Registries And Disease Management Nursing Essay Assignment Paper
Registries And Disease Management Nursing Essay Assignment Paper
Union Health Center (UHC) embraced the patient-centered care team model very early on, which helped ease the transition to new workfl ows, processes, and features that are critical to change management and quality improvement. UHC clinicians and staff members are assigned to clinical care teams, composed of physicians, nurse practitioners, physician assistants, nurses, medical assistants, and administrative staff members. The practice uses a full capitation model with standard fee-for-service and a fee-for-service plus care management payment model. Ten years ago, UHC instituted the California Health Care Foundation’s Ambulatory Intensive Caring Unit (AICU) model, which emphasizes intensive education and self-management strategies for chronic disease patients. The model relies heavily on the role of medical assistants (called patient care assistants or PCAs) and health coaches. Working closely with other members of the care team, PCAs and health coaches review and update patient information in the record, conducting personal outreach and self-management support, and providing certain clinical tasks. For instance, all PCAs have been trained to review measures (e.g., HgbA1C, blood pressure, and LDL cholesterol), provide disease education, and set and review patient health goals. A subset of higher- trained health coaches works more intensely with recently diagnosed diabetic patients or those patients whose condition is not well managed.
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