Care Coordination – Why It’s the Core of Comprehensive Health Care

Care coordination is not a new concept, but it has been garnering a lot of publicity over the last several years because of the 1999 Institute of Medicine (IOM) report To Err is Human: Building a Safer Health System. We sat down to speak with core faculty member at Capella University and 26-year nursing professional Marie-Elena Barry, DNP, RN, to discuss some of the basics of care coordination and why it is such a vital component of comprehensive health care at large.

What is care coordination?

Care coordination describes the career of a nurse who communicates, collaborates, and focuses on teamwork to meet patient needs, improve patient safety and outcomes, reduce medical waste, and effectively manage costs.

Care coordination is the orchestration and management of patient care across the health care continuum; and is geared towards individuals, communities and populations that require education, medication management, and assistance with chronic and complex medical conditions. Coordinated care is an essential aspect of the nursing process and is directed towards patients at all ages and at any stage of life. One goal of coordinated care is to promote health and wellness, to teach individuals how to manage their own care.

Has it become more important? Why?

Over the last couple of years, governmental and regulatory agencies discussed how miscommunication, and the lack of communication and collaboration between health practitioners and providers decreases patient safety,  increases patient costs, and creates a great deal of medical waste and redundancy.

Therefore, by communicating, collaborating, and using a more team-based approach, patient safety and patient outcomes are improved. Effective care coordination uses data to determine the effectiveness of care. Technology helps in coordinating care by using correct patient information which reduces errors and complications. It’s also best practice: There is a great deal of evidence-based practice that drives health care, and best practices support comprehensive patient care.

What does being a nursing care coordinator entail?

Excellent communication. A care coordinator needs to effectively communicate, not just with a physician or primary care provider but with a whole community, and understand the resources that are available. In addition, the care coordinator must recognize the changing landscape of health care today and apply current standards that are outlined by federal policies and regulations.

A care coordinator needs to have expertise, and understand what the resources are in the community, while working closely with both the patient and the family. Years ago, we told the patient the plan of care. Now, it is best practice that the patient is at the center of the care. An essential part of the discovery and planning process involves the family as well. The health care team could come up with a great plan, but if the patient and/or the family don’t buy into the plan, or nobody’s there to execute or understand it, or they can’t afford it, then a meaningful plan for the patient is not going to happen.

Does a nurse need a special degree?

I think to be a leader in care coordination, it would prove optimal to have one.  Earning a higher degree offers a well-rounded educational program that you may not be exposed to without special training. The care coordinator reflects on topics such as patient ethnicity, culture, legal and ethical aspects of coordinated care.  I think with a degree, you become aware of the importance of using a care coordination model for following best practices in this specialty

What type of information can a care coordination student expect to cover?

In the care coordination core at Capella University we are trying to make the coursework meaningful. We ask students to look at a health care organization – one that they’re most familiar with or have access to – and look at specific topics such as the nursing process, data collection, outcome measures, and ethical and legal aspects to name just a few. Care coordination courses examine elements of the Affordable Care Act (ACA) such as hospital readmissions, disease prevalence, and community and population health outcomes.  In addition, Capella utilizes a simulation tool to provide students with data that they use to learn how to collaborate with essential team members such as a health department or with a school system. There are a variety of patient care settings throughout the simulation as not every health care professional works in a hospital.

Do you have advice for nurses who are thinking about a degree in care coordination?

I do! One thing is that if you’re thinking about a degree in care coordination, it’s vital to look for an accredited program. An accredited program is one that follows the guidelines set by national educational regulatory systems. Accredited programs have to follow very stringent guidelines in order to meet educational standards.

What additional information about care coordination do you want Scrubs readers to know?

One of the things I would want Scrubs readers to know is that care coordination is a very exciting part of nursing. The nursing process is used throughout care coordination process. Like the nursing process, coordinated care that is safe and comprehensive is an essential part of nursing, in all aspects, and in all settings.

As you can tell, I am passionate about care coordination. I love it, and it’s a very dynamic field for nurses. Health care organizations and systems need nurses who are dedicated, enthusiastic and passionate about providing the best care for their patients.

Marie-Elena Barry, DNP, RN is a full-time core faculty member in the online MSN program at Capella University School of Nursing and Health Sciences. She is a Clinical Assistant Professor at the School of Nursing at Boise State University. She earned her bachelor’s degree in nursing from The College of Notre Dame in Baltimore, a Business of Nursing degree at John’s Hopkins School of Nursing, her master’s degree in Nursing Administration and Management at Stevenson University, and her Doctor of Nursing Practice degree at Chatham University. Marie-Elena Barry has 26 years of experience in medical and surgical nursing and specializes in case management and care coordination.

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