Ethical and Policy Factors in Care Coordination
Introduction:
Hello, I am Susie Tylor and today my topic of presentation is ethical and policy aspects in care coordination which affect care coordination.
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Care coordination is a key need of healthcare institutes. Agency of Healthcare Research and Quality (AHRQ) defines care coordination as a systematic process in which there is information sharing with interprofessional team members to handle patient care activities with the help of coordinated choice-making (Karam et al., 2021). The objectives of care coordination are provision of elite quality patient care facilities and strong communication among healthcare workers while aiming at patient’s requirements (Dinsdale et al., 2019). To prevent ethical issues and adverse outcomes, nurses should comply with professional ethical codes and healthcare regulations in a hospital setting. My targeted community to explain ethical and policy problems is nursing homes that can face different problems during provision of care coordination.
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Governmental Policies Related to the Health and Safety of a Community
In the US, there are different government-level policy frameworks assisting people for economical healthcare insurance options and facilities. These policy frameworks are for people’s well-being and betterment which provide equal safe and high-quality healthcare services to all community members without any discrepancy. Though there are many notable policies in the United States for provision of affordable healthcare services, the Affordable Care Act (ACA) is highly reputed (Ercia, 2021). To guarantee high-quality and safe health services in nursing homes, the Nursing Home Transparency and Improvement Act is important as the targeted community is nursing homes (Harrington et al., 2019). For protecting patient’s healthcare information, HIPAA (Health Insurance Portability and Accountability Act) is important (Chinmoy et al., 2020).
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Clear Instances of Particular Policies Affecting Care Coordination
Most extensive healthcare policy framework is the ACA which has three key objectives. The first objective is to guarantee economical healthcare insurance options, the second is to increase accessibility of people from lower income class to health services and the third is to encourage such patient care services which decrease the healthcare expenditure (Sturmberg & Bircher, 2019). ACA impacts the healthcare standard at different levels i.e., improving quality of healthcare services by provision of economical healthcare insurance options to people from lower income class. It also works for the community’s health and well-being by different illness prevention plans.
People in nursing homes are suffering from chronic illnesses i.e., high blood pressure, Chronic Obstructive Pulmonary Disease (COPD), pneumonia and cardiovascular problems. People suffering from chronic and pre-existing diseases can have elite-quality healthcare facilities under the Affordable Care Act (ACA). People in nursing homes can get intervention assistance from expert and able healthcare providers working there. ACA has an impact on care coordination as healthcare facilities are expensive for people and there are unaffordable insurance choices, resultantly people decide to ignore their health state. ACA is also assisting to manage the disease rate. Effective healthcare screening ensures timely medical interventions for patients in nursing homes which reduce the death and disease rate.
ACA has also introduced Hospital Readmission Reduction Program (HRRP) to discipline healthcare organizations such as nursing homes for increased hospitalization rates (Pugh et al., 2021). HRRP motivates healthcare institutes to strengthen their communication and care coordination. This has improved patient and healthcare providers involvement in hospital discharge which is eventually controlling the hospitalization rates (Ayabakan et al., 2021). HRRP enhanced the American Healthcare System as it encouraged healthcare organizations to enhance care coordination activities by involving patients in post-discharge design (Centers for Medicare and Medicaid Services, 2022).
Provision of elite-quality healthcare facilities to all and strong communication with healthcare workers is a major challenge at nursing homes. Changes in the transparency of patient healthcare information is brought about by the Nursing Home Transparency and Improvement Act which directly impacts the care coordination (National Academies of Sciences et al., 2022). This policy framework guarantees the healthcare providers’ accountability for patient care and healthcare facilities in nursing homes. Patients can inquire about the healthcare services standard offered in nursing homes. Ethical frameworks are also implemented under this policy framework to assess civil, administrative violations, performance and quality enhancement designs in nursing homes (Yew, 2020).
HIPAA regulations were formulated and passed by the US federal government in 1996 to ensure confidentiality and privacy for patient’s healthcare information (Moore & Frye, 2019). It forbids any act of sharing a patient’s information without consent (Cramer, 2023). HIPAA policy framework has been introduced for avoiding mishandling and breach of medical data. Under HIPAA, all the patient’s health information is kept secured and transferred safely among healthcare workers during care coordination. There are huge fines and penalties for breaching a patient’s data confidentiality (Anderson, 2019).
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National, State, and Local Policy Provisions that Raise Ethical Questions
Here’s the discussion about two state- and local-level policy frameworks which assisted the community but had many ethical concerns. ACA is the first policy framework and HRRP (Hospital Readmission and Reduction Program) is the second policy under discussion (Pugh et al., 2021).
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Ethical Dilemma for ACA, its Implication and Consequences
One of the reputable healthcare policy frameworks across the US is ACA which is providing economical healthcare services to many people (Cyr et al., 2019). For provision of affordable healthcare services to lower-income class and impoverished people, affordable insurance options are important (Habib & Zaidi, 2021). The ethical dilemmas of ACA are associated with healthcare expenditures. The target of ACA is to enhance healthcare quality, provision and reduce healthcare expenditures (Levine et al., 2022). ACA not only benefits insured people, but it is also beneficial for the uninsured people who are unable to bear the healthcare expenditures. In case of the unavailability of insurance options, people do not get appropriate treatment or get incomplete healthcare services (Sriram & Khan, 2020).
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Ethical Dilemma for HRRP, its Implication, and Consequences
Another measure to cater to the ethical problems is the government’s hospitalization reduction policy framework. HRRP is a strong framework which has assisted many healthcare providers including doctors and nurses for maintaining honest and trustworthy patient relationship (Warchol et al., 2019). The notable impacts of HRRP are reduced hospitalizations, decreased healthcare expenditures, improved patient’s contentedness and healthcare standards (Gai & Pachamanova, 2019). Though HRRP is beneficial, it has raised many ethical concerns such as misinterpretation and weak communication between healthcare workers and patients as the focus of healthcare providers’ shift from high-quality care provision to reduction of hospitalization. It gives rise to wrong disease identification and administrative faults regarding hospitalizations.
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Effect of the Nursing Code of Ethics on Coordination and Continuum of Care
In nursing practice, it is important to follow ethical codes while providing healthcare services with honesty and deliberation. The American Nurse Association is a government body that is responsible for compliance of nursing ethical codes. ANA has highlighted that nursing ethical codes are highly important to forge the nurses’ conduct and enhance their productivity in patient care provision (Hadian Jazi et al., 2019). A nurse should strictly comply with ethical values of justice, kindness, self-determination and assistance for healthcare unity, avoiding patient’s harm, patient-centric decision making and prevention of adverse outcomes respectively (Alnajjar, PhD & Abou Hashish, PhD, 2021).
Patient’s self-determination and autonomy in healthcare decision-making is extremely important which enables them to choose their care plan. For instance, a patient has full authority to select the healthcare treatment in accordance with his individual choice and autonomy (Dutta et al., 2019). Nurse’s duty is to give all available choices and full rights to the patient for decision-making. Justice is a healthcare ethical value that guarantees equal treatment and intervention for all patients regardless of their color, caste, race, or ethnicity (Olejarczyk & Young, 2022).
By complying with these ethical principles, effective care coordination can be ensured. The patient is responsible for his healthcare thus there should be strong communication with him. An open and friendly conversation with patients can help care coordination by excluding misinterpretations about intervention options and related misunderstandings. Furthermore, a patient’s self-determination can improve communication and interpretation as patients are contributing in choosing the healthcare treatment (Arrieta Valero, 2019). When patients have realization about fair treatment, positive environment and healthy interaction with the healthcare workers; their confidence in healthcare service provision is enhanced (Søvold et al., 2021).
By adhering to this idea of ethical codes, nurses will be unbiased and have a just behavior with all individuals regardless of color, caste, creed or culture. It is the responsibility of a nurse to provide equal healthcare services to all patients irrespective of their gender, culture, age or religion. To prevent violation of kindness, healthcare providers will find a least harmful intervention for the patients. Confidence between healthcare workers and patients can be strengthened by benefaction in care coordination (Bradshaw et al., 2022).
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Social determinants of Health: Healthy People 2030
It is also important to focus on health’s social determinants such as income status of people, educational and social background and living environment (Office of Disease Prevention and Health Promotion, 2023). There is a direct correlation between people’s health and social determinants of health. For instance, when a person is living in substandard environment, it can provoke various illnesses particularly in people of lower income class (Rowley et al., 2021).
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Factors Continuing in Health Disparities
There are various factors causing health care discrepancies i.e., lack of education, inaccessibility, limited resources, income level, unhealthy environment and inaccessibility to elite-quality healthcare facilities (CDC, 2020).
Conclusion
Conclusively, elite quality patient care can be ensured by different governmental acts impacting care coordination. However, many ethical dilemmas can be raised by some state- and federal level policy regulations. The presentation explains that the Affordable Care Act (ACA) guarantees provision of affordable and comprehensive insurance options. Whereas, HRRP has reduced the hospitalization rates in nursing homes.
References
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FAQS
How do social determinants of health, such as access to healthcare, impact the quality of care provided to older adults in the context of care coordination?
Social determinants of health, particularly access to quality healthcare, play a vital role in influencing the quality of care provided to older adults within the framework of care coordination. The accessibility and availability of quality healthcare services are crucial factors that directly affect the level of care older adults receive. When healthcare providers are unable to offer value-based care efficiently, older adults may face challenges in accessing the necessary healthcare services they require. Inadequate access to quality healthcare can lead to a decrease in the quality of care provided to older adults, impacting their overall health outcomes and well-being. Therefore, addressing social determinants of health, such as ensuring equitable access to quality healthcare services, is essential for enhancing the quality of care and outcomes for older adults in the context of care coordination.
How does the shortage of mental health providers for the geriatric population present challenges in care coordination?
The shortage of mental health providers for the geriatric population poses significant challenges in coordinating care for older adults. With a projected increase in the number of elderly individuals experiencing mental health issues, the lack of specialized providers specifically trained to address the unique needs of this demographic creates barriers in ensuring comprehensive care. This shortage leads to inadequate access to mental health services, which in turn can result in poor outcomes such as nursing home placement, hospitalization, increased mortality rates, and higher healthcare costs.
Furthermore, the limited number of professionals specializing in geriatric mental health care can also impact care coordination by creating a disparity in the quality of services provided to older adults. The absence of incentives for healthcare providers to specialize in geriatric care, coupled with lower earning potentials in this field compared to other specialties, further exacerbates the shortage and makes it challenging to attract and retain professionals with expertise in this area. Consequently, nurses and other healthcare providers may struggle to advocate effectively for their older adult patients, as policies and systemic barriers hinder access to specialized care for this vulnerable population.
What is the definition of care coordination according to the Agency for Healthcare Research and Quality?
According to the Agency for Healthcare Research and Quality, care coordination is the intentional arrangement of patient care activities among multiple individuals involved in a patient’s healthcare, including the patient themselves. This process aims to promote the effective delivery of healthcare services by fostering collaboration and communication among all parties engaged in the patient’s care.
What societal goals and initiatives are related to care coordination and improving healthcare outcomes, as mentioned in the passage?
The passage discusses various societal goals and initiatives related to care coordination and improving healthcare outcomes. Specifically, it highlights the Affordable Care Act (ACA), signed into law to ensure greater access to care, enhance care quality, and reduce healthcare spending for all Americans. Additionally, it mentions the Centers for Disease Control (CDC) Healthy People 2020 initiative’s goals, which include achieving high-quality, longer lives, health equity, eliminating disparities, creating healthy environments, and promoting healthy behaviors across all life stages. These initiatives emphasize the importance of improving healthcare outcomes through coordinated care efforts and addressing societal health challenges comprehensively.
How does the American Nurses Association (ANA) Code of Ethics guide nurses in ethical decision-making and practice in care coordination?
The American Nurses Association (ANA) Code of Ethics provides a comprehensive framework with nine provisions to guide nurses in ethical decision-making and practice in care coordination. These provisions encompass the nurse’s commitment to respecting the patient’s dignity, rights, and safety, as well as acknowledging the nurse’s obligation to ensure optimal care for each patient. Additionally, the Code of Ethics emphasizes the importance of ongoing professional growth and competency maintenance for nurses, encouraging them to utilize research to enhance their practice.
In the context of care coordination, the ANA Code of Ethics requires nurses to develop tailored care plans that align with the individual needs and preferences of each patient. Nurses are expected to coordinate care effectively to maximize positive outcomes for patients, staying informed about emerging evidence, healthcare resources, and community services. Furthermore, the Code emphasizes the collaborative nature of healthcare and highlights the nurse’s responsibility to work with other health professionals to promote health, reduce disparities, and integrate social justice into health policy. By adhering to these ethical provisions, nurses can navigate the complexities of care coordination while upholding the highest standards of patient-centered care and promoting the overall well-being of individuals and communities.
What ethical principles do nurses need to adhere to when coordinating care for patients, especially the elderly population?
Nurses coordinating care for elderly patients, especially those with additional health needs, must uphold key ethical principles to ensure the well-being and fair treatment of these individuals. One crucial principle is justice, which necessitates providing patients with impartial care regardless of factors such as insurance status, financial resources, age, gender identification, or ethnicity. In the context of elderly care coordination, justice implies that nursing decisions should prioritize fairness and equal access to necessary services.
Another vital ethical principle is beneficence, which involves acting in the best interests of the patients. With a projected significant increase in the elderly population over the next decade, there is a growing need for specialized care services for this demographic. However, there are challenges in meeting this demand, including inadequate mental health providers for the elderly. Nurses have a responsibility to advocate for what is best for their elderly patients, promoting specialized care and addressing barriers that hinder access to appropriate services.
Overall, nurses working with elderly patients in care coordination should adhere to the ethical principles of justice and beneficence, ensuring fair treatment, advocating for specialized care when needed, and striving to promote the well-being and best interests of the aging population.
What is the background and scope of services provided by HopeHealth?
HopeHealth, initially established in 1991 as a support organization for HIV/AIDS, later evolved into a Federally Qualified Health Center in 2004. With a team of 100 providers, HopeHealth delivers a wide range of services across five counties in South Carolina. These services extend beyond HIV care to include primary care, pediatric care, pain management, behavioral health/psychiatry, geriatrics, dentistry, substance use treatment, women’s health, chiropractic, endocrinology, and rheumatology. Notably, HopeHealth serves patients irrespective of their insurance status and offers a sliding scale fee plan to make healthcare accessible to all.
How does the American Nurses Association (ANA) define care coordination and its significance for registered nurses?
The American Nurses Association (ANA) defines care coordination as a fundamental competency and core standard that registered nurses are trained and equipped for. According to the ANA, care coordination involves nurses effectively managing patient care in alignment with the preferences and needs of both the patient and their family members. This coordination role that nurses play is seen as crucial in ensuring that patients receive quality care, are satisfied with their healthcare experience, and that healthcare resources are utilized effectively and efficiently.
What are the goals outlined in the CDC Healthy People 2020 initiative in relation to promoting health equity and access to healthcare?
The CDC Healthy People 2020 initiative highlights several key goals aimed at promoting health equity and improving access to healthcare. These objectives include achieving high-quality, longer lives that are free of preventable diseases, disabilities, injuries, and premature deaths. The initiative also seeks to address health disparities by striving to achieve health equity and enhance the well-being of all populations. Furthermore, it focuses on creating social and physical environments that support good health for everyone, as well as promoting healthy behaviors and quality of life across all stages of life.
How does the American Nurses Association (ANA) Code of Ethics guide nurses in ethical decision-making related to care coordination?
The American Nurses Association (ANA) Code of Ethics provides a comprehensive framework to assist nurses in making ethical decisions regarding care coordination. The code consists of nine provisions, each addressing different aspects of ethical nursing practice.
The first three provisions emphasize the nurse’s commitment to respecting the patient’s dignity, rights, and safety. This sets the foundation for care coordination by emphasizing the importance of tailoring care plans to meet each patient’s unique needs and preferences. Nurses are encouraged to consider the individuality of each patient and to ensure that their care is coordinated and personalized accordingly.
Provision four highlights the nurse’s responsibility to provide optimal care for patients. Care coordination involves not only providing necessary treatments but also ensuring that these treatments are well-organized and cohesive to enhance patient outcomes. This provision reminds nurses to coordinate care effectively to promote the best possible results for their patients.
Provisions five and seven underscore the importance of maintaining competency and engaging in continuous professional growth. To effectively coordinate care, nurses must stay updated on the latest evidence-based practices, healthcare resources, and community services. They are encouraged to utilize research to advance their knowledge and skills, enabling them to provide more effective care coordination.
Provisions eight and nine emphasize the significance of collaboration with other healthcare professionals to promote health, reduce disparities, and integrate social justice into health policy. Care coordination often involves working closely with a multidisciplinary team to address various aspects of patient care. Nurses are encouraged to engage in collaborative efforts to ensure that patients receive comprehensive and well-rounded care that considers all relevant factors.
Overall, the ANA Code of Ethics guides nurses in ethical decision-making related to care coordination by emphasizing the importance of patient-centered care, competency, collaboration, and advocacy for promoting the best interests of patients in the healthcare setting.
What organization is discussed in relation to providing primary and specialty services regardless of insurance status?
The organization mentioned in the passage provides primary and specialty services to patients without considering their insurance status. This organization is HopeHealth, which offers a sliding scale fee plan to ensure that individuals can access these services regardless of their insurance coverage.
How does the American Nurses Association (ANA) define care coordination as a competency for registered nurses?
The American Nurses Association (ANA) defines care coordination as a crucial competency and core standard that registered nurses must possess through education and qualifications. Registered nurses are educated and trained to coordinate care based on the preferences and needs of patients and their families. In doing so, nurses significantly contribute to ensuring that patients receive high-quality care, achieve satisfaction, and utilize healthcare resources effectively and efficiently.
