Which of the following best describes the method of funding for health care in the united states?

Care coordination in the primary care practice involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care.

The main goal of care coordination is to meet patients' needs and preferences in the delivery of high-quality, high-value health care. This means that the patient's needs and preferences are known and communicated at the right time to the right people, and that this information is used to guide the delivery of safe, appropriate, and effective care.

There are two ways of achieving coordinated care: using broad approaches that are commonly used to improve health care delivery and using specific care coordination activities.

Examples of broad care coordination approaches include:

• Teamwork.
• Care management.
• Medication management.
• Health information technology.
• Patient-centered medical home.

Examples of specific care coordination activities include:

• Establishing accountability and agreeing on responsibility.
• Communicating/sharing knowledge.
• Helping with transitions of care.
• Assessing patient needs and goals.
• Creating a proactive care plan.
• Monitoring and followup, including responding to changes in patients' needs.
• Supporting patients' self-management goals.
• Linking to community resources.
• Working to align resources with patient and population needs.

Why Is Care Coordination Important?

Care coordination is identified by the Institute of Medicine as a key strategy that has the potential to improve the effectiveness, safety, and efficiency of the American health care system. Well-designed, targeted care coordination that is delivered to the right people can improve outcomes for everyone: patients, providers, and payers.

Although the need for care coordination is clear, there are obstacles within the American health care system that must be overcome to provide this type of care. Redesigning a health care system in order to better coordinate patients' care is important for the following reasons:

• Current health care systems are often disjointed, and processes vary among and between primary care sites and specialty sites.
• Patients are often unclear about why they are being referred from primary care to a specialist, how to make appointments, and what to do after seeing a specialist.
• Specialists do not consistently receive clear reasons for the referral or adequate information on tests that have already been done. Primary care physicians do not often receive information about what happened in a referral visit.
• Referral staff deal with many different processes and lost information, which means that care is less efficient.

How Can Care Coordination Be Put Into Action?

Applying changes in the general approach and everyday routines of a medical practice can be overwhelming, even when it is obvious that the changes will improve patient care and provider efficiency. Fortunately, there are resources available for those who are interested in learning how to take a coordinated care approach to primary care practice.

The Care Coordination Quality Measure for Primary Care (CCQM-PC) builds on previous AHRQ work to develop a conceptual framework for care coordination. The CCQM-PC is intended to fill a gap in the care coordination measurement field by assessing the care coordination experiences of adults in primary care settings. It was developed, cognitively tested, and piloted with patients from a diverse set of 13 primary care practices to comprehensively assess patient perceptions of the quality of their care coordination experiences. The CCQM-PC is designed to be used in primary care research and evaluation, with potential applications to primary care quality improvement. Guidance regarding the fielding of the survey is provided in addition to the full survey, which is in the public domain and may be customized and used without additional permission.

Care Coordination Measures Atlas—June 2014 Update. Since publication of the original Atlas in 2011, many new care coordination measures have been developed. Appendix IVa (

Care Management: Implications for Medical Practice, Health Policy, and Health Services Research. Care Management Issue Brief. This issue brief highlights key strategies to enhance existing or emerging care management programs and summarizes recommendations for decisionmakers in practice and policy, as well as for future research.

AHRQ has assembled additional resources to help clinicians, clinical teams, and health care administrators measure care coordination and learn more about how to incorporate care coordination into routine primary care practice. Visit the PCMH Resource Center to view the following papers, briefs, and other resources:

• Care Coordination Accountability Measures for Primary Care Practice.
• The Roles of Patient-Centered Medical Homes and Accountable Care Organizations in Coordinating Patient Care.
• Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms.
• Coordinating Care for Adults With Complex Care Needs in the Patient-Centered Medical Home: Challenges and Solutions.
• Prospects for Care Coordination Measurement Using Electronic Data Sources.

The following AHRQ Annual Conference presentations on care coordination are also available:

Care Transitions: Navigating the Health Care System—2011

Elimination removes the hazard at the source. This could include changing the work process to stop using a toxic chemical, heavy object, or sharp tool. It is the preferred solution to protect workers because no exposure can occur.

Substitution

Substitution is using a safer alternative to the source of the hazard. An example is using plant-based printing inks as a substitute for solvent-based inks.

When considering a substitute, it’s important to compare the potential new risks of the substitute to the original risks. This review should consider how the substitute will combine with other agents in the workplace. Effective substitutes reduce the potential for harmful effects and do not create new risks.

Elimination and substitution can be the most difficult actions to adopt into an existing process. These methods are best used at the design or development stage of a work process, place, or tool. At the development stage, elimination and substitution may be the simplest and cheapest option. Another good opportunity to use elimination and substitution is when selecting new equipment or procedures. Prevention through Design is an approach to proactively include prevention when designing work equipment, tools, operations, and spaces.

Engineering Controls

Engineering controls reduce or prevent hazards from coming into contact with workers. Engineering controls can include modifying equipment or the workspace, using protective barriers, ventilation, and more. The NIOSH Engineering Controls Database has examples of published engineering control research findings.

The most effective engineering controls:

• are part of the original equipment design
• remove or block the hazard at the source before it comes into contact with the worker
• prevent users from modifying or interfering with the control
• need minimal user input for the controls to work
• operate correctly without interfering with the work process or making the work process more difficult

Engineering controls can cost more upfront than administrative controls or PPE. However, long-term operating costs tend to be lower, especially when protecting multiple workers. In addition, engineering controls can save money in other areas of the work process or facility operation.

Administrative Controls

Administrative controls establish work practices that reduce the duration, frequency, or intensity of exposure to hazards. This may include:

• work process training
• job rotation
• ensuring adequate rest breaks
• limiting access to hazardous areas or machinery
• adjusting line speeds

PPE

PPE is equipment worn to minimize exposure to hazards. Examples of PPE include gloves, safety glasses, hearing protection, hard hats, and respirators. When employees use PPE, employers should implement a PPE program. While elements of the PPE program depend on the work process and the identified PPE, the program should address:

• workplace hazards assessment
• PPE selection and use
• inspection and replacement of damaged or worn-out PPE
• employee training
• program monitoring for continued effectiveness

Employers should not rely on PPE alone to control hazards when other effective control options are available. PPE can be effective, but only when workers use it correctly and consistently. PPE might seem to be less expensive than other controls, but can be costly over time. This is especially true when used for multiple workers on a daily basis.

When other control methods are unable to reduce the hazardous exposure to safe levels, employers must provide PPE. This includes:

• while other controls are under development
• when other controls cannot sufficiently reduce the hazardous exposure
• when PPE is the only control option available

Administrative controls and PPE require significant and ongoing effort by  workers and their supervisors. They are useful when employers are in the process of implementing other control methods from the hierarchy. Additionally, administrative controls and PPE are often applied to existing processes where hazards are not well controlled.