Ethical and Policy Factors in Care Coordination Essay
Public health is one of the greatest investments for the local, state, and federal governments. Thus, the government coordinates care provided to various patient populations to ensure the delivery of high-quality, safe, and efficient care to the public. Care coordination is a high-priority aspect of the healthcare systems that require continuous improvement to achieve high-quality, patient-centered, efficient, and high-value healthcare delivery. Through care coordination, patients’ health-related information is shared amongst different parties involved in healthcare delivery, allowing them to plan for the delivery of high-quality, safe, efficient, and patient-centered care to an individual patient. Care coordination in various healthcare settings is highly influenced by ethical and policy factors. This presentation focuses on the effect of ethical and policy factors on care coordination in nursing homes. It will include the context of care coordination in nursing homes; the impact of governmental policies related to the community’s health or safety on the coordination of care in nursing homes; dilemmas in care coordination resulting from the HIPAA Privacy Rule; the implications and consequences of HIPAA Act; the code of ethics impact for nurses on the coordination and continuum of care; factors contributing to health, health disparities, and access to services in nursing homes; and the impact of social determinants of health (SDH) on the quality and disparity of care provided in nursing homes.
The Context of Care coordination in Nursing Homes
Care coordination is the backbone of providing high-quality patient care in any healthcare organization. It involves intentional synchronization of patients’ health-related data, which guides healthcare providers in planning for the care services to be provided to an individual patient. Care coordination leads to the delivery of healthcare services that address the preferences, interests, and values of an individual patient. In nursing homes, healthcare professionals rely on previously shared client information in providing quality and efficient care to an individual, leading to superior outcomes, including improving quality of life, longer life expectancy, the improved functioning capacity, and enhanced overall well-being. Thus, care coordination enables individuals residing in nursing homes to live fuller, happier, and longer lives.
The Impact of Governmental Policies Related to Community’s Health or Safety on the Coordination of Care in Nursing Homes
Various groups of individuals living in nursing homes, including seniors and people with disabilities, deserve high-quality, safe, and reliable health care. Thus, the government has implemented policies to improve the quality of care provided to these individuals, meeting their health care needs. The first policy is the Health Insurance Portability and Accountability Act (HIPPA) Privacy Rule. This policy prohibits the use and disclosure of individuals’ health-related information by unauthorized parties. Additionally, it gives individuals the right to control how their health-related information is used. Therefore, this policy enhances the safety of individuals living in nursing homes. Secondly, the government coordinates care provided to people residing in nursing homes via payment policies of the Medicare program. In the Value-Based reimbursement model, healthcare professionals are compensated for the quality and efficiency of care provided to patients (Teisberg et al., 2018). Healthcare providers strive to provide quality and efficient care to increase their income. Thus, this payment policy promotes the delivery of quality care provided to people residing in nursing homes.
Dilemmas in Care Coordination Resulting from the HIPAA Privacy Rule
Clinicians encounter dilemmas in various healthcare delivery activities, including care coordination. Care coordination involves deliberately sharing patient health information and organizing care activities amongst all parties involved in care delivery. This process enables healthcare professionals to meet patients’ needs and preferences through the provision of high-quality and high-value health care. Hence, care coordination benefits patients through the delivery of efficient, high-quality, and safe care, resulting in positive health outcomes (Ofei & Paarima, 2021). However, care coordination is compromised by the HIPAA Privacy Rule, which prohibits the use and disclosure of individuals’ health-related information by unauthorized parties without the owner’s consent. Therefore, this policy prohibits sharing of patients’ health information among the participants ahead of care delivery, compromising care coordination in nursing homes.
The Implications and Consequences of the HIPAA Act
The HIPAA Privacy Rule establishes standards for regulating the use and disclosure of protected health information. This policy prohibits the use and sharing of patients’ health-related data with third parties without the owner’s consent (Cohen & Mello, 2018). Failure to comply with the HIPAA Privacy Rule guidelines is associated with various implications and consequences. First, the act protects patients’ health-related information. The HIPAA Privacy Rule was primarily introduced to control the usage and disclosure of individuals’ health information (Cohen & Mello, 2018). Thus, violating this policy results in a lack of privacy and confidentiality of personal data, including identifiers and patients’ health-related information. Secondly, HIPAA Privacy Rule violation leads to civil and monetary penalties. Healthcare providers who violate this rule are either jailed for a specific period or required to pay fines depending on the magnitude of the crime. Thirdly, the HIPAA Privacy Rule contributes to the delivery of poor-quality care and adverse health outcomes. The act prohibits sharing of patients’ health-related information electronically without the owner’s consent, limiting access to health information needed during healthcare delivery.
The Code of Ethics Impact for Nurses on the Coordination and Continuum of Care
Ethics define acceptable nursing values and rules of conduct. The ANA Code of Ethics indicates ethical nursing practice standards. The Code of Ethics serves as a guide for nurses in all their clinical practices. The American Nursing Association established this non-negotiable standard of ethics for nurses to promote the quality and safety of all patients. The code of ethics reminds all nurses about their commitment to society. Nurses should prioritize the needs of the society members and work tirelessly to provide them with safe, quality, and efficient care. For this reason, nurses should continue with their learning to acquire evidence-based information based on scientific studies, enabling them to provide their patients with evidence-based care. According to Hashish et al. (2020), evidence-based practices results in quality care and positive health outcomes. Thus, incorporating evidence-based practices into nursing care results in positive health outcomes.
Care coordination aims at achieving a higher quality of care and better patient outcomes by organizing patient care and sharing information with different parties involved in healthcare delivery. Care coordination prevents adverse health outcomes, including longer stay, high cost of healthcare, and hospital readmissions (Fulmer et al., 2021). Additionally, it improves the continuity of care, contributing to positive health outcomes in the long term. Adequate care coordination is supported by the revised Code of Ethics for Nurses through provisions 2, 4, and 8. Provision 2 states that nurses should keep the patient at the center of care. Provision 4 holds that nurses should accept patients’ responsibility and accountability, providing quality care to patients based on delegated duties. Lastly, Provision 8 states that nurses should aim at meeting the health needs of the community at the national and international levels.
Factors Contributing to Health, Health Disparities, and Access to Services in Nursing Homes
The quality and access to care services provided in nursing homes are influenced by various factors. Government policies and initiatives are key determinants of quality and access to care provided to individuals living in nursing homes. The lack of adequate policies for coordination of care provided in nursing homes results in the delivery of poor-quality care to people residing in nursing homes. On the contrary, the availability of government initiatives such as lowering resident room crowding and increasing nursing home staffing improves the quality of care provided to individuals in nursing homes. The availability of local nursing homes enhances access to care among community members residing in the nursing care. Lastly, the number of community-seeking nursing home services influences the quality and access to care provided in nursing homes. Quality is high and services are high when few individuals are residing in nursing homes.
The Impact of Social Determinants of Health (SDH) on the Quality and Disparity of Care provided in Nursing Homes
SDH influences quality and disparity in the care provided in nursing homes. First, the availability of local nursing homes enhances access to care among community members interested in residing in the nursing homes. However, the quality of care provided in nursing homes significantly depend on the number of community members seeking nursing homes’ services. Quality of care is high and services are high when few individuals are residing in nursing homes. Secondly, social support and social interactions also influence the quality of care provided to individuals living in nursing homes. A high level of social interactions between individuals and nursing staff working in these facilities leads to quality care. Lastly, social norms and attitudes, such as discrimination influence the quality of care provided to individuals living in nursing homes. The quality is high when social attitudes are low.
Care coordination is the backbone of quality care in any healthcare organization. It involves the intentional synchronization of patients’ health-related data. Coordination of care in nursing homes is influenced by the government through provisions and the Code of ethics for nursing. The HIPAA Privacy Rule discourages care coordination by prohibiting sharing of health-related data among the participants. On the other hand, the code of ethics supports care coordination and continuum through provisions 2, 4, and 8. The provisions emphasize that nurses should be committed to providing quality nursing care to their patients, resulting in positive health outcomes.
Cohen, I. G., & Mello, M. M. (2018). HIPAA and protecting health information in the 21st century. Jama, 320(3), 231-232.
Fulmer, T., Reuben, D. B., Auerbach, J., Fick, D. M., Galambos, C., & Johnson, K. S. (2021). Actualizing Better Health And Health Care For Older Adults: Commentary describes six vital directions to improve the care and quality of life for all older Americans. Health Affairs, 40(2), 219-225
Hashish, A., Aly, E., & Alsayed, S. (2020). Evidence-Based Practice and its Relationship to Quality Improvement: A Cross-Sectional Study among Egyptian Nurses. The Open Nursing Journal, 14(1). DOI: 10.2174/1874434602014010254
Ofei, A. M., & Paarima, Y. (2021). Perception of nurse managers’ care coordination practices among nurses at the unit level. International Journal of Care Coordination, 24(1), 17-27. DOI: 10.1177/2053434521999978
Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care: a strategic framework. Academic Medicine, 95(5), 682. Doi: 10.1097/ACM.0000000000003122
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