A gap in quality related to care coordination for individuals with chronic illnesses
Institutional Affiliation
The Institute of Medicine has identified care coordination as a fundamental strategy in improving the safety, effectiveness, and efficiency of the United States’ healthcare system. However, the United States healthcare system experiences persistent deficiencies and significant disparity in healthcare quality and patient safety (Lu et al., 2020). Although several factors may illuminate the continuous variation and poor performance, one of the most common beliefs is that improving care coordination can decrease the disintegration of patient care, result in better healthcare quality, and possibly reduce the cost of care.
The disparity between healthcare outcomes seen in practice and those possibly available based on the present professional knowledge is common in care coordination for people with chronic illnesses. The number of individuals in the United States with chronic illnesses keeps increasing, and it is expected to reach 171 million by 2030 (Lu et al., 2020). Even though the prevalence of chronic illnesses increases with age, a large percentage of chronically ill are below 65 years old, and they are covered under private insurance. However, individuals with low socioeconomic status with chronic illnesses face numerous challenges when it comes to seeking healthcare because it is costly, they can barely afford food, and whenever they have money, they consider purchasing food rather than seeking healthcare.
Historically, the health of individuals with low socioeconomic status has been pushing public health advances in the United States. Gaps in quality care in chronic illnesses have been there since time immemorial. Managing chronic illnesses is not only costly to individuals with low income but also individuals who are beneficiaries of public health insurance programs (Tapper et al., 2016). Socioeconomic background affects a person’s ability to access the healthcare they need, the kind of care they require, and how they get the care they require.
Low socioeconomic status is a vital determinant of healthcare access. Individuals with low incomes have a higher likelihood to be uneducated, uninsured, or recipients of Medicaid, have poor healthcare quality, and are less likely to seek healthcare, and when they do, it is usually due to emergency. Individuals with higher education usually understand their chronic illness and the care required to treat it and perfectly manage their illness and treatment (Lu et al., 2029). Additionally, educated individuals are more willing to continue with their treatment, as indicated by the doctor. However, the uneducated are usually tentative and less proactive with their treatment plan, which could mean they are not aware of the importance of the treatment or they cannot afford the recommended treatment.
Besides, lack of insurance among these individuals prevents them from receiving quality care because they cannot afford it. It prevents them from receiving preventive care and only seek care when their conditions have worsened (more advanced stages). If the cost of care cannot be made affordable to everyone, the implications will be unbearable. For instance, there will be an increase in morbidity and mortality, communicable diseases, lower productivity, and staggering healthcare costs in the future.
Existing initiatives
There are numerous trials in overcoming the difficulties in improving the safety and quality of healthcare in the United States. Currently, the quality improvement initiative aims to accomplish the quadruple aim of improving patient experiences and outcomes, improving population health, reducing the cost of care, and enhancing the experiences of healthcare providers. In this case, the quality improvement initiative attempts to reduce the per capita cost of care, making it affordable to everyone. This initiative came about because of the increased morbidity and mortality rates among individuals in low-income areas, poor working conditions for care providers, poor patient outcomes, and higher costs of care (Hill et al., 2020). The Institute introduced the quality improvement initiative in 1996 for Healthcare Improvement.
Funding the quality improvement initiative requires resources such as government grants and subsidies, stakeholder contributions, business incubators, and healthcare unions. Although the quality improvement initiative is doing its best to achieve its goals, it faces challenges that hinder it from meeting its intended purpose, thus increasing patient safety and quality issues. These challenges include difficulties persuading the public and healthcare providers that there is an issue relevant to them, difficulties persuading them that the chosen solution is the best, getting the right monitoring and data collection systems, influences of organizational cultures, leadership issues, lack of healthcare personnel participation, and the risk of unexpected consequences.
Healthcare quality is not heavily regulated. The quality improvement initiative is regulated by the federal healthcare quality improvement Act approved by Congress in 1986. It was developed to protect physicians and nurses from harsh work conditions to improve the quality of care they provide to patients. Besides, the primary intention was to make sure that patients receive safe and high-quality healthcare. The quality improvement Act is important since it protects healthcare providers from liability in the sound belief that the Act was in the continuance of healthcare quality (Hill et al., 2020). This Act is being addressed at the federal government level, where the federal government is relying widely on regulatory stratagems to address healthcare quality concerns. Additionally, the quality improvement Act has a possibility for multiple levels of regulation.
Attempts to improve safety, efficiency, and quality of healthcare delivery have always aimed to changing methods to how services are structured and delivered. Quality improvement initiative has proved effective in improving the quality of care, patient safety, and improving the healthcare providers’ work environment. Although quality improvement initiatives focus on reducing healthcare per capita cost, it has not succeeded in that as the cost of healthcare keeps increasing, and it is expected to increase as healthcare becomes costly. This has hindered many chronically ill patients from seeking and receiving quality care, thus increased morbidity and mortality. Quality improvement initiative is associated with regulations like the federal healthcare quality improvement Act approved by Congress in 1986, and it ensures that healthcare systems work towards providing patients with quality care despite their socioeconomic background. This initiative aligns with other healthcare initiatives to ensure patients receive safe and quality care. There are no conflicting interests reported.
Hill, J. E., Stephani, A. M., Sapple, P., & Clegg, A. J. (2020). The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review. Implementation Science, 15(1).
Lu, S. J., Kao, H. O., Chang, B. L., Gong, S. I., Liu, S. M., Ku, S. C., & Jerng, J. S. (2020). Identification of quality gaps in healthcare services using the SERVQUAL instrument and importance-performance analysis in medical intensive care: a prospective study at a medical center in Taiwan. BMC Health Services Research, 20(1).
Purnell, T. S., Calhoun, E. A., Golden, S. H., Halladay, J. R., Krok-Schoen, J. L., Appelhans, B. M., & Cooper, L. A. (2016). Achieving Health Equity: Closing The Gaps In Health Care Disparities, Interventions, And Research. Health Affairs, 35(8), 1410–1415.
Tapper, E. B., Finkelstein, D., Mittleman, M. A., Piatkowski, G., Chang, M., & Lai, M. (2016). A Quality Improvement Initiative Reduces 30-Day Rate of Readmission for Patients With Cirrhosis. Clinical Gastroenterology and Hepatology, 14(5), 753–759.

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