RESUMEN
Children with medical complexity experience frequent hospitalizations and pose a unique challenge for the pediatric hospitalist and their healthcare team. Pediatric hospitalists are ideally positioned to champion improved care coordination for CMC and to address the areas of need in clinical practice, quality improvement and research. Lessons learned from programs who were Healthcare Innovation Award recipients from Center for Medicare and Medicaid Innovation that were aimed at improving care for this population are presented. We focused on care coordination activities implemented during hospitalization. Through a series of meetings with the participating programs, we identified common themes across awarded programs. Programs described key aspects of care coordination during the hospital stay, beginning on admission (multidisciplinary team goal setting, family partnership and action planning), through hospitalization (integrating outpatient and inpatient care), as well as during and after discharge (linking to community-based systems and supports, expanding the transition concept). Finally, we present actionable steps for inpatient providers seeking to improve care for this patient population at the time of hospitalization.
Asunto(s)
Distinciones y Premios , Médicos Hospitalarios , Anciano , Niño , Hospitalización , Humanos , Medicare , Alta del Paciente , Estados UnidosRESUMEN
BACKGROUND: With the current emphasis on including registered nurses (RNs) on the primary care teams, it is essential that nursing programs prepare students for employment in these settings. PURPOSE: This study explored the current state of prelicensure and RN-to-Bachelor of Science in Nursing (BSN) online education regarding the implementation of primary care content in the curricula. METHODS: A sample of 1,409 schools and/or colleges from across the United States was invited to participate in an online survey. About 529 surveys were returned for an overall response rate of 37.5%. Summative content analysis was used to analyze survey data. DISCUSSION: Although most respondents have implemented some primary care content, some found it challenging and others have demurred from incorporating primary care content altogether. CONCLUSION: Nursing leaders and faculty in academia must collaborate with clinical partners to design and expand didactic and clinical learning experiences that emphasize primary care content in the prelicensure and RN-to-BSN education.
Asunto(s)
Atención Ambulatoria/organización & administración , Competencia Clínica , Curriculum , Bachillerato en Enfermería/organización & administración , Educación de Postgrado en Enfermería/organización & administración , Licencia en Enfermería/normas , Enfermería de Atención Primaria , Humanos , Rol de la Enfermera , Investigación en Educación de Enfermería , Estudiantes de Enfermería , Estados UnidosRESUMEN
There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered.