Care coordination : the game changer : how nursing is revolutionizing quality care / Gerri Lamb, PhD, RN, FAAN, editor.

Format:

Book

Contributor:

Lamb, Gerri, editor.

Language:

English

Subjects (All):

Nursing.

Nursing--Quality control.

Evidence-based nursing.

Physical Description:

1 online resource (xix, 239 pages) : illustrations

Edition:

1st ed.

Place of Publication:

Silver Spring, Maryland : American Nurses Association, 2014.

Language Note:

English

System Details:

Mode of access: World Wide Web.

Summary:

Care coordination has always been a primary duty of nursing. Care Coordination: The Game Changer offers today's most comprehensive insights, case studies, and strategies to advance nursing's role in care coordination and healthcare transformation. Care Coordination is the first book to show in clear, concise language how care coordination is positioned in the context of healthcare reform. In this essential text, editor Gerri Lamb, PhD, RN, FAAN, and 23 of the brightest minds in care coordination at top universities and health systems examine care coordination from all sides, including models and tools for improving quality and safety; effective care coordination models; the role of nurse leaders in advancing care coordination; quality and safety outcomes for patients and families; and more. Find out how nursing is revolutionizing quality care--and how this impacts the national agenda for healthcare reform.

Contents:

Care Coordination: The Game Changer

Contents

Contributors

Introduction

Chapter 1. Care Coordination, Quality, and Nursing

Evolution of the National Quality Strategy

The Role of Care Coordination in Improving Quality and Safety

Care Coordination and Nurses

References

Section 1. Quality and Safety: The Foundation of Care Coordination Practice

Chapter 2. Nursing and Quality: A Historical Perspective

A Quality Chasm

IOM Reports on Quality and Safety

Nursing's History of Healthcare Quality and Safety

Quality and Safety Education for Nurses (QSEN)

Transforming Care at the Bedside (TCAB)

Practice Standards and Models of Excellence

Moving Quality Forward

National Patient Safety Goals

Translating Evidence into Practice

Never Events and Payment Incentives

The Importance of Quality Measurement

Capturing Nursing Contributions to Quality Outcomes

The Future of Quality and Safety Through Care Coordination

Chapter 3. Models and Tools for Improving Quality and Safety

Overview of Nurse Role in Continuous Quality Improvement

Better System Performance

Better Professional Development

Professional Competency

Change and Transformational Leadership

Frameworks and Tools for Quality Improvement

Better Patient and System Outcomes

Project Planning and Evaluation

Assessment of Meaningful Quality Measures

Communication of Results

Summary of Nursing's QI Role

Conclusion

Selected References on Quality

Section 2. Care Coordination: Practice and Leadership

Chapter 4. Effective Care Coordination Models

The Care Coordination Evidence Base

Transitional Care

Comprehensive Care Coordination

Effective Care Coordination Components and Practices

The Nursing Role in Effective Care Coordination.

Skills Needed for Effective Care Coordination

Moving toward Effective Care Coordination

Summary

Chapter 5. Recognizing Care Coordination in Nurses' Practice

Making Care Coordination Visible in Nursing Practice

Recognizing Care Coordination in Your Practice

Identifying Patients at Risk

Communicating Accurate and Meaningful Patient-Centered Information

Managing the Plan of Care

Preparing for Transitions

The Variety of Care Coordinator Roles

Preparing Nurses for Care Coordination in the Patient-Centered Medical Home

Reference

Chapter 6. The Role of Nursing Leaders in Advancing Care Coordination

Nurse Leadership Makes a Difference

Transformational Leadership Supports Improvement

Nurses Have "The Right Stuff" to Advance Care Coordination

Leading from Within: The Practice of Nurse Care Coordination

Moving Nurse Care Coordination Ahead in the Game

Creating and Communicating a Shared Vision

Developing Supportive Work Environments

Building Expertise: Systems Thinking and Teamwork

Section 3. Improving Quality Through Effective Care Coordination

Chapter 7. Care Coordination and Reducing Avoidable Hospital Stays

Background and Significance

Review of the Literature

Hospital-Initiated Programs

Community-Initiated Programs

Implications of Nurse-Led Care Coordination Programs

Patient Education

Self-Management of Patients and Families

Communication within Care Teams

Amount of Nurse - Patient Interaction

Innovation and Study Design

Measurement of Care Coordination Outcomes

Chapter 8. Quality and Safety Outcomes for Patients and Families

Care Coordination Interventions and Quality and Safety Outcomes

Improving Patient Engagement and Self-Care Practices.

Medication Management

Safe Practices

Healthcare-Acquired Conditions

Care Coordination Models: Targeting Outcomes

Making the Care Coordination and Quality Outcomes Link

Measurement of Care Coordination Processes and Selected Outcomes

Medication Management

Implications for Practice, Education, and Research

Acknowledgements

Chapter 9. Care Coordination and Health Information Technology

Definition of HIT Terms

The Role of HIT in Care Coordination

HIT in Care Coordination: Some Case Examples

Case 1. Pediatric Care

Case 2. Acute Care

Case 3. Home Care

Case 4. Primary Care

Case 5. Long-Term Care (LTC)

Summary of Case Studies

Nursing's Role in HIT Adoption

Future Directions for HIT in Care Coordination

Section 4. Transforming Healthcare Practice and Policy

Chapter 10. Coordinating Care through Authentic Partnership with Patients and Families

Identifying Members of the Care Team

Central Role for Patients and Families

Working Effectively as a Team

A Framework for Care Coordination

Domain 1. Needs Assessment for Care Coordination, Continuing Engagement

Domain 2. Care Planning and Communication

Domain 3. Facilitating Care Transitions (Inpatient, Ambulatory)

Domain 4. Connecting to Community Resources

Domain 5. Transitioning to Adult Care, Self-Care Skill Development

Care Coordination Functions Linked To Outcomes

Capacity Building: Workforce Training, and Interprofessional Education

Chapter 11. Community-Based Care Transitions: From Care Coordination Pilot to CMS Program

Building on a Long History of Innovative Nurse Care Coordination

Rediscovering Care Coordination for a New Time: The Heart Failure Transitions Pilot.

Step 1. Creating Consensus on the Care Delivery Model

Transitional Care Nurses and the Navigator

Step 2. Operationalizing the Model

FAST Approach to Disease Management

Step 3. Building Preferred Providers across the Continuum

Step 4. Using Technology

Moving in a CMS Community-Based Care Transitions Program

Lessons Learned

Chapter 12. Influencing Public Policy through Care Coordination Research

Key Stepping Stones to Ultimately Influencing Public Policy

The Vision: Dramatically Change U.S. Long-Term Care Delivery

Building a Business for the AIP Project: Sinclair Home Care

Strategic Planning for Shifting Public Policy: Electronic Health and Business Databases

Project Effectiveness Evaluations: Building the Case to Influence Public Policy

Challenging Existing Paradigms: Legislation to Enable Building TigerPlace

Involving Stakeholders: The Public-Private Relationship

Building the Demonstration Site: TigerPlace as AIP Long-Term Care Facility

Care Coordination: Central to Sinclair Home Care Services at TigerPlace

More Project Effectiveness Evaluations: AIP at TigerPlace

Technological Innovations: Technology to Enhance AIP

Challenges to Diffusing the Care Model: Becoming a National Long-Term Care Model

The Cutting Edge Challenge: Staying Alive Until Change Becomes Widespread

What to Do When You Are the Only One

Know When to Change

Successfully Infuencing Public Policy

Take Expert Advice Seriously

Publicize the Results

Continuously Engage Stakeholders

Always Engage in Public Policy Change

Author Profiles

Gerri Lamb

Chapter Contributors

Corrine Abraham

Richard C. Antonelli

Gail E. Armstrong

Patricia S. Button

Karen Jiggins Colorafi

Ingrid M. Hopkins Duva

Patricia C. Dykes.

Sheila Haas

Rosemary Kennedy

Laura Heermann Langford

Steven J. Miller

Katy Musterman

Lori L. Popejoy

Marilyn Rantz

Gina Rogers

Lipika Samal

Madeline H. Schmitt

Cheryl Schraeder

Daryl Sharp

Paul Shelton

Nan M. Solomons

Beth Ann Swan

Donna Zazworsky

Index.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references and index.

Description based on print version record.

Description based on publisher supplied metadata and other sources.

ISBN:

1-55810-544-1

OCLC:

1017004157