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

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

Technology, Care Coordination, and Community Resources Considerations
Management of chronic disease can best be achieved through both self-management and long-term clinical follow-up in the hospital and the community. The health problem of my patient in this practicum project was pediatric asthma. However, she also had gastroesophageal reflux disease (GERD) and childhood obesity. This health problem forms part of chronic lower respiratory diseases, which contribute a significant mortality and morbidity rates in the United States in recent years. Low socioeconomic status and asthma-related comorbidities such as GERD and obesity are associated with poor control of symptoms that lead to poor quality of care, quality of life, and health safety (Paoletti et al., 2021). Costs associated with care for asthma are related to access to direct care and health insurance. Therefore, strategies such as the use of technology, community resources, and care coordination have the potential to improve the patient’s healthcare quality and safety. The purpose of this paper is to describe the impact of technology on the patient’s health problem, discuss the effect of care coordination and community resources utilization in addressing the patient’s health problem, and analyze influential state and national policies that impact the utilization of community resources, care coordination, and technology used in the management of this health problem.
The Impact of Health Care Technology on the Health Problem
21st-century healthcare has been known for technological developments and the need for quality improvements in healthcare outcomes. Healthcare technology has impacted the care for asthma and associated comorbidities. Various healthcare technologies have impacted asthma care and can potentially improve future care for asthma. However, these technologies have their specific advantages and disadvantages in asthma manage. Some of these technologies are web-based technology, phone messaging services, mobile phone applications, smart devices, and social media.
Web-based Technology
Web-based technologies rely on the internet to facilitate interaction between asthma patients and their care providers. Examples of web-based technologies used in asthma include but are not limited to My Asthma Portal, My Child’s Asthma, and Puff city (Poowuttikul & Seth, 2020). Web-based technologies have served different purposes in asthma management. Web-based platforms that contain educational interactions were found to improve adherence among children with poor compliance with asthma medications (Ferrante et al., 2021). These technologies have also been used to monitor asthma treatment among children remotely. Web-based technologies overcome the time and distance barriers in care delivery. Therefore, these children can access care in a timely fashion at home. By enhancing patient edition, these technologies promote self-management and thus the quality of care improvement. However, the less physician-patient direct interaction time created by web-based technologies has an impact on the credibility of the interaction. The use of these technologies does not guarantee reimbursement to the care provider and is not licensable, thus reducing motivation by the care providers to use them.

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Mobile Phone Applications
The ubiquity of mobile phones, especially smartphones, has radicalized healthcare delivery due to the ease of access to information by patients. However, these technologies also offer an opportunity to promote physician-patient interaction through software applications called smartphone applications (Larsson et al., 2020). Some of the mobile health applications used in asthma management are the physician on-call patient engagement trial (POPET) and the adolescent adherence patient tool (ADAPT). Mobile health applications promote medication adherence and thus improve patient outcomes. Smartphones are generally convenient and efficient to use, making asthma management applications convenient for most people. Poowuttikul & Seth (2020) say these technologies reduce mortalities, improve patient satisfaction, and enhance self-management. The mobile health apps help the patient or caregivers track the medication treatment, document peak flow ratings, and provide reminders to enhance medication adherence and avoid triggers. However, some patients can find these reminders annoying or redundant. Seldom, the exists FDA regulations and guidelines on the use of these technologies (Poowuttikul & Seth, 2020). Therefore, usability constraints can limit their uptake. Security concerns such as phone theft or loss can jeopardize the safety of patient information. The cost-effectiveness of these technologies is also low due to the high cost of smartphones. Moreover, these applications often require an internet connection that can be costly to sustain for patients in low socioeconomic populations.
Smart and Digitally-enabled Technologies
The most common digitally-enabled technologies are digitally-enabled inhalers or smart inhalers. These technologies are becoming increasingly available for use among patients who require continuous long-term care. These technologies can be used to monitor medication use among these patients by monitoring time, date, and inhalations number (Mosnaim et al., 2021). Smart inhalers can also be connected to mobile health application systems to improve remote monitoring of care. Therefore, digitally-enabled inhalers can be used to provide information to modify and improve regimens. Tailoring self-management interventions is thus possible (Larsson et al., 2020). Examples of smart inhalers include but are not limited SmartMist Propeller, SmartTrack device, Doser, and MDILog (Poowuttikul & Seth, 2020). Smart inhalers improve patient satisfaction by improving the efficiency of care. However, they have questionable long-term compliance issues among users.
Phone Message Service Technologies
Phone messaging services such as short message services (SMS) are among the most commonly used and most basic remote health services (Larsson et al., 2020). SMS can be used to monitor the management of patients. Examples of SMS include personalized test messaging and automated text messaging. Automated text messaging can be sent out at a standard time every day to remind the patient or provide daily updates. These messages promote medication adherence and reduce morbidity. However, some patients report annoyance or redundancy of the message reminders. Therefore, controller adherence declines over time (Ferrante et al., 2021). Moreover, providing comprehensive care through short text messages is not feasible.
Social Media
The use of social media in healthcare has been marred with controversies and opportunities to improve care and health education. Social media technologies include Facebook, Twitter, LinkedIn, Pinterest, YouTube, Google +, and Instagram. These technologies require web-based or smartphone technologies to promote interaction between patients, their caregivers, and healthcare professionals. Social media has been used to provide asthma education, public awareness, and preventive health advertisements. Therefore, social media provide social connectivity, promotes feedback, and increases public education. This technology is low-cost and available to many people. However, privacy and security of protected health information are major issues with social media use. Cyberbullying is also a disadvantage of social media use. Social pressure from social media is also another way that this technology can disadvantage the mental health of the public and asthma patients.
Role of Care Coordination and the Utilization of Community Resources
Care coordination aim at bridging the gap between the patient, caregivers, and health care professionals. As the main care coordinator, the nurse deliberately collects pertinent patient information and shares it with relevant providers of direct and indirect care for smooth care continuity. Practice-based models have an essential role in care coordination for asthma patients. Unscheduled hospitalizations among asthma patients result from frequent asthma attacks and poor control of asthma symptoms. With coordinated care, these hospitalizations can reduce significantly. African American and Latino children face the highest burden of pediatric asthma. These disparities arise from low socioeconomic status and lower income (Homaira et al., 2022). Care coordination can achieve a reduction in these disparities by connecting the patients to community resources and healthcare providers to improve access to care.
The management of asthma has changed and improved over time. However, the implementation of national and international guidelines is still erratic, especially in primary care. Care coordination in the community and primary care settings can promote the implementation of the guidelines to reduce health disparities and achieve national goals (Dubaybo, 2021). Utilization of community resources has huge cost implications for asthma patients and their families. The use of community resources such as community pharmacies makes the cost of access to medication and refills cheaper. Community resources can also reduce the burden on caregivers and the risk of unplanned caregivers because asthma patients can access community resources such as daycare services and community emergency services.
Role of Health Policies
National policies such as the Affordable Care Act (ACA), Health Insurance Portability and Accountability Act of 1996 (HIPAA), and Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 are influential in the technology use, care coordination, and use of community resources to promote management of asthma. ACA provided programs and policies that changed the roles of healthcare professionals in the hospital and the community. This ensured that patients received quality care through access to care through health insurance and engagement of hospitals to strive to reduce unscheduled readmissions. Sharing of protected patient information has been regulated by the HIPAA and HITECH policies, thus ensuring the protection of patient confidentiality and data privacy.
At the state level, state boards of nursing standards determine the scope of practice for nurses. This regulation determines what nurses can legally perform on asthma patients. Referral and care coordination are included in the practice standards and scope of practice for nurses, enabling nurses to collaborate with other healthcare professionals and patient caregivers to coordinate care and improve the utilization of community resources. Local policies by the state department of health regulate environmental health that improves asthma preventive care. This is important to nurses because these policies determine the use and distribution of community resources for asthma patients.
Conclusion
Healthcare technology has become an integral part of the management of chronic diseases such as asthma. The various technologies discussed included web-based technology, mobile health applications, digitally-enabled technology, text messaging, and social media. The common themes from the review of these technologies were the promotion of patient satisfaction and remote care. Care coordination can reduce health disparities and reduce unscheduled hospitalizations. National and state-based regulations determine care coordination and utilization of community resources. ACA, HIPAA, and HITECH were the identified influential policies

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References
Dubaybo, B. A. (2021). The care of asthma patients in communities with limited resources. Research and Reports in Tropical Medicine, 12, 33–38. https://doi.org/10.2147/RRTM.S247716
Ferrante, G., Licari, A., Marseglia, G. L., & La Grutta, S. (2021). Digital health interventions in children with asthma. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology, 51(2), 212–220. https://doi.org/10.1111/cea.13793
Homaira, N., Dickins, E., Hodgson, S., Chan, M., Wales, S., Gray, M., Donnelly, S., Burns, C., Owens, L., Plaister, M., Flynn, A., Andresen, J., Keane, K., Wheeler, K., Gould, B., Shaw, N., Jaffe, A., Breen, C., Altman, L., & Woolfenden, S. (2022). Impact of integrated care coordination on pediatric asthma hospital presentations. Frontiers in Pediatrics, 10, 929819. https://doi.org/10.3389/fped.2022.929819
Larsson, K., Kankaanranta, H., Janson, C., Lehtimäki, L., Ställberg, B., Løkke, A., Høines, K., Roslind, K., & Ulrik, C. S. (2020). Bringing asthma care into the twenty-first century. NPJ Primary Care Respiratory Medicine, 30(1), 25. https://doi.org/10.1038/s41533-020-0182-2
Mosnaim, G., Safioti, G., Brown, R., DePietro, M., Szefler, S. J., Lang, D. M., Portnoy, J. M., Bukstein, D. A., Bacharier, L. B., & Merchant, R. K. (2021). Digital health technology in asthma: A comprehensive scoping review. The Journal of Allergy and Clinical Immunology in Practice, 9(6), 2377–2398. https://doi.org/10.1016/j.jaip.2021.02.028
Paoletti, G., Melone, G., Ferri, S., Puggioni, F., Baiardini, I., Racca, F., Canonica, G. W., Heffler, E., & Malipiero, G. (2021). Gastroesophageal reflux and asthma: when, how, and why. Current Opinion in Allergy and Clinical Immunology, 21(1), 52–58. https://doi.org/10.1097/ACI.0000000000000705
Poowuttikul, P., & Seth, D. (2020). New concepts and technological resources in patient education and asthma self-management. Clinical Reviews in Allergy & Immunology, 59(1), 19–37. https://doi.org/10.1007/s12016-020-08782-w

In a 5-7 page written assessment, assess the effect of the patient, family, or population problem you\’ve previously defined on the quality of care, patient safety, and costs to the system and individual. 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 your first two practicum hours.

Introduction
Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Health care organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.

Preparation
In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety, and costs to the system and individual. 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 research of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.
Review the Practicum Focus Sheet: Assessment 2 [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
Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. 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 2 [PDF] provided for this assessment to guide your work and interpersonal interactions.

Part 2
Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.

Whom did you meet with?
What did you learn from them?
Comment on the evidence-based practice (EBP) documents or websites you reviewed.
What did you learn from that review?
Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?
Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?
What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
What changes, if any, did you make to your definition of the problem, based on your discussions?
What might you have done differently?
Capella Academic Portal
Update the total number of hours on the NURS-FPX4900 Volunteer Experience Form in Capella Academic Portal.

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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.

Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Cite evidence that supports the stated impact.
Note whether the supporting evidence is consistent with what you see in your nursing practice.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.
Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.
Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
Use paraphrasing and summarization to represent ideas from external sources.
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:
A title page and reference page. An abstract is not required.
Appropriate section headings.
Length: Your paper should be approximately 5–7 pages in length, not including the reference page.
Supporting evidence: Cite at least 5 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 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.
Explain how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual and document the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
Competency 5: Analyze the impact of health policy on quality and cost of care.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Competency 8: Integrate professional standards and values into practice.
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.