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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

I am ________, the case manager at Sacred Heart, a rural hospital. This presentation aims to guide hospital members in achieving care coordination through the Triple Aim process.

Purpose

This presentation aims to enlighten Sacred Heart Hospital’s leadership on care coordination, aligning practices with Triple Aim objectives for the rural population. It also seeks to enhance understanding of supporting models for Triple Aim, focusing on the Patient-Centered Medical Home (PCMH) and Transitional Care.

Triple Aim

The Triple Aim focuses on improving healthcare quality with objectives centered on enhancing patient experience, healthier populations, and lower healthcare costs. This presentation details how the Triple Aim contributes to community health, patient care experience, and cost reduction.

Patient Experience of Care

Triple Aim prioritizes improving patient experience by reducing waiting times, improving communication, and involving patients in treatment plans. Patient satisfaction positively impacts adherence to treatment, engagement in care, and overall health outcomes.

Enhancing Community or Population Health

The Triple Aim aims to improve community health by recognizing and addressing health needs. Care coordination is crucial in identifying high-risk patients and ensuring they receive appropriate care. Collaboration with community partners for preventive measures is essential.

Reducing Per Capita Costs

Efficient care coordination contributes to reducing healthcare costs by minimizing waste, unnecessary procedures, and preventing readmissions. Collaboration with community partners and preventive care further decreases healthcare costs.

In conclusion, achieving Triple Aim objectives requires healthcare providers to enhance patient experience, community health, and minimize healthcare costs. Effective care coordination plays a critical role in achieving these goals.

Analyzing the Relationship Between Health Models and Triple Aim

The PCMH and Transitional Care models align with Triple Aim objectives, focusing on patient-centered care, improving population health, and reducing healthcare costs. These models show potential in enhancing patient outcomes and care coordination.

Structure of Healthcare Models

PCMH and Transitional Care models enhance care quality through a team-based approach, emphasizing comprehensive and coordinated care. They rely on electronic health records, evidence-based guidelines, and interdisciplinary teams to ensure appropriate care.

Evidence-based Data Shaping the Care Coordination Process

Care coordination in nursing relies on evidence-based data to identify patient needs, barriers to care, and develop tailored interventions. This data-driven approach improves patient outcomes, promotes continuity of care, and reduces the risk of medical errors.

Governmental Regulatory Initiatives

To achieve Triple Aim, Sacred Heart Hospital can incorporate regulatory initiatives like the Medicare Shared Savings Program (MSSP) and the Hospital Readmissions Reduction Program (HRRP). These programs incentivize care coordination, improve quality, and reduce healthcare costs.

Process Improvement Recommendations to Stakeholders

Stakeholders, including hospital administration, healthcare providers, patients, caregivers, and Vila Health representatives, should be informed about the need to update the care coordination process. Addressing questions about resources and timeline concerns will ensure successful implementation.

References

Bravo, F., Levi, R., Perakis, G., & Romero, G. (2022). Care coordination for healthcare referrals under a shared‐savings program. Production and Operations Management. https://doi.org/10.1111/poms.13830

Fønss Rasmussen, L., Grode, L. B., Lange, J., Barat, I., & Gregersen, M. (2021). Impact of transitional care interventions on hospital readmissions in older medical patients: A systematic review. BMJ Open, 11(1), e040057. https://doi.org/10.1136/bmjopen-2020-040057

Kangovi, S., Mitra, N., Grande, D., Long, J. A., & Asch, D. A. (2020). Evidence-based community health worker program addresses unmet social needs and generates positive return on investment. Health Affairs, 39(2), 207–213. https://doi.org/10.1377/hlthaff.2019.00981

NURS FPX 6612 Assessment 1 Triple Aim Outcome Measures

Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., O’Brien, E. C., & Kansagara, D. (2018). Impact of patient-centered medical homes on healthcare utilization. American journal of managed care, 24(5), 237-243.

M., S., & Chacko, A. M. (2021, January 1). 2 – Interoperability issues in EHR systems: Research directions (K. C. Lee, S. S. Roy, P. Samui, & V. Kumar, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/pii/B9780128193143000021

McNabney, M. K., Green, A. R., Burke, M., Le, S. T., Butler, D., Chun, A. K., Elliott, D. P., Fulton, A. T., Hyer, K., Setters, B., & Shega, J. W. (2022). Complexities of care: Common components of models of care in geriatrics. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.17811

NURS FPX 6612 Assessment 1 Triple Aim Outcome Measures

Ruediger, M., Kupfer, M., & Leiby, B. E. (2019). Decreasing re-hospitalizations and emergency department visits in persons with recent spinal cord injuries using a specialized medical home. The Journal of Spinal Cord Medicine, 44(2), 221–228. https://doi.org/10.1080/10790268.2019.1671075

Shahsavari, H., Zarei, M., & Aliheydari Mamaghani, J. (2019). Transitional care: Concept analysis using Rodgers’ evolutionary approach. International Journal of Nursing Studies, 99, 103387. https://doi.org/10.1016/j.ijnurstu.2019.103387