleem et al., 2021). These telehealth services not only provide timely solutions to the patient’s health problems but also give guidance and consultation on effective monitoring of the patient’s health conditions and education regarding a better understanding of the care management plans.
Key Care Coordination Efforts
Care coordination competency helps in implementing advanced information healthcare technologies like telehealth services and electronic health records effectively (Bulto, 2024). The collaboration of interprofessional teams provides a deep insight into the importance of the use of telehealth services for diabetes older adults through mutual experience, opinion sharing, and implementing expertise in decision-making. A few key care coordination efforts are given below;
- Telehealth services improve the coordination between interdisciplinary teams through enhanced communication between the team members and actual data sharing that will help them access the information timely and suggest proficient changes in the plans of the healthcare.
- The remote monitoring of the health situation of the patients allows the interdisciplinary care coordination team to provide early help to the patient along with generating alerts for harmful events informing them efficiently about deteriorating conditions (Thomas et al., 2021).
- The telehealth services allow the team to educate and guide the patients about self-management through proper management plans, physical activities, and counseling sessions.
- The integration of telehealth in patient care enhances the access to health for older people who are unable to visit hospitals regularly.
- Changes in medication are effective and regular through the integration of telehealth into the patient’s treatment.
Stakeholder Engagement within the Interprofessional Team
Stakeholders’ involvement in the interprofessional care coordination team is necessary to ensure the effectiveness of the new technologies that are implemented in the healthcare setting for better patient outcomes and to reduce the rate of hospital readmissions (Williams et al., 2020). The collaboration of an interprofessional team can only be effective if it involves all the people important for the efficient decision-making process.
The implementation of telehealth services in inpatient treatment is an advanced change that can be integrated into the team members along with the engagement of stakeholders through proper planning and evaluation (Ye et al., 2023). Telehealth services allow timely intervention, remote monitoring, and effective patient outcomes through its advanced technology thus benefiting the healthcare organizations and the team members. A few strategies to lead the change in practice are given below;
Effective Planning of Change
Any change can be effectively integrated into the healthcare setting if it is well planned with the proper identification of the health needs of the patient and the efficiency of the change in improving patient health records.
Involvement of Stakeholders
Stakeholder involvement and engagement of the interdisciplinary team members in planning and the decision-making process is one of the key factors in ensuring the effectiveness of the change (Williams et al., 2020).
Change Implementation
With careful consideration of the team members and the proper analysis of the demands of the population a change will be implemented in the healthcare setting which then be improved by the support of the staff.
Change Evaluation
The effectiveness of the change can be evaluated through patient feedback and the efficiency of team members in handling the change for better patient outcomes and improved clinical results.
Efforts to Engage Stakeholders
Stakeholders as the major part of the implementation and evaluation of the change should be engaged in each step of change in practice. A few efforts to involve stakeholders oath the interdisciplinary teams are as follows;
Well Organized Meetings and Updates
Effective and proper team meetings should be conducted to gather all the team members and stakeholders under one platform for shared opinions and effective strategies regarding telehealth in practice.
Mutual Decision Making
The decision-making process will only be sustainable if the stakeholders are actively involved in the interdisciplinary team meeting regarding the improvement of telehealth in the health practice to produce an enhanced patient experience.
Comprehensive Responsibilities
The responsibilities should be shared and aligned with the common goal of effectively implementing telehealth in the healthcare practice and enhancing the well-being and satisfaction of the patients and staff members.
Transparency in Information Sharing
The information shared regarding the change with all the team members and stakeholders should be accurate and transparent to prevent any ambiguity in the process of making decisions and the integration of telehealth in practice.
Recommendation for Thoughtful Resource Utilization
The integration of telehealth services within healthcare facilities should be effective for the patient’s health and safety along with the improved utilization of the resources (Anawade et al., 2024). A few recommendations for thoughtful resource utilization are as follows;
- Continuous assessment of the telehealth services can provide a review regarding the effectiveness of this technology in improving patient health.
- Excessive staff training to better implement telehealth services and provide proficient access to patients will optimize the use of resources.
- Integration of safety standards and advanced security technologies like data encrypting can ensure the sustainability of telehealth services.
- Use key performance indicators (KPIs) to ensure continuous improvement plans and sustain outcomes.
- Evaluate the financial influence of telehealth services on the cost of implementation to expand and improve its implications on the resources of the healthcare organization.
NURS FPX 6614 Assessment 3 Conclusion
Care coordination is needed to ensure enhanced patient outcomes along with cost reduction in clinical services for the betterment of healthcare organizations (Albertson et al., 2021). The integration of telehealth services in the treatment process of older adults suffering from diabetes results in effective monitoring of their deteriorating health conditions along with timely intervention of the healthcare providers. The involvement of the interdisciplinary teams and the stakeholders in planning the implementation of telehealth services is of great importance as it will ensure the effectiveness of the technology-based change introduced in the facility (Davidson et al., 2022). Proper assessment and security measures can be applied to ensure the continuous improvement of telehealth services.
NURS FPX 6614 Assessment 3 References
Albertson, E. M., Chuang, E., Masta, B., Lye, I., Haley, L. A., & Pourat, N. (2021). Systematic review of care coordination interventions linking health and social services for high-utilizing patient populations. Population Health Management, 25(1), 73–85. https://doi.org/10.1089/pop.2021.0057
Anawade, P. A., Sharma, D., & Gahane, S. (2024). A comprehensive review on exploring the impact of telemedicine on healthcare accessibility. Cureus, 16(3). https://doi.org/10.7759/cureus.55996
Anderson, A., Connell, S. S., Thomas, C., & Chimmanamada, R. (2022). Telehealth interventions to improve diabetes management among black and hispanic patients: A systematic review and meta-analysis. Journal of Racial and Ethnic Health Disparities, 9(6). https://doi.org/10.1007/s40615-021-01174-6
Brookes, G., & Baker, P. (2021). Patient feedback and duration of treatment: A corpus-based analysis of written comments on cancer care in england. Applied Corpus Linguistics, 1(3), 100010. https://doi.org/10.1016/j.acorp.2021.100010
Bulto, L. N. (2024). The role of nurse‐led telehealth interventions in bridging healthcare gaps and expanding access. Nursing Open, 11(1). https://doi.org/10.1002/nop2.2092
Crossen, S. S., Bruggeman, B. S., Haller, M. J., & Raymond, J. K. (2022). Challenges and opportunities in using telehealth for diabetes care. Diabetes Spectrum, 35(1), 33–42. https://doi.org/10.2337/dsi21-0018
Davidson, A. R., Kelly, J., Ball, L., Morgan, M., & Reidlinger, D. P. (2022). What do patients experience? Interprofessional collaborative practice for chronic conditions in primary care: An integrative review. BMC Primary Care, 23(1). https://doi.org/10.1186/s12875-021-01595-6
Haimi, M., & Edelsburg, A. (2022). Application and implementation of telehealth services designed for the elderly population during the COVID-19 pandemic: A systematic review. Health Informatics Journal, 28(1), 146045822210755. https://doi.org/10.1177/14604582221075561
Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, 2(2). https://doi.org/10.1016/j.sintl.2021.100117
Lee, J. Y., Chan, C. K., Chua, S. S., Paraidathathu, T., Lee, K. K., Tan, C. S., Nasir, N., & Lee, S. W. (2019). Using telemedicine to support care for people with type 2 diabetes mellitus: A qualitative analysis of patients’ perspectives. BMJ Open, 9(10). https://doi.org/10.1136/bmjopen-2018-026575
Martinez, Z., Koker, E., Truchil, A., & Balasubramanian, H. (2019). Time and effort in care coordination for patients with complex health and social needs: Lessons from a community-based intervention. Journal of Interprofessional Education & Practice, 15, 142–148. https://doi.org/10.1016/j.xjep.2019.03.002
Northwood, M., Shah, A. Q., Abeygunawardena, C., Garnett, A., & Schumacher, C. (2022). Care coordination of older adults with diabetes: A scoping review. Canadian Journal of Diabetes, 47(3). https://doi.org/10.1016/j.jcjd.2022.11.004
Thomas, E. E., Taylor, M. L., Banbury, A., Snoswell, C. L., Haydon, H. M., Rejas, V. M., Smith, A. C., & Caffery, L. J. (2021). Factors influencing the effectiveness of remote patient monitoring interventions: A realist review. BMJ Open, 11(8). https://doi.org/10.1136/bmjopen-2021-051844
Weinstock, R. S., Aleppo, G., Bailey, T. S., Bergenstal, R. M., Fisher, W. A., Greenwood, D. A., & Young, L. A. (2020). The role of blood glucose monitoring in diabetes management. American Diabetes Association. https://www.ncbi.nlm.nih.gov/books/NBK566165/
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Ye, J., He, L., & Beestrum, M. (2023). Implications for implementation and adoption of telehealth in developing countries: A systematic review of China’s practices and experiences. Npj Digital Medicine, 6(1), 1–14. https://doi.org/10.1038/s41746-023-00908-6