- Email: [email protected]
Lost in the shuffle
President’s Message
Lost in the shuffle
Bobbie Berkowitz, PhD, RN, NEA-BC, FAAN
What is it like for an individual with complicated health care needs to navigate our modern, technologically sophisticated and highly complex care environments? What is it like for their families when efforts to access information and assistance necessary to manage care at home are lost in the shuffle? Those questions have prompted health systems, governmental agencies, academia, and scholars to investigate the burden and poor health outcomes that patients and families may experience during the transition within and across care environments. It has also garnered the shared interest and commitment of the American Academy of Nursing (AAN) and the American Nurses Association (ANA) to create a collaborative approach to the creation of a policy agenda for the nursing role in care coordination. Although the research literature on care coordination has increased during the past 10 years and the emphasis within the U.S. Department of Health and Human Services (DHHS) on the application of care coordination processes to individuals and families has been impressive, the role of nurses in care coordination remains a largely untapped resource. I am writing about this in my President’s Message because I feel strongly that we need to stay focused on the importance of care coordination to gain the changes in policy necessary to assure that “lost in the shuffle” becomes a rare exception. Research on various methods to support individuals with chronic disease and reduce their need for hospitalization has had mixed results depending on the type of support individuals receive and from whom, adherence to evidence based care coordination models, and the education and competence required of health care providers to engage in care coordination activities. There is a lack of consensus on whom in the
health care workforce ought to be engaged in care coordination activities. Given the models developed for care coordination that include activities such as assume accountability, build relationships with care partners, support patients through the referral or transition process, and create connections to support information exchange (Wagner et al., 2014), the range of individuals and educational preparation for providing care coordination is quite extraordinary. The National Quality Strategy developed by the Department of Health and Human Services was designed to promote quality within health care environments by: making care safer by reducing harm caused in the delivery of care created in ensuring that each person and family is engaged as a partner in their care promoting effective communication and coordination of care promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease working with communities to promote wide use of best practices to enable healthy living making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models (National Quality Strategy Stakeholder Toolkit, 2015) The Centers for Medicare and Medicaid (CMS) is the agency within DHHS working to create strategies to support the achievement of these priority goals. CMS acknowledges that poor coordination of care can lead to a number of untoward events for individuals and families including medication errors, unnecessary procedures, treatment and services, and avoidable hospital admissions and readmissions. Individuals and families become lost in the complexity of the health care environment when care is not communicated and coordinated, and the outcomes can be tragic. One of the strategies to improve quality and reduce harm to patients is through a system that rewards providers to support and assure the coordination of care across care environments (CMS Quality Strategy, 2016). Additional strategies include discharge planning requirements, advancing primary care services and medical homes, promoting the development of Accountable Care Organizations, incentivizing meaningful use for electronic health records, payment initiatives, and a variety of other quality improvement initiatives. The National Quality
206
Nurs Outlook 64 (2016) 205e206
Forum has been tasked by CMS to create the measurement and incentive system that will drive care that meets the goals of the CMS Quality Strategy including communication and care coordination. Measurements within this category address the coordination of care and treatment across providers (National Quality Forum, 2016). Clearly, resources and policies are available to incentivize the system to focus on care coordination. However, the involvement of nurses in these efforts has been limited. The need for the development of a nursing response to the role, educational competencies, and practice for care coordination prompted the AAN and ANA to create a Care Coordination Task Force in 2014 and to develop a position paper on a policy agenda for care coordination. This policy agenda was published in Nursing Outlook (Lamb et al., 2015). Now, the AAN and ANA are collaborating on the dissemination of the recommendations from the policy agenda. The development of the key target audience and contacts for dissemination has been created, and I am very hopeful that this will promote significant progress. If you have not already read the policy agenda for care coordination, please do. You will be hearing more as dissemination gets underway. More importantly, you may be called upon to take this message to organizations that can influence the implementation of an agenda that calls for our profession to lead care coordination. We want health systems to use nurses prepared with at least a BSN in care coordination roles across care environments; we want schools of nursing to educate students for roles in care coordination; we want payment reform, so all qualified health professionals, including nurses, are reimbursed for care coordination services; and we want scholarship in this area to expand to include the design of measures for care coordination that are central to nursing. Most of all, we want to end the poor outcomes for patients when they get lost in the shuffle.
references
Centers for Medicare and Medicaid Services. (2016). Quality strategy. Retrieved from http://www.ahrq.gov/ workingforquality/agencyplans/2016-cms-agency-specificplan.pdf. Department of Health and Human Services. (2015). National quality strategy stakeholder toolkit. Retrieved from http://www. ahrq.gov/workingforquality/nqs/nqstoolkit.pdf. Lamb, G., Newhouse, R., Beverly, C., Toney, D., Cropley, S., Weaver, C., ., Naylor, M. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4), 521e530. National Quality Forum. (2016). MAP 2016 considerations for implementing measures in federal programs: Clinicians. Retrieved from file:///C:/Users/bb2509/Downloads/map_clinicians_2016_ final_report.pdf. Wagner, E. H., Sandhu, N., Coleman, K., Phillips, K. E., Sugarman, J. R. (2014). Improving care coordination in primary care. Medical Care, 52(11), S33eS38.
Author Description Bobbie Berkowitz is the President of the American Academy of Nursing. Bobbie Berkowitz, PhD, RN, NEA-BC, FAAN Dean and Professor Columbia University School of Nursing Sr. Vice President Columbia University Medical Center New York, NY Corresponding author: Bobbie Berkowitz, 630 West 168th St. MC6, New York, NY 10032. E-mail address: [email protected] Available online 31 March 2016 0029-6554/$ e see front matter Ó 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.outlook.2016.03.006
Lost in the shuffle
Bobbie Berkowitz, PhD, RN, NEA-BC, FAAN
What is it like for an individual with complicated health care needs to navigate our modern, technologically sophisticated and highly complex care environments? What is it like for their families when efforts to access information and assistance necessary to manage care at home are lost in the shuffle? Those questions have prompted health systems, governmental agencies, academia, and scholars to investigate the burden and poor health outcomes that patients and families may experience during the transition within and across care environments. It has also garnered the shared interest and commitment of the American Academy of Nursing (AAN) and the American Nurses Association (ANA) to create a collaborative approach to the creation of a policy agenda for the nursing role in care coordination. Although the research literature on care coordination has increased during the past 10 years and the emphasis within the U.S. Department of Health and Human Services (DHHS) on the application of care coordination processes to individuals and families has been impressive, the role of nurses in care coordination remains a largely untapped resource. I am writing about this in my President’s Message because I feel strongly that we need to stay focused on the importance of care coordination to gain the changes in policy necessary to assure that “lost in the shuffle” becomes a rare exception. Research on various methods to support individuals with chronic disease and reduce their need for hospitalization has had mixed results depending on the type of support individuals receive and from whom, adherence to evidence based care coordination models, and the education and competence required of health care providers to engage in care coordination activities. There is a lack of consensus on whom in the
health care workforce ought to be engaged in care coordination activities. Given the models developed for care coordination that include activities such as assume accountability, build relationships with care partners, support patients through the referral or transition process, and create connections to support information exchange (Wagner et al., 2014), the range of individuals and educational preparation for providing care coordination is quite extraordinary. The National Quality Strategy developed by the Department of Health and Human Services was designed to promote quality within health care environments by: making care safer by reducing harm caused in the delivery of care created in ensuring that each person and family is engaged as a partner in their care promoting effective communication and coordination of care promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease working with communities to promote wide use of best practices to enable healthy living making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models (National Quality Strategy Stakeholder Toolkit, 2015) The Centers for Medicare and Medicaid (CMS) is the agency within DHHS working to create strategies to support the achievement of these priority goals. CMS acknowledges that poor coordination of care can lead to a number of untoward events for individuals and families including medication errors, unnecessary procedures, treatment and services, and avoidable hospital admissions and readmissions. Individuals and families become lost in the complexity of the health care environment when care is not communicated and coordinated, and the outcomes can be tragic. One of the strategies to improve quality and reduce harm to patients is through a system that rewards providers to support and assure the coordination of care across care environments (CMS Quality Strategy, 2016). Additional strategies include discharge planning requirements, advancing primary care services and medical homes, promoting the development of Accountable Care Organizations, incentivizing meaningful use for electronic health records, payment initiatives, and a variety of other quality improvement initiatives. The National Quality
206
Nurs Outlook 64 (2016) 205e206
Forum has been tasked by CMS to create the measurement and incentive system that will drive care that meets the goals of the CMS Quality Strategy including communication and care coordination. Measurements within this category address the coordination of care and treatment across providers (National Quality Forum, 2016). Clearly, resources and policies are available to incentivize the system to focus on care coordination. However, the involvement of nurses in these efforts has been limited. The need for the development of a nursing response to the role, educational competencies, and practice for care coordination prompted the AAN and ANA to create a Care Coordination Task Force in 2014 and to develop a position paper on a policy agenda for care coordination. This policy agenda was published in Nursing Outlook (Lamb et al., 2015). Now, the AAN and ANA are collaborating on the dissemination of the recommendations from the policy agenda. The development of the key target audience and contacts for dissemination has been created, and I am very hopeful that this will promote significant progress. If you have not already read the policy agenda for care coordination, please do. You will be hearing more as dissemination gets underway. More importantly, you may be called upon to take this message to organizations that can influence the implementation of an agenda that calls for our profession to lead care coordination. We want health systems to use nurses prepared with at least a BSN in care coordination roles across care environments; we want schools of nursing to educate students for roles in care coordination; we want payment reform, so all qualified health professionals, including nurses, are reimbursed for care coordination services; and we want scholarship in this area to expand to include the design of measures for care coordination that are central to nursing. Most of all, we want to end the poor outcomes for patients when they get lost in the shuffle.
references
Centers for Medicare and Medicaid Services. (2016). Quality strategy. Retrieved from http://www.ahrq.gov/ workingforquality/agencyplans/2016-cms-agency-specificplan.pdf. Department of Health and Human Services. (2015). National quality strategy stakeholder toolkit. Retrieved from http://www. ahrq.gov/workingforquality/nqs/nqstoolkit.pdf. Lamb, G., Newhouse, R., Beverly, C., Toney, D., Cropley, S., Weaver, C., ., Naylor, M. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4), 521e530. National Quality Forum. (2016). MAP 2016 considerations for implementing measures in federal programs: Clinicians. Retrieved from file:///C:/Users/bb2509/Downloads/map_clinicians_2016_ final_report.pdf. Wagner, E. H., Sandhu, N., Coleman, K., Phillips, K. E., Sugarman, J. R. (2014). Improving care coordination in primary care. Medical Care, 52(11), S33eS38.
Author Description Bobbie Berkowitz is the President of the American Academy of Nursing. Bobbie Berkowitz, PhD, RN, NEA-BC, FAAN Dean and Professor Columbia University School of Nursing Sr. Vice President Columbia University Medical Center New York, NY Corresponding author: Bobbie Berkowitz, 630 West 168th St. MC6, New York, NY 10032. E-mail address: [email protected] Available online 31 March 2016 0029-6554/$ e see front matter Ó 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.outlook.2016.03.006