Concept Analysis

CONCEPT ANALYSIS

MAJDA

Concept Analysis

Introduction

Healthcare systems are formulated to promote health and reduce risk. As part of the policy extension towards the health institutions, policymakers encourage clinical integration to extend the health services towards all within the state. Clinical integration is, therefore, part of the initiative to provide effective population health. Clinical integration refers to the coordination and unified system of delivering healthcare within a healthcare organization. Clinical integration is not specified to certain practices or norms; however, it is bound by certain aims and goals which shall be central to the practice of clinical integration. The main aims of clinical healthcare are to ensure improved quality of healthcare, controlled or limit the cost of care and equitable access to care and service experience to the patient. Therefore performance management stands as a foundation to the clinical integration, clinical integration towards population health. The performance management refers to compliance of physicians, nurses and other healthcare staff deliver their professional and expert service in an efficient and equitable manner CITATION Gil92 \l 1033 (Gillies, Shortell, Anderson, Mitchell, & Morgan, 1992). The basic aim of healthcare management is to pursue healthcare objectives by providing valued care. Therefore it is essential to offer quality healthcare and patient satisfaction through care management. The concept refers to managing data management, patient engagement, and coordination of care; performance measurement and stratification of patients CITATION Eli19 \l 1033 (Elina Farmanova, 2019).

Terms and Domains of the Concept

There are certain terms and domains the performance management and care management that are vital to their operation and implementation CITATION Eli19 \l 1033 (Elina Farmanova, 2019). The core terms and domain care management is associated are as follows;

Integrated Care;

It refers to the ideals of a well-coordinated and collective care ensured by the physicians, nurses and health care staff. It is encouraged by effective communication between them not only in one unit or facility but also to other facilities across the country. Integrated care is promised through shared patient’s health records information.

Population Health,

The target population that extends to all and everyone for healthcare policy is referred to as population health.

Determinants Of Health

The health care management takes under consideration the social, economic and physical determinants with regard to the needs of the patients.

Efficiency

Improved performance and quality assurance lead to efficiency in health care management.

Real Time

With the integration of patient’s previous data regarding diagnoses, lab test treatments, and prescriptions aids in delivering real-time adjudication by health care management.

Prevention

A competent care management mechanism reduces health risks and prevents diseases and readmissions.

Equity

The health care management system discourages partiality or distinction between the patients. The healthcare providers are compelled to provide equitable healthcare delivery to those in need of them.

Integration

The health care management is a multidisciplinary approach it incorporates different healthcare disciplines and stretches outside the discipline to information technology and social services.

Attributes

Care management is imperative for healthcare facilities. Health care management is an instrument to assess the performance of the staff against the patient experience and satisfaction. It focuses on providing health care to the population by establishing strategies to gain better outcomes. The attributes that the care management mechanism is built upon resolving issues and overcome challenges that halt the process CITATION JLa05 \l 1033 (J Lavis, 2005). The management ensures that there is sufficient data to identify risks and diagnose and stratify the patients according to their health needs. It focuses on the overall functions to develop practice in order to inform the patients of their treatments. Overall measurement of performance is also an essential component of any care management program. The attributes of care management programs are followed;

Data Integration

The data integration reflects upon collection of clinical information, socio-economic data, and claims of the patient.

Patient stratification

This attributes that patients are categorized and prioritized on the basis of the severity of their health needs, risks, and treatments they require.

Care Coordination

The physicians and nurses coordinate in order to formulate care plans, interpret assessment reports and treatment options. The care coordination also incorporates patient-reported outcome measurements to instill better synchronization amongst the patient and healthcare staff.

Patient Engagement

This attribute holds the knowledge, ability, willingness and skills of the patient to manage his own health. Healthcare management collaborates with the staff to achieve better health outcomes.

Performance measurement

Strategies and performance based on applied methods, processes and outcomes by the professionals also attribute to effective performance measurement.

Care Management Model

The Allina Health is a facility which has incorporated and introduced care management in cardiology care. Effective care management at Allina is known as the Heart Failure Management Program. It is formulated and designed to overcome challenges and identify gaps in healthcare delivery to cardiac patients. The complexity of healthcare systems involving treatment, costs, time and diagnoses are administratively handled by the facility. The primary focus areas of this program are nursing care, guidelines, electronic health records, protocols, performance measurement, management plan, reporting, and patient education. The teams are led by cardiologists, there are nurses specifically allocated to HF patients. This helps them identify patients with a higher and higher need for care. The nurses are responsible for the patients care plans, their implementation and ensuring patient care post discharge. Moreover, the patients are regularly called for follow-ups, their health status is updated, and any gaps that are linked to health care are regularly filled with the help of physicians, social service specialists, and the health systems. HF care management promotes cardiac health through informed and collective decision making, effective communication; all reflective of a patient’s health status. Such management plans offer patient satisfaction and consequently healthy results.

Impacts of Integrated Care Management

Integrated care management involves management strategies and tools that have a great impact on the overall working of a health facility. The sufficient implementation and application of strategies involve positive outcomes. The impact of the integrated healthcare systems reduces the time involved prior to the treatment of the patient. The presence of a patient's past information treatments and diagnoses helps in delivering timely treatment especially to those patients who are in critical conditions CITATION DLK02 \l 1033 (DL Kodner, 2002). This also provides sufficient time for the patient and physicians to create a bond between them and examine more patients. Integrated care management produces positive outcomes which lead to a significant decrease in the readmissions CITATION OGr01 \l 1033 (O Gröne, 2001). The reduction in readmissions is a result of timely diagnoses and treatment through coordinated care. This also decreases the overall costs involved both by the patient and the hospital. The cut in costs can be used to promote further research and buying improvised technology. Integrated care management is a multidisciplinary approach in healthcare which reduces the health risks and promises patient satisfaction. Healthcare management achieves population health through promising administrative controls.

Summary

In order to achieve an all-inclusive and comprehensive strategy towards the population health, many strategies and multiple design models are formulated. Clinical integration is one of the most definitive approaches due to first-hand exposure and research towards achieving the goals. Clinical goals sustain performance management core to its ideals, while performance management holds care management essential to its enactment. Care management is a coherent approach towards achieving coordinated care that reduces risks, costs and time. This improves health delivery through all continuums equitably and attains patient satisfaction.

References

BIBLIOGRAPHY DL Kodner, C. S. (2002). Integrated care: meaning, logic, applications, and implications–a discussion paper. International journal of integrated care.

Elina Farmanova, G. R. (2019). Combining Integration of Care and a Population Health Approach: A Scoping Review of Redesign Strategies and Interventions, and their Impact. International Journal on Integrated Care.

Gillies, R. R., Shortell, S. M., Anderson, D. A., Mitchell, J. B., & Morgan, K. L. (1992). Conceptualizing and measuring integration: Findings from the health systems integration study. Hospital & Health Services Administration; 467.

J Lavis, H. D. (2005). Towards systematic reviews that inform health care management and policy-making. Journal of Health Services Research and Policy.

O Gröne, M. G.-B. (2001). Integrated care. Journal of Integrated Care.