Difference between revisions of "Care Plan Development"

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Revision as of 15:24, 22 November 2016

A clearly communicated care plan must be developed to ensure a successful health outcome. The following types of care plans

  • Preventive & Wellness - This care plan is typically addressed with the Annual Wellness Visit
  • Episode - This care plan is developed in the physician office, emergency room or hospital to ensure the treatment address the acute condition
  • Chronic Care - This care plan address the long term management of chronic conditions

The following are components of the care plan that must be developed

  • Diagnosis - patient and physician mutually understanding of the diagnosis
  • Prognosis - patient and physician mutually understanding of the diagnosis means to their health, risk factors and the potential progression
  • Shared Decision Making - patient and physician alignment of treatment options
  • Care Goals - clearly articulated care goals of the care plan
  • Communication - within the Care Team members
  • Alignment - ensure the interventions, activities and actions are aligned with Care Goals
  • Integration - ensure the interventions are integrated
  • Care Team - identification (including Social Workers, Pharmacists, Social Services, etc.), planned actions, roles and communication
  • Qualified Option development - explore the many facets of healthcare decision making (i.e., Complex Cancer Treatment Options, End-of-Life)