One aspect of the health care system that seems to inspire everyone’s consensus is the need for health care reform. The debate, however, revolves around WHAT to reform. One concept to drive much change that has gained much attention in health policy and political circles is the “medical home”. The concept of medical home means that the care of people with chronic illnesses will result in better care coordination. My major project over the last several months has been to identify what every nurse should know about care coordination. I am nearly finished with a paper describing the role of nurses in care coordination.
Americans are living longer and the number of older adults is rapidly increasing. With increased age comes increased risk for chronic illness. The high and increasing prevalence of multiple chronic conditions poses challenges for our current health care system. The high cost of care associated with treatment for persons with chronic conditions gives rise to questions about the most appropriate models of care for persons with multiple chronic illnesses. People with multiple chronic illnesses have substantially more health provider contacts and are more likely to be hospitalized each year than those with only one chronic condition. Prior attempts to manage costly utilization of services by persons with chronic illness have been unsuccessful with traditional fee for service methods. Mounting pressure for health care reform has resulted in consideration of easy solutions to restrain health costs—including the concept of a “medical home”.
The “medical home” concept grows out of the disease management literature and was introduced in 1967 by American Academy of Pediatrics with the intent to provide care to children with disabilities. In the United States, projects to put this Medical Home concept into practice center on physicians, not nurses. Yet, the medical literature and experience of providers to improve chronic care indicate that nurses are the key to implementing the chronic care model. By nature of our holistic education and role, nurses are in a position to champion the transformation of chronic care.
Care coordination is one of the priorities to transform the health care system (IOM, 2008). Nurses have taken on the central role in care coordination for decades, and are now being recognized as leaders in care coordination. Nursing models that use coordinated care and report outcomes are very helpful in the debate. Examples of nursing models using care coordination with reported outcomes of this practice include that of the Transitional Care model, EverCare model, and outcomes reported in the literature on Advanced Practice Nursing.
Recommendations regarding care coordination follow:
- Development of comprehensive, coordinated approaches to financing and delivering a wide range of needed care in Medicare must be supported. Payment must create incentives to better coordinate care.
- "Medical Home” must be conceptualized as a broader, more holistic health home approach, characterized by client and family centeredness that includes health promotion and disease prevention with contributions of all providers optimized (AAN, 2008).
- Nursing must continue to transform health care by developing models of care coordination. Models of care coordination must be supported by evidence with outcomes and cost effectiveness reported.
- Medicare payment must be inclusive of nursing models that include Advanced Practice Nurses as equal practitioners who provide care coordination to Medicare beneficiaries.
My major paper describing nursing’s role in care coordination will soon be finished. This paper will be a major product that I’ve enjoyed working on during this Fellowship. Pat Ford-Roegner, Executive Director at American Academy of Nursing (AAN), has mentored me in understanding these issues.
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