Determining Critical Evidence-based Strategies for Optimal Population Health Management NURS FPX Assessment 1: Comprehensive Needs
Determining Critical Evidence-based Strategies for Optimal Population Health Management
Implementing a successful plan of care for Mr. Decker from a population health perspective requires the integration of evidence-based practices drawn from current and credible sources. Effective care coordination practices are vital for improving patient outcomes and managing population health efficiently (Colvin et al., 2023). For Mr. Decker, utilizing patient-centered medical homes (PCMHs) can be highly beneficial. PCMHs provide comprehensive, coordinated care through a team-based approach, ensuring continuous, accessible, and family-centered care. Research by Xie et al. (2021) indicates that PCMHs improve care quality and patient satisfaction and reduce healthcare costs by focusing on preventive care and chronic disease management. This model can address Mr. Decker’s chronic diabetes and other health concerns effectively, ensuring he receives holistic and continuous care.
Another essential practice for Mr. Decker’s care is the implementation of health information technology systems, i.e., EHRs. EHRs facilitate the sharing of Mr. Decker’s health information among healthcare providers, improving communication, reducing errors, and enhancing care coordination. Research by Upadhyay & Hu (2022) has shown that using EHRs leads to better patient outcomes and more efficient healthcare delivery. By ensuring that all relevant health data is accessible, Mr. Decker’s care team can make informed decisions quickly and accurately.
Care transition programs are also critical for Mr. Decker, especially given his recent hospital readmission due to sepsis. These programs ensure continuity of care, patient education, and follow-up, reducing readmissions and improving health outcomes. A study by Shah et al. (2022) demonstrates that structured care transition interventions, such as the Care Transitions Intervention (CTI), significantly decrease hospital readmissions and enhance patient satisfaction. Implementing such a program for Mr. Decker can ensure he understands his care plan and receives the necessary support during transitions between care settings.
Employing community health workers (CHWs) can enhance care coordination for Mr. Decker. CHWs, who often share cultural and social backgrounds with the populations they serve, can improve access to care, provide education, and support chronic disease management. Research by Killough et al. (2023) supports the effectiveness of CHWs in improving health outcomes and reducing healthcare disparities. For Mr. Decker, a CHW could provide personalized support, helping him manage his diabetes and navigate the healthcare system. Integrating evidence-based practices allows Mr. Decker’s healthcare providers to develop a thorough care plan that improves his health and overall well-being.
Benefits of a Collaborative Strategy in Care Coordination
Promoting collaborative medical care is essential for effectively addressing immediate and long-term health needs (Duru et al., 2020). For patients like Mr. Decker, collaboration among specialists, including endocrinologists, infectious disease experts, pharmacists, nurses, and social workers, is imperative. This teamwork integrates diverse perspectives and resources, significantly enhancing patient outcomes. A study by Korytkowski et al. (2020) suggests that a multidisciplinary team can minimize medical mistakes, boost safety, and elevate the quality of care. Integrating all elements of care, i.e., from emergency treatment to post-discharge follow-up and sustained long-term care of conditions like diabetes—a multidisciplinary approach ensures continuity of care, a critical factor in improving health outcomes for patients with complex medical conditions. This collaborative model supports seamless transitions between different stages of care and incorporates various therapeutic viewpoints, leading to more effective and comprehensive treatment outcomes. Research by Srinivas et al. (2023) has shown that patients receiving coordinated care from multidisciplinary teams experience better health outcomes, lower hospital readmission rates, and higher satisfaction levels. Thus, advocating for a multidisciplinary approach is crucial for fostering a healthcare environment prioritizing comprehensive, focused care, resulting in better health results and greater patient contentment.
NURS FPX Assessment 1: Comprehensive Needs Assessment Conclusion
A multidisciplinary approach to patient care is pivotal for addressing patients’ complex and varied health needs, like Mr. Decker’s. By fostering collaboration among a diverse team of healthcare professionals, the multidisciplinary model ensures comprehensive, coordinated care that improves patient outcomes, reduces readmissions, and enhances patient satisfaction (Commons et al., 2022). This analysis points out several interconnected elements, aging, diabetes, social support networks, and economic factors that are vital for ensuring high-quality patient care. It describes holistic, evidence-based approaches to managing sepsis efficiently. Furthermore, it strongly endorses a team-based approach to care coordination, backed by research, to enhance the effectiveness of patient care plans. This approach integrates diverse therapeutic perspectives, improving health outcomes and patient satisfaction.
Assessment References
Buléon, C., Mattatia, L., & Minehart, R.D. (2022). Simulation-based summative assessment in healthcare: An overview of key principles for practice. Advances in Simulation, 7, 42. https://doi.org/10.1186/s41077-022-00238-9
Colvin, C. L., Akinyelure, O. P., Rajan, M., Safford, M. M., Carson, A. P., Muntner, P., Colantonio, L. D., & Kern, L. M. (2023). Diabetes, gaps in care coordination, and preventable adverse events. The American Journal of Managed Care, 29(6), e162–e168. https://doi.org/10.37765/ajmc.2023.89374
