.png "back to home page")
Name: Capella University
FPX4050: Coord Patient-Centered Care
Instructor’s Name
May 2023
Slide 1
Hello, I am ABC and today my topic of presentation is ethical and policy aspects in care coordination which affect care coordination.
Slide 2
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.
Slide 3
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).
Slide 4
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).
Slide 5
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).
Slide 6
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).
Slide 7
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.
Slide 8
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).
Slide 9
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).
Slide 10
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).
Slide 11: 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
Alnajjar, PhD, H. A., & Abou Hashish, PhD, E. A. (2021). Academic Ethical Awareness and Moral Sensitivity of Undergraduate Nursing Students: Assessment and Influencing Factors. SAGE Open Nursing, 7, 237796082110267. https://doi.org/10.1177/23779608211026715
Anderson, C. L. (2019). Data Breaches and Electronic Personal Health Information (ePHI): What Is Injury-in-Fact and Does HIPAA Set a Negligence Standard of Care? Journal of Legal Medicine, 39(3), 263–277. https://doi.org/10.1080/01947648.2019.1653695
Arrieta Valero, I. (2019). Autonomies in Interaction: Dimensions of Patient Autonomy and Non-adherence to Treatment. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.01857
Ayabakan, S., Bardhan, I., & Zheng, Z. (Eric). (2021). Triple Aim and the Hospital Readmission Reduction Program. Health Services Research and Managerial Epidemiology, 8, 233339282199370. https://doi.org/10.1177/2333392821993704
Bradshaw, J., Siddiqui, N., Greenfield, D., & Sharma, A. (2022). Kindness, Listening, and Connection: Patient and Clinician Key Requirements for Emotional Support in Chronic and Complex Care. Journal of Patient Experience, 9, 237437352210926. https://doi.org/10.1177/23743735221092627
CDC. (2020, November 24). Health Disparities. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyyouth/disparities/index.htm
Centers for Medicare and Medicaid Services. (2022). Hospital readmissions reduction program (HRRP) . Cms.gov. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program
Chinmoy, B., Ho, C. H., & Brodell, R. T. (2020). Time to revisit HIPAA? Accelerated telehealth adoption during the COVID-19 pandemic. Journal of the American Academy of Dermatology, 83(4). https://doi.org/10.1016/j.jaad.2020.06.989
Cramer, J. (2023). Privacy, Data Sharing, and Other Legal Considerations. Surgical Clinics of North America, 103(2), 347–356. https://doi.org/10.1016/j.suc.2022.12.003
Cyr, M. E., Etchin, A. G., Guthrie, B. J., & Benneyan, J. C. (2019). Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4815-5
Dinsdale, E., Hannigan, A., O’Connor, R., O’Doherty, J., Glynn, L., Casey, M., Hayes, P., Kelly, D., Cullen, W., & O’Regan, A. (2019). Communication between Primary and Secondary care: Deficits and Danger. Family Practice, 37(1). https://doi.org/10.1093/fampra/cmz037
Dutta, O., Lall, P., Patinadan, P. V., Car, J., Low, C. K., Tan, W. S., & Ho, A. H. Y. (2019). Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals. Palliative and Supportive Care, 1–6. https://doi.org/10.1017/s1478951519000865
Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas. BMC Health Services Research, 21(1), 1–9. https://doi.org/10.1186/s12913-021-06961-9
Gai, Y., & Pachamanova, D. (2019). Impact of the Medicare hospital readmissions reduction program on vulnerable populations. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4645-5
Habib, S. S., & Zaidi, S. (2021). Exploring willingness to pay for health insurance and preferences for a benefits package from the perspective of women from low-income households of Karachi, Pakistan. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06403-6
Hadian Jazi, Z., Peyrovi, H., & Zareian, A. (2019). Nurse’s social responsibility: A hybrid concept analysis in Iran. Medical Journal of the Islamic Republic of Iran, 33, 44. https://doi.org/10.34171/mjiri.33.44
Harrington, C., Mollot, R., Edelman, T. S., Wells, J., & Valanejad, D. (2019). U.S. Nursing Home Violations of International and Domestic Human Rights Standards. International Journal of Health Services, 50(1), 62–72. https://doi.org/10.1177/0020731419886196
Karam, M., Chouinard, M.-C., Poitras, M.-E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: a Scoping Review. International Journal of Integrated Care, 21(1), 16. https://doi.org/10.5334/ijic.5518
Levine, D. M., Chalasani, R., Linder, J. A., & Landon, B. E. (2022). Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016. JAMA Network Open, 5(6), e2218167. https://doi.org/10.1001/jamanetworkopen.2022.18167
Moore, W., & Frye, S. (2019). Review of HIPAA, Part 1: History, Protected Health Information, and Privacy and Security Rules. Journal of Nuclear Medicine Technology, 47(4), 269–272. https://doi.org/10.2967/jnmt.119.227819
National Academies of Sciences, E., Division, H. and M., Services, B. on H. C., & Homes, C. on the Q. of C. in N. (2022, April 6). Summary. Www.ncbi.nlm.nih.gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK584660/
Office of Disease Prevention and Health Promotion. (2023). Social Determinants of Health. Healthy People 2030; U.S. Department of Health and Human Services. https://health.gov/healthypeople/priority-areas/social-determinants-health
Olejarczyk, J. P., & Young, M. (2022, November 28). Patient Rights and Ethics. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538279/
Pugh, J., Penney, L. S., Noël, P. H., Neller, S., Mader, M., Finley, E. P., Lanham, H. J., & Leykum, L. (2021). Evidence based processes to prevent readmissions: more is better, a ten-site observational study. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06193-x
Rowley, J., Richards, N., Carduff, E., & Gott, M. (2021). The impact of poverty and deprivation at the end of life: a critical review. Palliative Care and Social Practice, 15, 263235242110338. https://doi.org/10.1177/26323524211033873
Søvold, L. E., Naslund, J. A., Kousoulis, A. A., Saxena, S., Qoronfleh, M. W., Grobler, C., & Münter, L. (2021). Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Frontiers in Public Health, 9(1). frontiersin. https://doi.org/10.3389/fpubh.2021.679397
Sriram, S., & Khan, M. M. (2020). Effect of health insurance program for the poor on out-of-pocket inpatient care cost in India: evidence from a nationally representative cross-sectional survey. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05692-7
Sturmberg, J. P., & Bircher, J. (2019). Better and fulfilling healthcare at lower costs: The need to manage health systems as complex adaptive systems. F1000Research, 8, 789. ncbi. https://doi.org/10.12688/f1000research.19414.1
Warchol, S. J., Monestime, J. P., Mayer, R. W., & Chien, W.-W. (2019). Strategies to Reduce Hospital Readmission Rates in a Non-Medicaid-Expansion State. Perspectives in Health Information Management, 16(Summer). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669363/
Yew, G. C. K. (2020). Trust in and Ethical Design of Carebots: The Case for Ethics of Care. International Journal of Social Robotics. https://doi.org/10.1007/s12369-020-00653-w