Sunday December 17th 2017

Staking our claim

ANA promotes nurses’ unique contributions to care coordination

RNs in all practice settings carry out essential care coordination activities every day, working to ensure patients get the right care, at the right time, by the right person. Whether it’s educating patients at the bedside or managing care for a person at home, care coordination is a core competency and standard of nursing. It is what nurses do and what they have done since the very beginning of the profession.

Today, care coordination is in the spotlight. The National Quality Strategy, established as part of the Affordable Care Act, includes care coordination as one of six priorities that guide the nation’s plan for improving health care. In addition, hospitals, health systems, insurers, and others are focused on care coordination as an important tool in providing patients with high-quality and cost-effective care.

“With care coordination as a hallmark of health care reform, it is critical that nurses be formally recognized for this aspect of their practice,” said American Nurses Association (ANA) President Karen A. Daley, PhD, RN, FAAN.  “ANA has consistently promoted initiatives to solidify nurses’ important role in coordinating patient care and to ensure that nurses are appropriately paid for it.”

Setting the stage

In 2012, ANA issued a position statement, Care Coordination and Nursing’s Essential Role, urging the federal government and other health care financing systems to acknowledge and fully fund nurses for the central part they play in providing effective care coordination services.

To complement the statement, ANA released The Value of Nursing Care Coordination, a report that provides a thorough examination of the literature on the benefits of care coordination provided by nurses.

The report highlights the results of numerous studies showing the positive impact of nurse-led and nurse-managed care coordination to reduce emergency department visits and hospital readmissions; lower total annual Medicare costs; and improve patient satisfaction, among many other benefits.

In a big win for nurses, the Centers for Medicare and Medicaid Services (CMS) released a new rule in November 2012 calling for payments to Medicare providers, including nurse practitioners, clinical nurse specialists and certified nurse-midwives, for care coordination services by RNs who effectively manage patients’ transitions from hospitals to other settings. CMS will also create new payment codes for chronic care management services, also largely performed by RNs and APRNs, that reduce costs and improve patient outcomes.

Breaking new ground

Two months later, in January 2013, ANA convened its inaugural professional issues panel to develop a framework that reflects the contribution of nurses in care coordination quality measures. Anecdotes and evidence already exist to support nurses’ contributions.  But as health care moves from a fee-for-service era to a pay-for-quality era, there is an urgent need for universally accepted measures for quantifying these contributions.

Responding to this need, members of the Care Coordination Quality Measures Professional Issues Panel created and released ANA’s Framework for Measuring Nurses’ Contributions to Care Coordination. The panel members included co-chair Ellen Kurtzman, MPH, RN, FAAN, an ANA member who has extensive experience in framework development and care coordination measurement, an expert 12-member Steering Committee, and hundreds of advisory members. “The Framework is a roadmap that can be used to fill important measure gaps in care coordination,” said Maureen Dailey, PhD, RN, CWOCN, panel co-chair and an ANA senior policy fellow.  “It will help identify the best existing measures, as well as concepts for new measure development that reflect nurses’ unique roles in coordinating high quality care.  It can also be used to paint a picture of the measurement environment and establish priorities for short- and long-term measure development.”

The next step is to populate the Framework with existing measures and new measure concepts that reflect nursing’s contributions in care coordination — and to distribute it widely so it can meet its intended goal.

To that end, ANA has requested that CMS disseminate the Framework and use it in all discussions to fill important measurement gaps. ANA also has asked that the National Quality Forum, the Office of the National Coordinator for Health Information Technology and other key organizations in the National Quality Measurement Enterprise do the same. The Framework has already informed participants at ANA’s Ambulatory Care Measurement Summit in January 2014, where experts met with the goal to better define high quality outside the acute care setting and how to measure it effectively.

The sum of many parts

Recently, ANA took a big step forward in highlighting the important role of RNs in care coordination with the publication of the book, Care Coordination: The Game Changer — How Nursing is Revolutionizing Quality Care.

Gerri Lamb

Author Gerri Lamb, PhD, RN, FAAN, brings an experienced and highly respected point of view to the project. Lamb is an associate professor at Arizona State University and an Arizona Nurses Association (AzNA) member with a distinguished background in the complementary areas of care coordination, case management and interprofessional education. She has served as co-chair of several care coordination committees at the National Quality Forum and has worked with many organizations and universities on care coordination initiatives.

Lamb chose to create a comprehensive view of care coordination from many viewpoints rather than just her own. The book’s 23 authors, including Lamb, share powerful examples of evidence-based practice as a part of care coordination efforts at their organizations.

“Care coordination is spoken about with passion and a variety of voices — researchers, academics and bedside nurses — all focused on what nurses can do to serve patients better,” Lamb said.

Divided into four sections, the book provides nurses with a strong foundation for understanding the importance of care coordination; their crucial role in care coordination; the relationship of care coordination roles and quality and safety models; and the development of innovative care coordination models.

Daryl Sharp

Daryl Sharp, PhD, PMHCNS-BC, NPP, an ANA-New York member who co-authored the chapter, Recognizing Care Coordination in Nurses’ Practice with Lamb and ANA-New York member Madeline Schmitt, PhD, RN, FAAN, believes that nurses must heighten their awareness of the care coordination activities they carry out every day in their own practice.

“I think nurses often see many of their care coordination functions as just what they do,” Sharp said. “They don’t see it as a specialized skill, which can enhance their critically important role on health care teams.

“Nurses are experts in care coordination. Being articulate and thoughtful about this vitally important role and function has never been more important than it is now.”

Donna Zazworsky

In the chapter, Community-Based Care Transitions: Coordination Pilot to CMS Program, Donna Zazworsky, MS, RN, CCM, FAAN, vice president of Community Health and Continuum Care at Carondelet Health Network and an AzNA member, thought it important to share the story of how nurses at her facility led a care coordination project funded by CMS to reduce preventable hospital readmissions and improve quality outcomes for persons admitted with heart failure. The project focuses on the Transitional Care Nurse (TCN), whose responsibilities included care coordination for patients in their community setting for up to 60 days.

In a sidebar article illustrating the scope of challenges these nurses face, Amy Salgado, MS, RN, a TCN in the Carondelet project, said, “As a floor nurse you did not get the full picture on how the patient functioned and what the challenges were in their home environment. Patients were often classified as noncompliant when seen in the hospital.  Being able to go into the patient’s home, it became clear that what we were calling noncompliant was far more complicated. The social issues out in the community are huge.”

Said Zazworsky, “I think nurses need to realize the whole picture of how they contribute to care coordination over all — in the community, in the skilled nursing facility and in the provider’s office.”

Steering patients safely through myriad settings and providers, RNs lend their specialized skills in collaboration, interpersonal communication and teamwork to facilitate positive patient outcomes. “My hope is that nurses read this book and think, wow, care coordination is really important work and we’re experts at it,” Lamb said. “If not for our extensive work and commitment, it would not be recognized and in the spotlight today. I think nurses should take great pride in this.”

— Mary Davis is a professional writer.

ANA resources

ANA’s Framework for Measuring Nurses’ Contribution to Care Coordination can be
accessed at http://nursingworld.org/Framework-for-Measuring-Nurses-Contributions-to-Care-Coordination

Order copies of Care Coordination: The Game Changer at www.nursesbooks.org.

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