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Quality improvement and cost control rely on effective coordination of patient care. Registered nurses (RNs) across the continuum of care play an essential role in care coordination. Greater health care efficiencies can be realized through coordination of care centered on the needs and preferences of patients and their families. Professional nursing links these approaches, promoting quality, safety, and efficiency in care, resulting in improved health care outcomes that are consistent with nursing's holistic, patient-centered framework of care. This model for RN care coordination provides a guideline for nurses in direct care as well as those in highly specialized care coordination positions.
Fragmentation of care within the United States has been attributed to a lack of care coordination, producing cost inefficiencies and poor patient outcomes. Current health care reform under the Patient Protection and Affordable Care Act of 2010 supports quality improvement and cost control to transform the health care delivery system, functions that are reliant on effective care coordination. Nursing possesses a unique set of skills to contribute to the care coordination role that could lead to higher quality care as well as cost reductions. In alignment with health care reform and the emphasis on the medical home, nurses are central to organizing patient care needs, focusing on improved patient care outcomes and cost efficiencies for diverse patient groups.
DEFINING CARE COORDINATION
Care coordination has been defined by various health policy groups, professional organizations, regulatory agencies, and advocacy groups, focusing on application and implementation. According to McDonald et al. (2010), care coordination is conceptually intertwined with organizational analysis, quality improvement, and prevention science. For the purposes of this discussion, two complementary definitions that capture the essence of care coordination will be used, authored by the National Quality Forum (NQF) and the Agency for Healthcare Research and Quality (AHRQ). The NQF defines care coordination as "a function that helps ensure that the patient's needs and preferences for health services and information sharing across people, functions, and sites are met over time" (National Quality Forum, 2006, p. 1). Complementing this definition, the AHRQ defines care coordination as "the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of health care services"...