Difference between revisions of "Care Plan Development"

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* Barriers - patient barriers for treatment options  
 
* Barriers - patient barriers for treatment options  
 
* Determinants - patient determinants that could impact health outcomes  
 
* Determinants - patient determinants that could impact health outcomes  
* Shared Decision Making - patient and physician mutual understanding of healthcare treatment options, [[E Interventions]] and [[PC interventions]] based on understanding of diagnosis, risk factors, prognosis, barriers and determinants  
+
* Shared Decision Making - patient and physician mutual understanding of healthcare treatment options, [[E Interventions]] and [[PC Interventions]] based on understanding of diagnosis, risk factors, prognosis, barriers and determinants  
 
* [[Healthcare Interventions]]  
 
* [[Healthcare Interventions]]  
 
* [[E Interventions]]
 
* [[E Interventions]]

Revision as of 08:46, 23 November 2016

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

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

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

  • Diagnosis - diagnosis of health conditions (ICD) based on evidence
  • Risk Factors - patient risks for health conditions with recommended screening and treatments
  • Prognosis - understanding of the diagnosis and risk factors to current health conditions and potential progression
  • Barriers - patient barriers for treatment options
  • Determinants - patient determinants that could impact health outcomes
  • Shared Decision Making - patient and physician mutual understanding of healthcare treatment options, E Interventions and PC Interventions based on understanding of diagnosis, risk factors, prognosis, barriers and determinants
  • Healthcare Interventions
  • E Interventions
  • PC Interventions
  • 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)