ETHICS IN CARE COORDINATION

[Virtual Presenter] Welcome . Student Name Institution Date.

[Audio] Care coordination is a critical element of healthcare systems inherent in the operation of the multidisciplinary teams involved in ensuring holistic, comprehensive, and continuous health coverage. Care coordination is a deliberate process, although it is effectively guided by policies at the federal, state, and local levels. In addition, organizations often develop their own protocols to facilitate interdisciplinary collaboration. The deliberations of every healthcare provider involved in care coordination require a duty to themselves, the consumers, and the institutions that support professional practice. The broad scope of care coordination includes ensuring there is teamwork and patient-centeredness in the utilization of resources and the operationalization of policies and guidelines for quality healthcare. Care coordination is a critical avenue for realizing the triple bottom line, where the healthcare system is supposed to assure consumers safe and quality care that is cost-effective. Care coordination is also an avenue for actualizing accountability and sharing responsibility across multiple stages and agencies involved in meeting patient, family, and community healthcare needs. Care coordination is therefore an evidence-based approach to measuring and improving the effectiveness and efficiency of the healthcare system in providing high-quality and safe care to citizens..

[Audio] The Affordable Care Act (ACA) focuses on care coordination with respect to quality improvement and payment effectiveness to ensure there are cost savings in Medicaid-Medicare services. In particular, the ACA has policies that ensure there is continuity between clinical and community healthcare settings. The ethical focus of the ACA is patient-centeredness and teamwork in care coordination. Under Section 3502, there are guidelines that require the various care teams to collaborate in quality-driven care plans that ensure continuity of health in communities. Some of the fundamental ethical concerns of the ACA include the cultural appropriateness of services to ensure patient-centered care through the coordination of standards and complementary and alternative medical services. The ACA also ensures that coordinated efforts are measured for effectiveness, health promotion, and the support of all the stakeholders involved in Medicare and Medicaid services (Care Coordination in the Affordable Care Act, 2012)..

[Audio] During care coordination, communication is a critical component of collaboration. Coordination of care often happens between healthcare organizations that categorically collect and store protected health information. As a reminder, protected health information is any healthcare information that can be traced to an actual person due to the presence of the 18 identifiers of protected health information and is collected during a treatment process. It is only natural that the coordination of care will involve stakeholders within the clinical setting and within the community setting. To ensure continuity of care, organizations and professionals must exchange information, therefore invoking the HIPAA privacy rule. During the disclosure of information to ensure continuity of care, many ethical dilemmas can arise because, in addition to HIPAA privacy rules, the HHS also requires that care coordinators limit disclosure to the minimum reasonable amount of protected health information. If you recall that care coordination also preserves patient-centeredness, it seems plausible to share all the information that would ensure patient needs are covered. Consequently, the Notice of Proposed Rulemaking (NPRM) was issued in 2021 to overcome the inherent ethical complications that HIPAA presents to care coordination, courtesy of the Office of Civil Rights (OCR)..

[Audio] The nurse is bound by the ethical considerations that fall within her nursing competencies. As a nurse in coordination of care, the code of ethics for nurses is the most dynamic ethics guideline that allows adaptation of care coordination modalities within the social context of any community setting. Within the nine provisions of the nursing code are guidelines on duty to oneself, other nurses, consumers, peers, and society. There are three ethical dimensions for a nurse involved in care coordination, including commitment to nursing professionalism as a provider, loyalty, and duty as a member of a healthcare system institution and as a private member of the community. TheInternationall Council of Nurses supports the code of ethics for nurses, providing overarching obligations that integrate with local laws that govern coordination of care in all settings that deploy nursing professionalism. The World Health Organization also supports ethical practice in care coordination through the Framework on Integrated People-Centered Health Services (IPCHS) to allow the transformation of care coverage to be universal and people-oriented in care collaboration between organizations, systems, and providers in meeting the comprehensive needs of diverse communities..

[Audio] As a nurse involved in care management, there are decisions that will raise conflicting ethical situations because of the duty to provide services and the obligation to put the patient first as much as possible. In situations such as the recent COVID-19 outbreak, the high demand for resources can create shortages, which puts a lot of pressure on care coordination. There are administrative and professional obligations expected of the nurse, which means that there will be professional judgments at the nurse's discretion. You have to be loyal to your patients, the healthcare organization, the families, and the community at large. Through ethical policies, you can determine the limits of your responsibility and level of accountability when some decisions are overruled by other decision-makers. One of the scenarios you would encounter is the obligation to notify other care services in cases where vulnerable populations, private lives, laws, and policies coincide..

[Audio] Care coordination must strive for patient-centeredness in all care processes. It is important for nurses to keep in mind that PCC is distinguished by a focus on the patient as opposed to the illness. The patient is therefore a bio-psycho-social entity that demands care and continuity of care in all these dimensions of health. Three themes dictate how ethical policies can be applied to ensure PCC. The first is holism because care has to extend to all areas of a patient's life, such as economic, social, and family life, because they can be sources of illness or cause disparity in accessing health care services. The second is personal relationships in therapeutic contexts and outside, based on the continuity of care pathways and the individual narratives of caregivers and patients. The third theme is shared decision-making, since quality medical services are now known to be based on interdisciplinary practice. Within these themes, many ethical conflicts can arise in the pursuit of patient-centeredness and duty to policy guidelines..

[Audio] The quality of therapeutic relationships is an important determiner of the quality of treatment processes. Within a comprehensive and therapeutic encounter, there is a lot of familiarity that patients and their families develop with caregivers, necessitating limits to the level of disclosure. Details such as sexual orientation, marital, and family conflicts are likely to be exchanged between a caregiver and other stakeholders. The information is likely to be shared through informatics systems that also raise ethical issues regarding privacy and security of information. HIPAA provides definitive guidance on protecting protected health information. In the pursuit of patient-centered care, there may be the temptation to over-engage the patient, leading to reverse quackery. This is a situation where caregivers find themselves addressing non-medical concerns in the process of seeing the patient as a whole being with complex needs. The ultimate ideal in the end is to ensure there is professional egalitarianism and extending equal rights to all patients and themselves..

[Audio] If the professionals do manage to form mutually beneficial relationships in the course of care coordination and treating their patients, there are conflicts that can arise in the ethical dispositions assumed within these personal relationships. To avoid getting caught up in limited relationships, always ensure that the foundation of each relationship is the patient narrative. The context of that narrative is limited within the scope of care needed and professional limitations of competence, and it is extended with each new contact along the clinical pathways. Each member of the interdisciplinary team should collaborate to broaden the view, using their specialization to strengthen the teamwork. No matter how satisfying the personal relationships become, each collaborator must remember to protect themselves from unsustainable relationships that fall outside the patient narrative..

[Audio] Patient-centered care advocates for shared decision-making among informed stakeholders. This is one of the reasons informed consent is a critical part of quality healthcare processes: to ensure the patient, who is at the core of the care coordination process, is empowered to participate in shared decision-making. All stakeholders must therefore ensure they involve others by sharing the necessary information necessary to ensure continuity of care, preserve autonomy, and promote collaboration and non-discrimination in decision-making. While the primacy of the patient should not be questioned, there should be a justified contribution in their care pathways to allow care managers and other professionals to apply defensible decisions that do not raise ethical issues..

[Audio] In conclusion, the most important elements in care coordination and the ethical considerations that must be part of every professional's decision-making process include focus on the policy guidelines at the international, national, local and organizational level. The second focus is on person centered care, collaboration among the various teams of professionals, quality and continuity of care..

[Audio] Thank you. . References. Alder, S. (2023). HIPAA Continuity of Care. The HIPAA Journal. https://www.hipaajournal.com/hipaa-continuity-of-care/#:~:text=HIPAA%20continuity%20of%20care%20is,guidance%20on%20minimum%20necessary%20disclosures. Hansson, O., & Fröding, B. (2020). Ethical conflicts in patient-centred care. Clinical Ethics, 147775092096235. https://doi.org/10.1177/1477750920962356 International Council of Nurses. (2021). ICN Code of Ethics for Nurses. Retrieved December 18, 2023, from https://www.icn.ch/sites/default/files/2023-06/ICN_Code-of-Ethics_EN_Web.pdf Tønnessen, S., Ursin, G., & Brinchmann, B. S. (2017). Care-managers’ professional choices: ethical dilemmas and conflicting expectations. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2578-4.