1

Care Coordination Presentation to Colleagues

Student’s Name

University

Course

Professor

Date
 2

Care Coordination Presentation to Colleagues

Hello everyone! My name is (Name), and I will discuss care coordination in this video.

Care coordination is the organized planning of patient care actions and information sharing

among all those involved in a patient's care to provide safer and more effective care. I will talk

about essential ways to work with patients and their families, how change management affects

the patient experience, how healthcare policies affect patient results, and ethical issues when

coordinating care.

Effective Strategies for Collaborating with Patients

Patient-family involvement is crucial in care coordination to meet the intended health

objectives. It is necessary to use an individualized approach and focus on teaching the patient

about the specific medication. These interventions should be tailored to the patient's medication,

health literacy, and learning ability. Nurses can teach drug purposes, dosages, side effects, and

administration verbally, in writing, and through the use of graphics. As stated by (Ampofo et al.,

2020), individualized medication education improved patients' compliance with the prescribed

treatment and decreased the number of adverse drug reactions by 30%. Cultural competence is

another essential care coordinating method. This entails acknowledging patients' cultural beliefs,

attitudes, and behaviors that may influence their health and choices. Nurses should understand

how culture affects communication, family, and health-related beliefs. In some cultures, the

family plays a role in the decision-making process of the patient's treatment. Realizing this and

involving family members in care discussions can enhance patients' engagement and compliance

with the recommended treatment. Henderson et al. (2018) noted that culturally competent care

coordination interventions enhanced patient satisfaction, health status, and health inequalities in

various patient groups.

 3

Another successful collaboration technique encourages patients and their families to

engage in their care: decision-making. In this method, patients are provided with accurate

information regarding their health, treatment, and outcomes, and then they are assisted in making

decisions that are consistent with their values. Option grids and visual decision trees can help the

nurses understand and evaluate the patients' choices. In a randomized controlled trial, Bartlett et

al. (2020) established that shared decision-making improved treatment compliance, satisfaction,

and health status over routine care. Lastly, technology-supported communication tools can

enhance the patient-family partnership in chronic illness and post-discharge care. Telemedicine

tools such as patient portals, mobile health applications, and remote monitoring devices allow

patients to track their health parameters, communicate with their healthcare providers, and access

information on their health conditions from the comfort of their homes. A nurse-led telehealth

program may include video check-ins, medication reminders, and symptom monitoring for heart

failure patients. As stated by (Guo et al., 2020), the application of care coordination treatments

through technology helped reduce hospital readmissions by 25% and enhanced the patient's

quality of life. These digital technologies can help patients and families manage their health in

ways that are not conventional nursing care.

Identification of the Aspects of Change Management

Change management in healthcare impacts several vital patient experience characteristics

essential for delivering high-quality, patient-centered care. The care system must shift to a more

coordinated and person-centered model of care. This transformation requires that healthcare

providers alter their processes, interactions, and organizational structure to collaborate across

disciplines and settings (Kim et al., 2024). This can enhance patient satisfaction by decreasing

the number of duplicate handovers and guaranteeing that all clinicians follow the same
 4

management plan. However, such changes can be challenging and may disrupt the flow of work,

thus affecting the patients and staff. These challenges can be mitigated through effective change

management strategies such as communication, staff training, and phased implementation to

ensure that patients receive quality care during the transition. Patients and their families can also

be involved in the change process through feedback systems and co-design projects to enhance

patient-centeredness.

Another essential component of change management that affects the patient experience is

the implementation of new technologies and digital health solutions. EHRs, telemedicine

platforms, and patient portals can enhance care coordination, access, and patient control (Lyles et

al., 2020). Such advancements challenge the elderly and people with low technological skills.

The change management process must facilitate patients' transition to these tools, which includes

interfaces, training, and options for those who have difficulties with digital solutions. Also, the

shift in culture towards evidence-based and technology-supported practice needs to be addressed

by healthcare practitioners alongside the human element of patient-centered care. Thus, change

management is required to guarantee that technology enhances patient-provider relationships.

Innovation can help healthcare organizations enhance efficiency, effectiveness, and patient

satisfaction by managing these technological changes.

The Rationale for Coordinated Care Plans

Medical ethics principles of autonomy, beneficence, non-maleficence, and justice support

ethical decision-making of coordinated care plans. Ethical coordinated care plans uphold

patients' rights and preferences, provide care in the patient's best interest, avoid harm, and use

resources efficiently. Ethical decision-making in care coordination assists the providers in

dealing with the dilemmas that arise when priorities clash or when there is a shortage of
 5

resources (Kim et al., 2024). In situations where a patient's desire is not aligned with what the

healthcare providers believe would be best for the patient, an ethically based coordinated care

plan would respect patient self-determination while at the same time educating the patient on the

implications of his or her decision. It is patient-centered because it recognizes patients' right to

choose their care and fosters trust between them and their caregivers. Ethical decision-making in

care coordination requires healthcare providers to act in a way justified by ethical principles

rather than prejudice or convenience.

Ethical care coordination must be considered, and its impact must be assessed. It may

lead to short-term decisions that take longer or are more expensive. In order to have informed

consent and involve the patient in the decision-making process for every aspect of a multifaceted

care plan, multiple discussions and consultations may slow the treatment process. Ethical

decision-making may conflict with organizational policies or financial gains and losses, making

the healthcare providers advocate for the patient's needs even if there are more efficient and

economical solutions. Other factors affecting care coordination ethics include patient capacity,

culture, and "quality of life. "The healthcare providers should not entertain such biases since they

should act based on ethical principles, not prejudice. The short-term issues of an ethical approach

to care coordination are overshadowed by the benefits of better patient outcomes, satisfaction,

and trust in the healthcare system. Healthcare practitioners can continue to provide patient-

centered care and, therefore, more holistic, empathetic, and effective care by applying ethical

principles to care coordination.

The Potential Impact of Specific Healthcare Policy Provisions

Healthcare policy, especially care coordination, can affect patient outcomes and

experiences. The Affordable Care Act's Hospital Readmissions Reduction Programme (HRRP)
 6

has had a significant impact (Qiu et al., 2022). Hospitals with higher-than-expected 30-day

readmission rates for particular diseases are penalized to enhance care transitions and decrease

avoidable hospitalizations. This strategy encourages hospitals to improve discharge planning and

post-discharge follow-up, improving care coordination. Thus, patients may receive better

discharge education, medication reconciliation, and primary care physician and community

resource communication. Zuckerman et al. (2016) discovered in the New England Journal of

Medicine that the HRRP significantly reduced readmission rates for specified conditions.

Targeted condition readmission rates dropped from 21.5% to 17.8% between 2007 and 2015.

Critics say this approach may lead to hospitals avoiding high-risk patients or coding techniques

that cut readmissions without enhancing treatment.

Telehealth growth is another crucial policy element, especially after the COVID-19

pandemic and regulatory changes that increased virtual care availability. This policy reform

should make healthcare more accessible, especially for rural and mobility-impaired people. More

frequent check-ins, earlier health issue intervention, and better continuity of treatment can result.

Patients may benefit from reduced travel time, costs, convenience, and faster service. However, it

raises worries about the digital divide and technology access inequities. A large-scale Health

Affairs study by Barnett et al. (2021) examined over 36 million outpatient visits before and

during the COVID-19 epidemic, supporting telehealth expansion. Telehealth visits rose from

0.3% of total visits before the pandemic to 23.6% during it, with metropolitan and high-income

patients using it more. Telehealth can potentially enhance access to care, but rules are needed to

address any inequities. To ensure fair, high-quality care coordination for all patients, healthcare

policies must be continuously monitored as they affect patient outcomes and experiences.

Conclusion
 7

A care coordination discussion should have emphasized the intricacy of this crucial

nursing job. Research has explored effective collaboration strategies, including personalized

education and cultural competence. The implications of change management on patient

experiences and care coordination ethics have been studied. Policy impacts on nursing practice

and patient outcomes are also addressed. Remember that care coordinators power patient

healthcare. Care coordinators teach, advocate, and navigate beyond clinical knowledge. Modern

thinking and practices can help nurses enhance patient outcomes, care quality, and efficiency.

Participants should apply these principles to their daily lives after this workshop. Consider

patients and how greater coordination could help them. Together, we can improve community

care facility care. I appreciate your coordinated efforts to improve patient care.
 8

References

Ampofo, A. G., Khan, E., & Ibitoye, M. B. (2020). Understanding the role of educational

interventions on medication adherence in hypertension: A systematic review and meta-

analysis. Heart & Lung, 49(5), 537–547. https://doi.org/10.1016/j.hrtlng.2020.02.039

Bartlett, S. J., De Leon, E., Orbai, A.-M., Haque, U. J., Manno, R. L., Ruffing, V., Butanis, A.,

Duncan, T., Jones, M. R., Leong, A., Perin, J., Smith, K. C., & Bingham, C. O. (2020).

Qualitative results include patient-reported outcomes in RA care to improve patient

communication, decision-making, satisfaction, and confidence. Rheumatology, 59(7),

1662–1670. https://doi.org/10.1093/rheumatology/kez506

Guo, Y., Lane, D. A., Wang, L., Zhang, H., Wang, H., Zhang, W., Wen, J., Xing, Y., Wu, F., Xia,

Y., Liu, T., Wu, F., Liang, Z., Liu, F., Zhao, Y., Li, R., Li, X., Zhang, L., Guo, J., &

Burnside, G. (2020). Mobile health technology to improve care for patients with atrial

fibrillation. Journal of the American College of Cardiology, 75(13), 1523–1534.

https://doi.org/10.1016/j.jacc.2020.01.052

Kim, E.-J., Koo, Y.-R., & Nam, I.-C. (2024). Patients and Healthcare Providers’ Perspectives on

Patient Experience factors and a Model of patient-centered care communication: A

systematic review. Healthcare, 12(11), 1090.

https://doi.org/10.3390/healthcare12111090

Lyles, C. R., Nelson, E. C., Frampton, S., Dykes, P. C., Cemballi, A. G., & Sarkar, U. (2020).

Using electronic health record portals to improve patient engagement: Research priorities

and best practices. Annals of Internal Medicine, 172(11), 123–129.

https://doi.org/10.7326/m19-0876
 9

Qiu, L., Kumar, S., Sen, A., & Sinha, A. (2022). Impact of the hospital readmission reduction

program (HRRP) on hospital readmission and mortality: An economic analysis.

Production and Operations Management, 31(5), 2341–2360.

https://doi.org/10.1111/poms.13724