Phillip October 6, 2023 No Comments

NURS FPX 6612 Assessment 3 Patient Discharge Care Planning

-NURS FPX 6612 Assessment 3 Patient Discharge Care Planning Student Name Capella University NURS-FPX 6612 Health Care Models Used in Care Coordination Prof. Name Date Patient Discharge Care Planning This assessment focuses on the discharge care planning for Marta Rodriguez, who was recently admitted to the hospital following a severe accident while on her way to college. After a four-week stay in the trauma center, undergoing multiple surgeries, and receiving antibiotic treatment, Marta’s care coordination is essential. In my capacity as the senior care coordinator, I will present Marta’s case during an upcoming interdisciplinary team meeting to discuss her discharge plans. Longitudinal, Patient-Centered Care Plan To ensure Marta Rodriguez receives comprehensive, patient-centered care, the interdisciplinary team will employ Health Information Technology (HIT) components to enhance communication and coordination across her care journey. These HIT elements encompass electronic health records (EHRs), secure messaging platforms, telehealth technology, and medication reconciliation tools. EHRs will facilitate real-time access and updates to Marta’s medical records, enabling the development of a comprehensive care plan (Schwab et al., 2021). Secure messaging platforms will streamline communication among team members, particularly regarding changes in Marta’s condition, appointments, and medication schedules (Flickinger et al., 2022). Telehealth technology will enable remote monitoring of Marta’s vital signs, enabling early intervention (Chowdhury et al., 2020). Additionally, medication reconciliation tools will ensure the accuracy of her medication list, thereby reducing medication errors. NURS FPX 6612 Assessment 3 Patient Discharge Care Planning To prevent Marta’s readmission within 48 hours after discharge, the inter-professional team must ensure Marta receives adequate education, support, and follow-up care (Oksholm et al., 2023). The utilization of HIT elements can bolster these efforts. For instance, telehealth technology can monitor Marta’s post-discharge progress, offer virtual support, and identify potential issues that might lead to readmission. Furthermore, secure messaging platforms can provide Marta with timely and accurate information regarding her medication and follow-up appointments. Meanwhile, the incorporation of these HIT elements will promote care coordination for Marta by fostering communication and collaboration among team members. Access to uniform information about Marta will enable the development of a comprehensive care plan. Furthermore, EHRs will permit team members to track Marta’s progress, ensuring that she receives appropriate care throughout her recovery. By harnessing HIT elements, the inter-professional team can deliver a patient-centered, coordinated, and effective care plan tailored to Marta’s unique needs. Data Reporting Data reporting holds immense significance in the healthcare industry, shaping care coordination, administration, clinical efficiency, and interdisciplinary innovation in treatment. In Marta Rodriguez’s case, data reporting pertaining to her behaviors can enhance the quality of her care and support her recovery in three key ways: Care Coordination: Data reporting can facilitate care coordination among inter-professional team members by providing a shared understanding of Marta’s condition and progress (Brooks et al., 2020). For instance, data on Marta’s medication adherence, vital signs, and symptoms can be reported through EHRs or secure messaging platforms, enabling effective collaboration in her care management and reducing the risk of complications or readmissions. Care Management: Data reporting can shape care management by identifying areas where Marta may require additional support or interventions. Information on her pain levels, mobility, and nutritional status, for example, can be reported to the team, allowing them to adjust her care plan as needed to improve its quality and enhance her recovery. Inter-professional Innovation: Data reporting can drive innovation in inter-professional care by providing insights into Marta’s behaviors and preferences. Data regarding her language preferences or cultural background can be shared with the team, enabling them to tailor their care to her specific needs, thereby promoting patient-centered care and better outcomes. To ensure data quality, the team should implement data validation protocols, conduct regular audits, and provide training on data entry and reporting best practices. Additionally, the data must be relevant to Marta’s care goals and aligned with evidence-based practices, allowing the team to make informed decisions and provide her with the best possible care. Client’s Record Influencing Health Outcomes Patient records play a pivotal role in improving health outcomes. Marta Rodriguez’s case demonstrates how interprofessional teams can leverage Health Information Technology (HIT) to collect, analyze, and share information from client records, ultimately enhancing patient care and outcomes. This discussion explores how data obtained from patient records can positively influence health outcomes and how interprofessional teams can coordinate their efforts using HIT. HIT enables interprofessional teams to gather and analyze data from client records, offering insights into trends, patterns, and care gaps (Leslie & Paradis, 2018). For instance, Marta’s records can provide valuable information about her medical history, medication regimen, and health status, facilitating the development of a comprehensive care plan tailored to her unique needs. HIT can also help identify potential risks, such as adverse drug reactions or postoperative complications, enabling prompt intervention to prevent negative health outcomes. Moreover, HIT enhances care coordination among interprofessional team members. By sharing information from client records, team members can collaborate more effectively in managing patient care. Tools like EHRs and secure messaging platforms enable real-time communication, ensuring that all team members are up-to-date with the latest patient information. This reduces the risk of miscommunication and errors, ultimately leading to improved health outcomes for the patient. NURS FPX 6612 Assessment 3 Patient Discharge Care Planning Effective coordination of findings among interprofessional team members requires clear communication, a shared care plan, and a willingness to collaborate towards common goals (Rawlinson et al., 2021). HIT tools provide a centralized platform for accessing and sharing information, ensuring that all team members have a comprehensive understanding of the patient’s care needs. This collaborative approach enables the provision of holistic care that addresses all aspects of the patient’s health, resulting in better health outcomes. Positive health outcomes can be influenced by the use of HIT to collect, analyze, and distribute data from patient records. Interprofessional teams can utilize HIT tools to coordinate their efforts, ensuring access to the latest patient information. Through effective collaboration and the proficient use of HIT tools, these teams can provide patient-centered care that comprehensively addresses all

Phillip October 6, 2023 No Comments

NURS FPX 6612 Assessment 2 Quality Improvement Proposal

NURS FPX 6612 Assessment 2 Quality Improvement Proposal Student Name Capella University NURS-FPX 6612 Health Care Models Used in Care Coordination Prof. Name Date Quality Improvement Proposal In pursuit of the goal to deliver high-quality healthcare while enhancing patient safety, healthcare organizations should strive to qualify as Accountable Care Organizations (ACOs). Such a designation instills greater confidence in patients as they manage their health needs, all while reducing hospital costs and providing superior healthcare solutions. Evidence-based approaches, such as care plans, have proven effective in improving patient outcomes while reducing expenses. ACOs are ideally positioned to leverage care plans in managing the complex healthcare requirements of patients (Fraze et al., 2020). ACOs have demonstrated success in delivering quality healthcare to patients with depression and have effectively reduced preventable hospitalizations. A comparison between ACO and non-ACO hospitals reveals significantly lower rates of preventable hospitalizations in ACO-affiliated healthcare settings (Barath et al., 2020). NURS FPX 6612 Assessment 2 Quality Improvement Proposal The establishment of coordinated medical care for the broader community and population has led to improved quality and safety outcomes for patients within ACOs. Accountable Care Organizations are specifically designed to address the cost and quality of healthcare services provided to patients. In ACO healthcare settings, all stakeholders share responsibility for delivering affordable care while minimizing waste (Moy et al., 2020). This assessment recommends expanding an organization’s Health Information Technology (HIT) to incorporate quality metrics. It delineates the primary focus of information gathering and how it contributes to guiding organizational practice. Additionally, it identifies potential challenges that may arise within data-gathering systems. Recommendations for Expanding HIT Health Information Technology (HIT) is essential for delivering high-quality, cost-effective healthcare. HIT enhances access to data, streamlines information retrieval, and provides healthcare practitioners and caregivers with comprehensive insights into patients’ complex health needs through data analytics. Each patient’s health records are meticulously managed via a unique Medical Registration Number (MRN). Electronic folders, containing detailed examinations and prescribed medications, are accessible to all healthcare staff, including doctors, paramedics, and nurses, enabling better healthcare planning and improved patient outcomes at reduced hospitalization costs. To ensure that healthcare organizations meet the healthcare needs of their patients, HIT should be expanded comprehensively across all facets of healthcare settings. A user-friendly and accessible system should be designed to facilitate timely patient care. Patients can access their health charts and detailed examinations via mobile applications, while healthcare staff can access patient portfolios through hospital site computers, with remote access available via hospital databases. For instance, consider a case like that of Caroline McGlade, a 61-year-old woman whose Electronic Health Record (EHR) contains information about her medical history, laboratory examinations, and a potential breast cancer diagnosis. Health information technologies play a pivotal role in effectively managing and providing nursing care, ultimately contributing to the desired quality improvement in patient outcomes (Alaei et al., 2019). Focus on Information Gathering and Guiding Organizational Development The primary objective of information gathering is to deliver high-quality healthcare to patients at reduced costs while addressing complex healthcare needs. Data collection, informatics, and analytics enable caregivers to plan more effectively, eliminating redundancies in hospital databases. Organizations have evolved through the progressive implementation of database-driven changes. A robust and dedicated health system now serves every individual, resulting in significantly improved patient outcomes and employee efficiency. Healthcare staff have gained greater control over their achievements and performance, with access to performance charts and projected growth. Employees can provide feedback on their job satisfaction levels and make inquiries during work hours. While monitoring and managing healthcare databases present challenges, their effectiveness is crucial for organizational development within ACO hospitals. Artificial Intelligence and advanced information and communication technologies hold the potential to provide better solutions for healthcare, particularly in nursing informatics (Robert, 2019). Problems with Data Gathering Systems Data gathering is a complex task, and its management and handling are equally demanding. The problems associated with data gathering systems can be addressed through a three-step process: data gathering, preprocessing of relevant data, and data analysis. Firstly, healthcare staff must receive comprehensive training in using digital health databases to prevent complications in patient data collection and management. The information required should be explicitly defined, and healthcare staff should be well-versed in essential healthcare tools. Adequate training and guidance should be provided to healthcare staff. NURS FPX 6612 Assessment 2 Quality Improvement Proposal Ensuring data security and controlled access is vital to safeguard patients’ sensitive data. Stringent information security protocols must be implemented to prevent any unauthorized access or breaches of patient data. Efforts should be made to establish a secure data protection system with strong management support. Dedicated resources should be allocated to data security, ensuring that sensitive patient information is accessible only to authorized healthcare staff. The challenge of handling and storing continuously expanding data can be addressed through the implementation of cloud-based data storage strategies. It is imperative for healthcare organizations to acknowledge and address the stress and burnout experienced by physicians and other healthcare staff in their daily use of health information technologies (HIT) (Gardner et al., 2018). Conclusion In summary, the central role of health information technology (HIT) in the development of Accountable Care Organizations cannot be overstated. HIT implementation is essential for leveraging new and innovative information and communication technologies effectively. Coordinated data gathering, supported by unique MRNs for individual patients, addresses complex health needs. Challenges in data gathering systems can be resolved through formal training, enhanced data security, and effective data storage solutions. By overcoming these challenges, healthcare organizations can deliver high-quality healthcare at reduced costs. References Alaei, S., Valinejadi, A., Deimazar, G., Zarein, S., Abbasy, Z., & Alirezaei, F. (2019). Use of health information technology in patients care management: A mixed methods study in Iran. Acta Informatica Medica, 27(5), 311. https://doi.org/10.5455/aim.2019.27.311-317 Barath, D., Amaize, A., & Chen, J. (2020). Accountable care organizations and preventable hospitalizations among patients with depression. American Journal of Preventive Medicine, 59(1), e1–e10. https://doi.org/10.1016/j.amepre.2020.01.028 Fraze, T. K., Beidler, L. B., Briggs, A. D. M., & Colla, C. H. (2020). Translating evidence into

Phillip October 6, 2023 No Comments

NURS FPX 6612 Assessment 1 Triple Aim Outcome Measures

NURS FPX 6612 Assessment 1 Triple Aim Outcome Measures Student Name Capella University NURS-FPX 6612 Health Care Models Used in Care Coordination Prof. Name Date Triple Aim Outcome Measures Introduction My name is Albert S. Smith, and I will be assuming the role of a case manager at Sacred Heart, a rural hospital, for this presentation. The purpose of this presentation is to guide hospital members on achieving care coordination through the Triple Aim process. Purpose The aim of this presentation is to enlighten the leadership of Sacred Heart Hospital regarding the care coordination process and align their practices with the Triple Aim objectives for the rural population. Additionally, this presentation seeks to enhance understanding of supporting models for Triple Aim and facilitate a comparative analysis. Two models have been chosen for this presentation: the Patient-Centered Medical Home (PCMH) and Transitional Care. Triple Aim The Triple Aim concept comprises objectives focused on enhancing healthcare quality services. These objectives encompass a better patient experience, healthier populations, and lower healthcare costs. Efficient care coordination plays a pivotal role in achieving these objectives. The following sections will elaborate on how the Triple Aim contributes to community health, enhances patient care experience, and reduces healthcare costs. Patient Experience of Care One of the primary objectives of the Triple Aim is to enhance the patient experience, achievable through various means such as reducing waiting times, improving communication, and involving patients in treatment plans. Patient satisfaction is vital as it impacts patient adherence to treatment, engagement in care, and overall health outcomes. Improving patient experience leads to better health outcomes, as patients are more likely to comply with treatment plans, attend follow-up appointments, and report any issues. Enhancing Community or Population Health The Triple Aim seeks to improve community health by recognizing and addressing their health needs. Healthcare providers must assess population data and formulate plans to enhance health outcomes. Care coordination is critical in this process, as care coordinators can identify high-risk patients and ensure they receive appropriate care. Furthermore, collaboration with community partners to address social determinants of health and execute preventive measures like immunization and health screenings is essential. Reducing Per Capita Costs The Triple Aim aims to reduce per capita healthcare costs by enhancing care quality and minimizing waste. Efficient care coordination can contribute to cost savings by reducing hospital stays, unnecessary procedures and tests, and preventing readmissions. Moreover, healthcare providers can reduce chronic disease management costs by collaborating with community partners and addressing social determinants of health. Population health management programs that promote preventive care can also decrease healthcare costs by addressing health issues before they become severe and costly to treat. In conclusion, achieving Triple Aim objectives necessitates healthcare providers to enhance patient experience, community health, and minimize healthcare costs. Effective care coordination plays a critical role in achieving these goals, helping to identify high-risk patients, minimize waste, and promote preventive care. Moreover, by assessing population data, working with community partners, and implementing evidence-based strategies, healthcare providers can achieve Triple Aim objectives and enhance patient care quality. Analyzing the Relationship Between Health Models and Triple Aim The Patient-Centered Medical Home (PCMH) and Transitional Care models have gained prominence due to their potential to improve patient outcomes and align with the Triple Aim objectives, including enhancing patient experience, improving population health, and reducing healthcare costs. The PCMH model emphasizes comprehensive, coordinated, and patient-centered care that is accessible, continuous, and team-based. It empowers patients to become active partners in their own care, while enhancing care coordination among healthcare providers. The model has evolved to incorporate technology, patient engagement tools, and quality metrics, thereby improving patient outcomes and reducing healthcare costs (Kaufman et al., 2018). On the other hand, Transitional Care is designed to support patients during transitions of care, such as from hospital to home or from one healthcare provider to another (Shahsavari et al., 2019). Furthermore, the model employs a team-based approach that includes a care coordinator working with the patient and their family to ensure a smooth transition and follow-up care. Technology like telehealth is integrated to enhance communication and improve care coordination. NURS FPX 6612 Assessment 1 Triple Aim Outcome Measures These healthcare models enhance healthcare quality in several ways. For example, the PCMH model has reduced hospital readmissions and emergency department visits, and improved chronic disease management (Ruediger et al., 2019). Additionally, it has enhanced patient and provider satisfaction (Ruediger et al., 2019). Similarly, Transitional Care has been found to reduce hospital readmissions, improve patient outcomes, reduce medication errors, enhance patient satisfaction, and reduce healthcare costs (Fønss Rasmussen et al., 2021). In summary, the PCMH and Transitional Care models possess the potential to improve patient outcomes, enhance care coordination, and reduce healthcare costs. Moreover, they align with the Triple Aim by focusing on patient-centered care and improving population health. As healthcare evolves, these models are likely to be refined and adapted to meet the changing needs of patients and providers. Structure of Healthcare Models The Patient-Centered Medical Home (PCMH) and Transitional Care models are designed to enhance the quality of care provided to patients while ensuring better health outcomes (McNabney et al., 2022). These models employ various strategies to gather and evaluate evidence-based data, aiding healthcare providers in making informed decisions to improve patient care quality. The PCMH model emphasizes a team-based approach to healthcare, focusing on providing comprehensive and coordinated care to patients. This model heavily relies on electronic health records (EHRs) to gather and evaluate evidence-based data (McNabney et al., 2022). EHRs allow healthcare providers to access patient data in real time, enabling more informed decisions regarding patient care (M. & Chacko, 2021). Furthermore, the PCMH model emphasizes the use of evidence-based guidelines to ensure patients receive the most appropriate care, based on the latest research and clinical evidence. NURS FPX 6612 Assessment 1 Triple Aim Outcome Measures On the other hand, the Transitional Care model is designed to provide continuity of care for patients transitioning from one healthcare setting to another. It emphasizes using

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