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Care Coordination Best Practices

The best practices of care coordination involve identifying and addressing any healthcare needs, creating an effective treatment plan, and working collaboratively with other providers to ensure that each patient receives the support and resources they need. A patient's care should be at the forefront, and the care teams and all participants concerned should provide conducive care settings for patient needs.

There are a number of strategies and practices that can be used to effectively coordinate care, including communicating regularly with patients and their families to understand their needs, tracking patient progress and health outcomes over time, utilizing technology tools and other resources to help stay organized, and partnering with other providers in the community to develop coordinated care plans that meet each patient's unique needs.

While there is no one "right" way to provide care coordination, it is critical that providers and accountable care organizations put the needs and well-being of their patients first, utilizing evidence-based care practices to ensure high-quality and effective outcomes for all.

Here are several of the best care coordination practices that can be used to ensure the most effective care for your patients.

 

How Healthcare Providers Can Create Personalized Care Plans

Creating personalized care plans that take into account each patient's unique needs and preferences can include developing individualized goals and strategies, as well as communication protocols with both the patient and their family members or caregivers. Personalized patient plans work to cater to the patient's individual needs with a focus on effective care and positive outcomes. Patient information can also be uploaded to electronic health records for up-to-date patient care, medication management, and other health challenges needing addressing.

Monitoring And Support

Providing ongoing monitoring and support throughout the treatment process may involve checking in regularly with patients to assess their progress and offer any necessary assistance or guidance. This is an instance where electronic health records are beneficial since they offer a streamlined system for providers who are viewing and sharing information with hospitals, primary care providers, home-based care agencies, and other organizations involved in a patient's care. Support and monitoring are especially essential in a patient-centered medical home model so that clinical teams and specialists can provide safe and quality care.

Teamwork And Collaboration

Engaging in regular teamwork and collaboration with other healthcare providers involved in a patient's care, such as physicians, nurses, hospital teams, social workers, and therapists, can help ensure a coordinated, consistent approach to care and minimize any gaps or conflicts in the treatment process. Having a teamwork mindset in these healthcare systems can be valuable in positive health outcomes and patient satisfaction in care coordination.

Evidence-Based Resources

Healthcare teams should utilize evidence-based resources and tools to support care coordination efforts. Examples of these resources may include specialized databases or software applications that can track patient progress over time and identify areas for improvement. Healthcare research is a largely advantageous tool in care coordination since it gives tangible data for patients, providers, and health organizations to share information that can improve quality of life.

Overall, by prioritizing effective care coordination practices, healthcare providers can give the best possible care to their patients and help them achieve their health goals. Let's take a look at some of the strategies involved in coordinated health care.

Strategies For Care Coordination In The Healthcare System

When providing care coordination for patients, there are a number of key strategies and best practices that can help ensure the highest quality of health care. These include cognitive decentering, collaborative decision-making, backup behaviors, and contingency planning.

Cognitive Decentering

By focusing on cognitive decentering, care coordinators can put themselves in their patients' shoes and better understand what they are going through. This allows them to more effectively collaborate with patients on decisions about their treatment and care. When providers consider a patient's health care through the lens of cognitive decentering, more effective care transitions can be provided after their initial assessment.

Collaborative Decision-making

Another important practice in care coordination is collaborative decision-making. This method involves actively engaging patients in discussions about their health needs and goals to ensure that everyone involved has a clear understanding of the treatment plan and helps to build rapport between caregivers and patients. It's helpful to align resources between clinical teams and patients, and it focuses on a patient's complex care needs.

Backup Behaviors

In addition to these strategies, care coordinators should also be prepared to use backup behaviors. This involves having a plan in place for situations where patients need extra support or assistance, such as emergency situations or aid in ongoing illness or chronic conditions. Planning for this may include communication with family members, friends, social workers, or other healthcare providers when necessary for coordinating care. It's always good practice to have a "plan B" for patient care, and it can help to achieve safer health coordination.

Contingency Planning

Finally, by incorporating contingency planning into their care coordination practices, caregivers can help ensure that patient care is at the level they need while minimizing the risk of complications or setbacks. Whether it's anticipating potential challenges with medication adherence or identifying alternative resources in case of an emergency, having a well-thought-out plan in place can make a huge difference in terms of patient outcomes. This is helpful for patients and their loved ones in coordinating care between multiple providers and making arrangements ahead of time for better peace of mind.

While there is no "one size fits all" approach to providing care coordination, these are some of the most effective strategies for helping patients get the care they need and deserve.

Utilizing Forcura For Patient-Centered Coordinated Care

At Forcura, we partner with more than 800 post-acute care organizations to provide workflow management solutions that help them operate more efficiently and focus on delivering high-quality care. Forcura’s technology platform facilitates best practices in care coordination among teams and contributes to more than half a million patients each month experiencing less friction and more positive results in their care. Like the home health, hospice, personal care, and other clients we serve, we believe the role of patients in coordinating care plans with their team should be easy so that the only thing they need to focus on is their health. For more information, check out Forcura today!


 

Topics: Care Coordination

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