Assessing the Problem: Technology, Care Coordination, and Community Resources Considerations Essay

Assessing the Problem: Technology, Care Coordination, and Community Resources Considerations Essay

In my last encounter with Mr. KJ, we discussed the role of technology and available community resources that might change his life during his journey with hypertension. We deliberated on various types of technology, including simple technologies like his smartphone, that would positively impact his quality of life. Mr. KJ showed great optimism in the discussion, and through patient engagement and shared decision making we agreed with Mr. KJ that we would use these technologies as they fit his care. Concerning community resources and care coordination, Mr. KJ was willing to use some of the resources that would fit his daily schedule and needs. This napper aims to describe the impact technology has on care for hypertension, explain the role of care coordination on community resource utilization, and analyze the state board of nursing regulations and standards that impact technology, care coordination, and community resource utilization for hypertensive patients.

Impact of Technology on Care for Hypertensive Patients

The World Health Organization defines healthcare care technology as the use of organized knowledge and abilities in the form of tools, drugs, vaccinations, processes, and systems to solve a health issue and enhance the quality of life and health technology (World Health Organization, n.d.). Healthcare technology is synonymous with health technology. There are various types of health technology that have impacted care for patients with hypertension. Key types of technologies used include but are not limited to web-based technologies, phone technology, smartphone technology, technological devices, and telehealth. In care for hypertension, health technology has been used in self-monitoring, ambulatory care, mobile health, virtual clinics, and self-screening.

Self-monitoring

Self-monitoring is useful for patients already diagnosed with hypertension. Technologies for self-monitoring include automated blood pressure cuffs. In more ideal settings, these cuffs are connected to technologies such as Bluetooth or the internet to relay the recording to appropriate devices and share it with the care providers (Kitt et al., 2020). Wearable technologies such as cuffless blood pressure remontoirs are newer technologies used for self-monitoring (Omboni, 2019). Self-monitoring can also be achieved by traditional blood pressure monitoring. For quality purposes outside clinical areas, patients require validated blood pressure monitoring devices. Self-monitoring and self-screening use the same concepts of technology.

The disadvantage of self-monitoring technologies is data privacy issues as the patient needs to relay their information to third parties for monitoring. Nevertheless, it is a low-cost strategy that ensures patient autonomy and promotes convenience in hypertension monitoring. Ambulatory care for hypertension patients relies on these self-monitoring technologies to follow up and monitor patients. Patients with comorbidities such as diabetes mellitus can benefit from self-monitoring to detect hypertension in the non-hypertensive prehypertension stages. This strategy can reduce their cardiovascular risks through primary prevention.

Telemonitoring

Telemonitoring builds on remote health and uses various technologies to transfer data and information remotely between the healthcare provider and the patient. In most, if not all, cases, this technology relies on self-monitoring because patients are required to regularly record and communicate blood pressure readings to their care providers for monitoring. Emails and phone text messages are some of the methods of telemonitoring that can be used for hypertension management. Telemonitoring is an excellent remote care and monitoring technology because it eliminates the impact of distance and time in monitoring. It increases patient collaboration and engagement to ensure awareness of hypertension complications, thus early detection of these patient safety risks. However, the security and privacy of protected patient health information (PHI) are at risk because sometimes patients may rely on insecure public networks to share data and information. Higher costs are more likely to be incurred in telemonitoring as compared with self-monitoring.

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Mobile Health and Smartphone Technology

The ubiquity of smartphones in contemporary society makes their significance in health care unquestionable. Despite their low validity in health care, smartphone technologies have played a significant part in remote care, especially for chronic diseases such as hypertension. Smartphone applications have been used to monitor blood pressure and schedule self-management. Some smartphone applications have alert features that remind patients to measure their blood pressure and share it with their care providers. Some applications alert their users in cases when their blood pressure goes beyond the preset normal ranges (Kitt et al., 2020). These mobile technologies work in conjunction with the self-monitoring technology that was explained earlier. Mobile technology reduces costs of care, improves access to care due to its widespread use, and is convenient to use by patients. However, PHI privacy and security are still a concern for mobile technology. Certain populations, such as the aged and children have minimal use of these technologies.

Virtual Clinics and Web-based Technologies 

Virtual clinics also improve remote care for patients through improved access and care monitoring. In these clinics, clinicians can schedule meetings with patients to monitor them or follow them up. Usually, these technologies are used as follow-up for physical interaction with the patient to save transport costs. They, therefore, enhance clinician-patient collaboration and patient engagement, thus patient-centered care. Web-based portals and teleconferencing sites are specific technologies used by these technologies. Online appointments and medical records are also used in virtual clinics. They are time convenient but require an internet connection that may be expensive to patients from low-income families.

Social Media and Online Forums

Social media platforms such as Facebook and Twitter offer opportunities for peer-peer support to hypertensive patients. These interactions allow the patient to share information and support each other socially (Omboni, 2019). To healthcare providers, social media offer the opportunity to offer patient education and health promotions to a large audience. However, PHI security and privacy are still ethical and legal concerns with this technology. Sharing patients’ identifying data or information breaches the confidentiality and privacy rules of fair data use.  WhatsApp is a special media messenger application that is currently used by many patients and healthcare professionals for synchronous and asynchronous communication. Sharing of images, images, videos, and other multimedia risks breaching HIPAA privacy rules. Nevertheless, social media is a potential technology and community resource for hypertensive patients.

Care Coordination and Community Resources for Hypertensive Patients

Care Coordination

Care coordination entails organizing patients’ data and information pertinent to their care and sharing this information for purposes of patient care with other care stakeholders (Agency for Healthcare Research and Quality, 2018). According to The Centers For Disease Control And Prevention (CDC, 2020), care for hypertensive patients requires a multidisciplinary approach and team-based care. Key healthcare providers that should constitute the multidisciplinary teams include but are not limited to physicians, nurses, primary care providers, community health workers, paramedics, and pharmacists (The Community Guide, 2021). To the patient, care coordination is essential because it ensures that their needs and preferences are met over time through information sharing with relevant stakeholders, organizations, and resources. Hypertensive patients receive care from different providers resulting in many care transitions.

Transitions in care involve shifting patient care responsibilities from one care provider to the next. For example, care for elderly hypertensive patient care can shift from family caregivers to adult day care services or nursing care. During these transitions, patients can face challenges in communicating and sharing their previous care progress and needs without a care coordinator. Chances of medication errors or medical errors of omission and duplications are highly likely during these transition times. Care transition for hypertensive patients from their caregiver to healthcare professionals requires nursing care coordination because sometimes a family member or caregiver may not understand the medical and nursing care efforts and needs during these times. To the healthcare professional, care coordination provides an opportunity to ensure patient-centered or family-centered care. At this point, the care coordinator decides the sequence of care for the patient, and it is their discretion to decide where to send the patient, what information to gather, and gaps in their care needs.

Community Resources

Good care coordination promotes the continuum of competition for patient care. This includes the utilization of community resources to complement clinical care (Substance Abuse and Mental Health Administration, 2022). The need for team-based care is the best solution for a multidisciplinary approach after these community resources have been identified (CDC, 2020). The care coordination ring model by the agency of healthcare research and quality includes the nursing process, specialty care, community resources, primary care, medications/pharmacy, family support, patient support, medical services, and home care. Community resources for hypertension care are varied and depend on the patient care needs. Community pharmacy is a vital community resource for a patient with hypertension because of regular refilling of the medications that these patients require. The Community Preventive Services Task Force (CPSTF) recommended tailored pharmacy-based interventions to improve adherence to better cardiovascular disease prevention and health maintenance. Tailored interventions with community pharmacies include communication between the patient’s care provider and the community pharmacy (The Community Guide, 2021). In some cases, these interventions can consist of patient education material to reduce cardiovascular disease risks such as hypertension complications through awareness and secondary prevention. Community pharmacies can offer medication reconciliation and medication counseling to promote patient safety by reducing medication error risks.

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Independent nurse-led practice clinics are important resources for the follow-up and monitoring of hypertensive patients. Adult daycare services and home care services are important community resources for debilitated hypertensive patients and their caregivers because they provide relief to caregivers. For ambulant and otherwise stable hypertensive patients, gymnasia and playgrounds offer the best services for weight management and fitness to reduce risk factors. Obesity and overweight are known risk factors for hypertension and other cardiovascular diseases. Community health workers and social workers are essential community human resources that link hypertensive patients to appropriate care services. As primary coordinators, they understand patient care needs and refer them to the appropriate care professionals and resources (Egan et al., 2018). Potential barriers to the utilization of community resources are sometimes related to costs, awareness, and access to these services. Rural primary care clinics should serve as important awareness centers providing adequate patient education regarding community resource utilization.

State Boards of Nursing Standards and Relevant Policies

State boards’ regulation of nursing practice standards impacts cares coordination. Regulation of the scope of practice of various cadres of nurses by the state boards of nursing defines their roles in care coordination. Community nurses and primary care nurses have more responsibilities in care coordination at the community levels of care (Egan et al., 2018). The scope of nurses, especially advanced practice registered nurses (APRNs), is important in hypertension care because, in some states, they have prescriptive authority that allows them to treat and follow-up up with hypertensive patients. States with the nurse licensure compact even allow these nurses to practice and offer care coordination in more than one state.

Federal policies such as the Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are essential in care coordination. HIPAA regulates sharing and transmission of patient information, especially PHI. Therefore, it protects patient information privacy and safety. Technologies used must adhere to these rules during care coordination, especially in social media and other internet technologies. ACA and Medicaid services have significantly improved access to care by patients, especially the elderly. Through the removal of health insurance barriers, ACA has made care for hypertensive patients affordable and accessible to many users (Courtemanche et al., 2018). As a result, care coordination and utilization of community resources have improved.

Conclusion

Care coordination is an activity rather than a service delivery. Most of the time, it is incorporated during care transitions. The use of technology has made care coordination and utilization of community resources. Web-based, self-screening, self-monitoring, telemonitoring, social media, mobile, and smartphone technologies are some of the health technologies used in coordinating care for hypertensive patients. Data and information sharing have ethical implications relating to data safety and privacy that are regaled by HIPAA and ACA policies.

References

Agency for Healthcare Research and Quality. (2018, August). Care Coordination. Ahrq.gov. https://www.ahrq.gov/ncepcr/care/coordination.html

CDC. (2020, June 25). Promoting Team-Based Care to Improve High Blood Pressure Control. Centers for Disease Control and Prevention. https://www.cdc.gov/dhdsp/pubs/guides/best-practices/team-based-care.htm

CDC. (2021, May 10). Cost-Effectiveness of High Blood Pressure Interventions. Cdc.gov. https://www.cdc.gov/chronicdisease/programs-impact/pop/high-blood-pressure.htm

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2018). Effects of the Affordable Care Act on health care access and self-assessed health after 3 years. Inquiry: A Journal of Medical Care Organization, Provision, and Financing, 55, 46958018796361. https://doi.org/10.1177/0046958018796361

Egan, B. M., Sutherland, S. E., Rakotz, M., Yang, J., Hanlin, R. B., Davis, R. A., & Wozniak, G. (2018). Improving hypertension control in primary care with the measure accurately, Act rapidly, and Partner with patients protocol. Hypertension, 72(6), 1320–1327. https://doi.org/10.1161/HYPERTENSIONAHA.118.11558

Kitt, Fox, & Tucker. (2020). Digital Health: New Approaches in Hypertension Management. Journal of Cardiology and Cardiovascular Sciences, 4(1). https://www.cardiologyresearchjournal.com/articles/digital-health-new-approaches-in-hypertension-management-1-1186.pdf

Omboni, S. (2019). Connected health in hypertension management. Frontiers in Cardiovascular Medicine, 6, 76. https://doi.org/10.3389/fcvm.2019.00076

Substance Abuse and Mental Health Administration. (2022, April 21). Care Coordination for Certified Community Behavioral Health Clinics (CCBHCs). Sahmsa.gov. https://www.samhsa.gov/section-223/care-coordination

The Community Guide. (2019, July 19). Heart Disease and Stroke Prevention: Tailored Pharmacy-based Interventions to Improve Medication Adherence. The Guide to Community Preventive Services (The Community Guide). https://www.thecommunityguide.org/findings/heart-disease-stroke-prevention-tailored-pharmacy-based-interventions-improve-medication-adherence

The Community Guide. (2021, December 7). Heart Disease and Stroke Prevention: Team-based Care to Improve Blood Pressure Control. The Guide to Community Preventive Services (The Community Guide). https://www.thecommunityguide.org/findings/heart-disease-stroke-prevention-team-based-care-improve-blood-pressure-control

World Health Organization. (n.d.). Medical devices. Who.int. Retrieved August 25, 2022, from https://www.who.int/teams/health-product-policy-and-standards/assistive-and-medical-technology/medical-devices

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3 Instructions: Assessing the Problem: Technology, Care Coordination, and Community Resources Considerations
• PRINT
• In a 5-7 page written assessment, determine how health care technology, coordination of care, and community resources can be applied to address the patient, family, or population problem you’ve defined. In addition, plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Report on your experiences during the second 2 hours of your practicum.
Introduction
As a baccalaureate-prepared nurse, you’ll be positioned to maximize the use of technology to achieve positive patient outcomes and improve organizational effectiveness. Providing holistic coordination of patient care across the entire health care continuum and leveraging community resource services can lead both to positive patient outcomes and to organizational improvements.
Preparation
In this assessment, you’ll determine how health care technology, coordination of care, and community resources can be applied to address the health problem you’ve defined. Plan to spend at least 2 direct practicum hours working with the same patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts.
To prepare for the assessment:
• Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.
• Conduct sufficient research of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.
• Review the Practicum Focus Sheet: Assessment 3 [PDF], which provides guidance for conducting this portion of your practicum.
Note: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.
Instructions
Complete this assessment in two parts.
Part 1
Determine how health care technology, the coordination of care, and the use of community resources can be applied to address the patient, family, or population problem you’ve defined. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 3 [PDF] provided for this assessment to guide your work and interpersonal interactions.
Part 2
Report on your experiences during the second 2 hours of your practicum.
• Whom did you meet with?
o What did you learn from them?
• Comment on the evidence-based practice (EBP) documents or websites you reviewed.
o What did you learn from that review?
• Share the process and experience of exploring the effect of the problem on the quality of care, patient safety, and costs to the system and individual.
o Did your plan to address the problem change, based upon your experiences?
o What surprised you, or was of particular interest to you, and why?
Capella Academic Portal
Update the total number of hours on the NURS-FPX4900 Volunteer Experience Form in Capella Academic Portal.
Requirements
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
• Analyze the impact of health care technology on the patient, family, or population problem.
o Cite evidence from the literature that addresses the advantages and disadvantages of specific technologies, including research studies that present opposing views.
o Determine whether the evidence is consistent with technology use you see in your nursing practice.
o Identify potential barriers and costs associated with the use of specific technologies and how those technologies are applied within the context of this problem.
• Explain how care coordination and the utilization of community resources can be used to address the patient, family, or population problem.
o Cite evidence from the literature that addresses the benefits of care coordination and the utilization of community resources, including research studies that present opposing views.
o Determine whether the evidence is consistent with how you see care coordination and community resources used in your nursing practice.
o Identify barriers to the use of care coordination and community resources in the context of this problem.
• Analyze state board nursing practice standards and/or organizational or governmental policies associated with health care technology, care coordination, and community resources and document the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
o Explain how these standards or policies will guide your actions in applying technology, care coordination, and community resources to address care quality, patient safety, and costs to the system and individual.
o Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of technology, care coordination, and community resources.
o Explain how nursing ethics will inform your approach to addressing the problem through the use of applied technology, care coordination, and community resources.
o Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
• Support main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.
• Apply APA style and formatting to scholarly writing.
Additional Requirements
• Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your paper. Be sure to include:
o A title page and reference page. An abstract is not required.
o Appropriate section headings.
• Length: Your paper should be approximately 5–7 pages in length, not including the reference page.
• Supporting evidence: Cite at least five sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
• Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
• Competency 4: Apply health information and patient care technology to improve patient and systems outcomes.
o Analyze the impact of health care technology on a patient, family, or population problem.
• Competency 5: Analyze the impact of health policy on quality and cost of care.
o Analyze state board nursing practice standards and/or organizational or governmental policies associated with health technology, care coordination, and community resources and document the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
• Competency 6: Collaborate interprofessionally to improve patient and population outcomes.
o Explain how care coordination and the utilization of community resources can be used to address a patient, family, or population problem.
• Competency 8: Integrate professional standards and values into practice.
o Support main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.
o Apply APA style and formatting to scholarly writing.

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Assessing the Problem: Technology, Care Coordination, and Community Resources Considerations Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Analyze the impact of health care technology on a patient, family, or population problem.	Does not describe the impact of health care technology on a patient, family, or population problem.	Describes the impact of health care technology on a patient, family, or population problem.	Analyzes the impact of health care technology on a patient, family, or population problem.	Conducts an astute analysis of the impact of health care technology on a patient, family, or population problem. Cites credible and balanced evidence of the advantages and disadvantages of specific technologies. Provides clear insight into current technology use in professional practice, as well as potential barriers and costs.
Explain how care coordination and the utilization of community resources can be used to address a patient, family, or population problem.	Does not describe the value of care coordination and the utilization of community resources in addressing health care challenges.	Attempts to describe the value of care coordination and the utilization of community resources in addressing health care challenges.	Explains how care coordination and the utilization of community resources can be used to address a patient, family, or population problem.	Provides a convincing explanation of how care coordination and the utilization of community resources can be used to address a patient, family, or population problem. Cites credible and balanced evidence of the benefits of care coordination and the use of community resources. Provides clear insight into current use in professional practice, as well as potential barriers.
Analyze state board nursing practice standards and/or organizational or governmental policies associated with health technology, care coordination, and community resources and document the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form.	Does not describe state board nursing practice standards and/or organizational or governmental policies associated with health technology, care coordination, and community resources, and does not document practicum hours in Capella Academic Portal Volunteer Experience Form.	Attempts to describe state board nursing practice standards and/or organizational or governmental policies associated with health technology, care coordination, and community resources, and/or does not document practicum hours in Capella Academic Portal Volunteer Experience Form.	Analyzes state board nursing practice standards and/or organizational or governmental policies associated with health technology, care coordination, and community resources and documents the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form.	Conducts an astute analysis of state board nursing practice standards and/or organizational or governmental policies associated with health technology, care coordination, and community resources. Clearly articulates the implications for ethical professional practice of applying standards and/or policy guidance or legislative requirements to the problem. Documents the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form
Support main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.	Does not support main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.	Sources lack relevance or credibility, or the evidence is not persuasive or explicitly supportive of main points, assertions, arguments, conclusions, or recommendations.	Supports main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.	Supports main points, assertions, arguments, conclusions, or recommendations with relevant, credible, and convincing evidence. Skillfully combines virtually error-free source citations with a perceptive and coherent synthesis of the evidence.
Apply APA style and formatting to scholarly writing.	Does not apply APA style and formatting to scholarly writing.	Applies APA style and formatting to scholarly writing incorrectly and/or inconsistently, detracting noticeably from good scholarship.	Applies APA style and formatting to scholarly writing.	Applies APA style and formatting to scholarly writing. Exhibits strict and nearly flawless adherence to stylistic conventions, document structure, and source attributions.