NURS-FPX 6612 Health Care Models Used in Care Coordination ​​​​​​​Patient Discharge Care Planning

Longitudinal, Patient-Centered Care Plan

To ensure Marta Rodriguez receives comprehensive, patient-centered care, the interdisciplinary team will employ Health Information Technology (HIT) components to enhance communication and coordination across her care journey. These HIT elements encompass electronic health records (EHRs), secure messaging platforms, telehealth technology, and medication reconciliation tools. EHRs will facilitate real-time access and updates to Marta’s medical records, enabling the development of a comprehensive care plan (Schwab et al., 2021).

Secure messaging platforms will streamline communication among team members, particularly regarding changes in Marta’s condition, appointments, and medication schedules (Flickinger et al., 2022). Telehealth technology will enable remote monitoring of Marta’s vital signs, enabling early intervention (Chowdhury et al., 2020). Additionally, medication reconciliation tools will ensure the accuracy of her medication list, thereby reducing medication errors.

NURS FPX 6612 Assessment 3 Patient Discharge Care Planning

To prevent Marta’s readmission within 48 hours after discharge, the inter-professional team must ensure Marta receives adequate education, support, and follow-up care (Oksholm et al., 2023). The utilization of HIT elements can bolster these efforts. For instance, telehealth technology can monitor Marta’s post-discharge progress, offer virtual support, and identify potential issues that might lead to readmission. Furthermore, secure messaging platforms can provide Marta with timely and accurate information regarding her medication and follow-up appointments.

Meanwhile, the incorporation of these HIT elements will promote care coordination for Marta by fostering communication and collaboration among team members. Access to uniform information about Marta will enable the development of a comprehensive care plan. Furthermore, EHRs will permit team members to track Marta’s progress, ensuring that she receives appropriate care throughout her recovery. By harnessing HIT elements, the inter-professional team can deliver a patient-centered, coordinated, and effective care plan tailored to Marta’s unique needs.

Data Reporting

Data reporting holds immense significance in the healthcare industry, shaping care coordination, administration, clinical efficiency, and interdisciplinary innovation in treatment. In Marta Rodriguez’s case, data reporting pertaining to her behaviors can enhance the quality of her care and support her recovery in three key ways:

Care Coordination: Data reporting can facilitate care coordination among inter-professional team members by providing a shared understanding of Marta’s condition and progress (Brooks et al., 2020). For instance, data on Marta’s medication adherence, vital signs, and symptoms can be reported through EHRs or secure messaging platforms, enabling effective collaboration in her care management and reducing the risk of complications or readmissions.

Care Management: Data reporting can shape care management by identifying areas where Marta may require additional support or interventions. Information on her pain levels, mobility, and nutritional status, for example, can be reported to the team, allowing them to adjust her care plan as needed to improve its quality and enhance her recovery.