NURS FPX 6618 Assessment 1 Planning and Presenting A Care Coordination Project

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Assessment 1: Planning and Presenting a Care Coordination Project
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Student Name
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Capella University
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Course Name
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Nov 8, 2023
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Planning and Presenting a Care Coordination Project
Greetings everyone! I am [Your Name], a student, and today I am presenting a care
coordination project for chronic care patients with a focus on planning and presentation. In this
presentation, I will explore a comprehensive strategy to coordinate and organize patient care in
the role of a Care Coordinator Project Manager.
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Purpose of the Care Coordination Plan
The purpose of presenting a care coordination plan for chronic care patients is to efficiently
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organize patient care practices and related activities. This plan aims to coordinate crucial
medical information among professionals to prevent misunderstandings or adverse events. An
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effective care coordination plan ensures improved quality of care and establishes an assurance
plan to manage patients, monitor their condition, and support them through the development of
efficient information systems.
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Vision for Interagency Collaboration
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Organizing and coordinating care for chronic care patients is crucial for effectively managing
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their conditions and enhancing their overall experience, satisfaction, and outcomes. The primary
approach to care coordination involves integration and patient-centered collaboration with
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patients and their families to fulfill specific patient needs (Welkin, 2022). This vision establishes
accountability, proactive care plans, linkage to community resources, highlighting patients'
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needs and goals, supporting self-management goals, and assigning leadership roles to foster
teamwork. Such a plan aims to reduce healthcare inefficiencies by enhancing the exchange of
information about patients' status and medications, reporting symptoms promptly, and arranging
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necessary equipment (Welkin, 2022).

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Collaboration among psychologists, nurses, chronic care specialists, psychiatrists, and patients
is essential for addressing the diverse needs of chronic care patients. This collaborative effort is
particularly crucial when patients are experiencing trauma and distress due to treatment
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procedures. The underlying assumptions include the high costs of treatments for chronic care,
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resulting in significant patient distress across various age groups and backgrounds. Areas of
uncertainty involve the necessary skills for nursing staff to enhance collaboration and
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communication.
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Identifying Participating Organizations
Numerous organizations are actively participating in caring for chronic patients to improve
outcomes. The National Association of Chronic Disease Directors (NACDD) is a prominent
organization uniting over 7,000 chronic disease professionals in the US, advocating, educating,
and providing technical assistance for the health protection of chronic care patients (National
Association of Chronic Disease Directors, n.d.).
The Worldwide Hospice Palliative Care Alliance, established in 2008, aims to meet the needs of
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chronic care patients and minimize the challenges they face (The Worldwide Hospice Palliative
Care Alliance, n.d.). The inter-professional care coordination team will comprise nurses, nursing
leaders, chronic care specialists, insurance providers, psychologists, psychiatrists, and
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pharmacists.
Determining Resources for Chronic Care
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Efficiently determining and utilizing appropriate resources for chronic care is essential.
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Economic costs associated with chronic illnesses account for a significant portion of the nation's
healthcare expenditures. For instance, heart disease costs about $216 billion, cancer costs
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$240 billion, and diabetes costs $327 billion annually (Centers for Disease Control and
Prevention, n.d.). Preventive measures can help reduce these costs. Funding programs like the
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CDC's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) aim
to reduce unhealthy behaviors and prevent chronic diseases nationwide.
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Accountable Care Organizations (ACOs) improve care outcomes with financial incentives and
promote affordable and quality care (Rural Health Information Hub, n.d.). These resources help
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patients manage chronic illnesses and alleviate pain. Chronic care staffing is also crucial,
requiring well-trained staff dedicated to treating each patient. The assumption is that the
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coordinated care plan developed will be eligible for patient funding programs, and these funds
will sufficiently assist the patients. Areas of uncertainty involve the impact of these funding
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programs on patient outcomes.
Project Milestones
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Establishing an efficient care plan is crucial for improving the quality of life for chronic patients.
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The care coordination team, comprising specialists from various fields, will collaborate to help
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patients manage the challenges associated with chronic illnesses. The coordination team will
focus on improving health literacy, enabling better self-management, and assessing patient
progress for continuous improvement. Results from the coordinated care plan will be evaluated
through patient satisfaction surveys or questionnaires, aiming to minimize errors and problems.
The expected outcomes include enhanced patient knowledge of their illness, increased
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confidence in self-management, reduced patient distress through improved collaboration and
communication, and successful short-listing of resources for utilization.
Presentation of Project to Decision-Makers

Implementing a successful healthcare coordination plan for chronic care patients requires
enhanced communication, collaboration, and the efficient utilization of appropriate resources.
Every milestone will be achieved through careful planning to increase patient satisfaction.
Contacting different organizations for funding to alleviate financial distress among patients is
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crucial, and the plan's implementation should be periodically evaluated through surveys to
ensure program quality.
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Conclusion
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In this project, we discussed chronic care patients facing lifelong diseases. The proposed care
coordination plan aims to coordinate medical information, organize care, and improve health
literacy for better healthcare outcomes.
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References
Centers for Disease Control and Prevention. (n.d.). Chronic Disease Center Budget and
Funding | CDC. https://www.cdc.gov/chronicdisease/budget-funding/index.htm
Centers for Disease Control and Prevention. (n.d.-b). Health and Economic Costs of Chronic
Diseases | CDC. https://www.cdc.gov/chronicdisease/about/costs/index.htm
National Association of Chronic Disease Directors. (n.d.). NACDD.
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https://chronicdisease.org/page/about_nacdd/
Rural Health Information Hub. (n.d.). Rural Health Funding & Opportunities: Chronic disease
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management – Rural Health Information Hub.
https://www.ruralhealthinfo.org/funding/topics/chronic-disease-management
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The Worldwide Hospice Palliative Care Alliance. (n.d.). https://www.thewhpca.org/
Welkin. (2022, August 24). Managing Chronic Conditions Through Care Coordination. Welkin
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Health. https://welkinhealth.com/managing-chronic-conditions-through-care-coordination/
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Assessment 1: Planning and Presenting a Care Coordination Project

necessary equipment (Welkin, 2022).

Determining Resources for Chronic Care

programs on patient outcomes.

Presentation of Project to Decision-Makers

National Association of Chronic Disease Directors. (n.d.). NACDD.

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