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Lack of coordination leads to health care that is fragmented, inconsistent, and poorly planned. Conversely, effective care coordination supports achieving the Quadruple Aim. Care coordination, roles of RNs in care coordination, and implications for healthcare delivery are explored.
Six in ten adults in the United States have a chronic illness and four in ten adults have two or more chronic illnesses. Chronic diseases are the leading cause of death and disability and leading drivers of the nation's $3.3 trillion in annual healthcare costs (National Center for Chronic Disease Prevention and Health Promotion, 2019). Concurrently, the incidence and prevalence of chronic health conditions has increased, with conditions such as diabetes, heart disease, cancer, hypertension, stroke, arthritis, obesity, renal disease, and respiratory diseases leading the way as the most common causes of illness, long-term disability, reduced quality of life, and death (National Center for Chronic Disease Prevention and Health Promotion, 2019; Raghupathi & Raghupathi, 2018). With such a large chronically ill population, the need for improved care is obvious. Individuals with chronic diseases generally receive care by more than one provider in more than one setting, and, too often, their care is not coordinated across the continuum. Within this care environment, medical decision-making occurs in a vacuum without complete information about an individual's condition, health history, medications ordered, care managed, or services rendered. In addition, no one facility is officially responsible and accountable for the individual, meaning no one practitioner takes the lead in making the plan and next steps in care clear. Instead, the job of coordinating care is transferred from the professionals to individuals and their families who are often unprepared to manage the task.
The lack of coordination leads to care that is fragmented, inconsistent, and poorly planned. Medical errors, duplication of tests, and paper shuffling can occur, with results ranging from inconvenient to life-threatening. The lack of coordinated care can also lead to unnecessary emergency room visits and hospitalizations, avoidable readmissions, and excessive resource use causing billions of dollars in wasteful spending each year. In fact, researchers estimate that $25 to $45 billion is spent on avoidable complications and unnecessary hospital readmissions (Burton, 2012).
Conversely, effective care coordination supports achieving the Quadruple Aim: improving the care experience for individuals, improving individual health,...