Care Coordination Definition“Care coordination promotes greater quality, safety, andefficiency in care, resulting in improved healthcareoutcomes and is consistent with nursing’sholistic, patient-centered framework of care. Aknowledgeable healthcare professional deliberatelydesignated to coordinate care is necessary to effectivelyutilize resources within the set of complex healthsystems and multiple providers in accordance withpatient and family care needs (McDonald et al., 2011;OMalley, Tynan, Cohen, Kemper, & Davis, 2009)” –ANA’s Policy Statement on Care Coordination, 20122
ANA Scope and Standard of Practice (2010)Registered Nurses (RN): Are central to organizing the patient-centered careexperience, among diverse populations and acrosssettings. Influence care at every level Utilize CC competencies (ANA, 2010,p. 40) andprocesses as a central aspect of professional practice Enhance care value by contributions to successfulquality outcomes and increased efficiencies.3
National Quality Strategy (HHS) Guide Star for Improving Healthcare Quality Updated Annually Informed by the National Priorities Partnership (NPP)– ANA is an NPP Partner Focuses Needed Action for Performance Improvement Web link:http://www.ahrq.gov/workingforquality/index.html4
New Payment Environment Health Care Reform – Accountable Care Act Pay for Reporting – Transparent Quality Hospital Compare and other settings Pay for Quality & Value - Results Focus – NQS Tri-part National Aim: Improve Quality (e.g., improve safety) Improve Health (e.g., prevention) Reduce Excessive cost (e.g., readmissions)5
Hospital Acquired Conditions Partnership for Patients (Pf) - Campaign in the CMMI 40 % Reduction in Hospital Acquired Conditions (HAC) Falls, Pressure Ulcers & Hospital Acquired Infections Adverse Medication Events 20% Reduction in Avoidable Rehospitalization ANA is a PfP Partner PfP Hospital Engagement Networks: Charged with reaching goals ANA’s National Database of Nursing QualityIndicators® (NDNQI®) provides national comparisondata6
Value of Nursing Care Coordination (CC) Reduction of HACs Falls with injury Pressure Ulcers Hospital Acquired Infections (e.g., catheter associatedurinary tract infections – CAUTI, Central LineAssociated Infections – CLABSI) Reduction in Medication Errors Reduction in Maternity Harm7
Value of Nursing Care Coordination (CC) Reduction of Hospital Readmissions 30 day Readmission (avoidable) All Cause All Settings (e.g., skilled nursing facilities, home healthetc.) Diagnosis Related (e.g., Heart Failure) Reduction of Index Admission8
Value of Nursing Care Coordination (CC)Results from the Literature Reductions in emergency department visits Noticeable decreases in medication costs Reduced inpatient charges Reduced overall charges Average savings per patient Significant increases in survival with fewer readmissions Lower total annual Medicare costs for those beneficiaries participating in pilotprojects compared to control groups Increased patient confidence in self-managing care Improved quality of care Increased safety of older adults during transition from an acute care setting tothe home Improved clinical outcomes and reduced costs Improved patient satisfaction overallANA Value of Care Coordination Paper (2012)9
Strategies to Demonstrate Value NDNQI Participate in Unit Data Dashboard Review(e.g., structure, process, and outcome measures) Identify successes & improvement opportunities Participate at unit level to improve outcomes (e.g., join skin careteam) Identify Contributions to Prevention (e.g., consistent use ofevidence-based tools and practice) Contribute to Improved Transitional Care Patient/Caregiver Education (include teach back) Continuum of Care Collaboration (e.g., team-based collaboration –consistent education, timely supplies/equipment etc.)10
Future Issues ForNursing Care Coordination ANA convening Care Coordination Quality Measures ProfessionalIssues Panel + Advisory Group . No “Nurse Care Coordinator” Certification Only for Nurse Case Managers, other types of Care/Case Managers. Medicare quality reporting, shared savings programs (ACOs, HospitalValue Based Purchasing, etc.) – communication, coordination amonghealth practitioners & facilities essential to success. Dual eligible (Medicare & Medicaid) care coordination projects. Medicare wants more bundled payments, less “fee for service” (FFS). Care coordination helps aging patients remain in home, community. Physician shortage shifting work to APRNs & RNs. 30% of Medicare FFS beneficiaries received services from an APRN in 2011.
ResourcesCare Coordination and Registered Nurses’ EssentialRole, Position Statement of the American NursesAssociation. www.nursingworld.org/position/care-coordination.aspx.The Value of Nursing Care Coordination, White Paper of theAmerican Nurses Association.www.nursingworld.org/carecoordinationwhitepaper.CMS Approves New Codes & Reimbursement for TransitionalCare & Chronic Care Coordination.www.capitolupdate.org/index.php/2013/01/cms-approves-new-codes-reimbursement-for-transitional-care-chronic-care-coordination/.2013 CPT® Codebook. American Medical Association.www.ama-assn.org/go/online-catalog.
Resources Center for Medicare and Medicaid Innovation:http://innovation.cms.gov/ Partnership for Patients: http://partnershipforpatients.cms.gov/ Strong Start: http://innovation.cms.gov/initiatives/strong-start/ Million Hearts: http://millionhearts.hhs.gov/index.html National Priorities Partnership (NPP):https://www.qualityforum.org/Setting_Priorities/NPP/National_Priorities_Partnership.aspx Action Teams:https://www.qualityforum.org/Setting_Priorities/NPP/NPP_Action_Teams.aspx Maternity Action Team Readmissions Action Team13