Design and Implementation of Collaborative Care Model

Current Population
The population of the area comprises mostly of African Americans. The community is a low-income area and individuals who live here struggle to make ends meet. This makes it hard for them to access premium health care that is offered at private hospitals. Therefore, most of them have to rely on the community health center. Poor people have been associated with numerous chronic health problems that are as a result of their lifestyles and a lack of viable income. The community is underserved in terms of social amenities. Other structural challenges that are faced by the community is the reduced access to fresh foods, high density of fast food restaurants, and the area is not conducive for physical activity. This makes people have sedentary lifestyles that contribute towards them developing chronic diseases. Access to health care is reduced and the few who are able to access the community health center have to contend with receiving substandard service. While the nurses and doctors who work in the facility mean well, the sheer lack of proper communication and direction has made the services being offered to seem lackluster. With increasing numbers of obese community members, it is vital that the community get appropriate health care and health care professionals should be able to address the increasing obesity rates within the community. A majority of the community members do not have medical insurance and they work odd jobs. Others do not have jobs at all. People living in public housing account for the majority of patients that visit the community health center. Without any other option of health care access, they have to rely on the health center for all their medical needs. The lack of proper care might be discouraging but since they do not have any other option, they have to contend with what is currently available and accessible to them.
The level of education in the community is limited. Schools are not well maintained, gang violence is rife, and drugs are sold on every street corner. The neighborhood is what might be considered to be unhealthy. With limited access to education, many of the people who live in the community have only managed to go to high school. School dropout rates far outnumber the rates of those who managed to finish their studies. This makes the population less educated and discriminated upon. Since the area comprises mostly of black Americans, there are unique economic barriers that face the community. Development is minimal in the area and this makes it hard for young people to have any ambitions in life. Making the area perennially prone to continued social injustices and lack of proper health facilities. Reduced income has made many people to not seek medical help even from the health center for fear of being charged to access care. The nurses who work in the community health center are mostly from other neighborhoods and they do not closely understand the community relations.
Current Operations of The Community Health Center
The community health center is charged with offering outpatient medical services and care to the residents of the community. The services include counseling, primary care, pre, and post-natal care, and health education. The health center is supposed to offer services regardless if the patient has the ability to pay or not. The services offered at the community health center are tailored to meet the needs of the community. Studies have indicated that community health centers offer services that improve the health outcomes of their patients. However, in our case, this has not been the case. A majority of the patients have been complaining that while they do get access to primary care, receiving information and proper care is quite difficult. This has been due to the fact that a patient is not likely to meet the same nurse or doctor who had handled his or her case. Handing over patients is not done in the correct manner and a patient has to introduce and state their issue to every medical personnel they meet. Follow up of patients is not possible since the health care workers assume that a particular person is doing the follow-up (Overbeck, Kousgaard, & Davidsen, 2018). This creates confusion in the operations of the health center and patients end up suffering.
Chronically ill patients are sometimes not able to make their appointment either because they are unable to leave their house or they do not have someone who can escort them to the health center. While the health center is supposed to have noted all the chronically ill patients who have regular appointments and to always check to ensure that the patients always make their appointments. This is not the case. The health care workers seem to be overwhelmed and all this can be attributed to a lack of proper communication and role definition. A patient can stay at the health center for hours before he or she is attended to and making an inquiry is always answered with wait for your turn. Therefore, patients end up suffering and might fail to be seen by a health care worker. Some of the workers are able to identify patients who have been waiting for long and attempt to attend to them. However, this is not possible all the time since the worker might be overwhelmed or they might be working a different shift. When patients come to the facility, they are first registered and then they will be called based on this register. Most times this strategy does work and the patients do not have to wait for long hours to get services. The issue comes when there is a mix up of files and patients are not called based on the order they arrived at the facility. This simple mix up might be caused by files being misplaced or forwarded to the wrong office.
Without appropriate care being offered, the health workers are going against their ethical duty of non-maleficence. They should ensure that no harm comes to their patients as they are offering their services. The lack of proper care means that patients are not the intended services and this could result in harm coming to the patients. The likelihood of prescribing wrong medications or treatment to a patient increases due to the lack of proper communication between the health care professionals. A provider might administer medications to a patient and leave the patient. In case another provider visits the same patient they too might give the patient another dose of the medication resulting in double medication that might result in adverse effects for the patient.
Proposed Collaborative Model and Implementation Plan
The proposed collaborative model will comprise of teams that will have a compilation of caregivers. The aim of the model is to ensure that there is an integration of care within the health center. Primary care providers, care managers, and consultants will work together to deliver care and monitor the progress of the patients. By ensuring there is a collaboration between the caregivers' communication will be improved and patients will benefit since they will be receiving the best available care. Having a multidisciplinary group of professionals discussing and coming up with a treatment plan for the patient will ensure that there are discussion and consideration given to each individual patient. The idea is to ensure that there are coordination and discussion amongst the primary caregivers. For instance, in cases of mental health conditions, the team will comprise of a social worker, psychiatric nurse practitioner, therapist, and psychologist. With the team in place, there will be internal accountability, checks and balances, and follow-up of patients, which will assist in protecting the team members from burnout when they are faced with a challenging scenario. A team focused approach ensures that no single team member will be in charge of handling the patient alone. Team discussions will allow for the collaboration in the delivery of care and each team member will have the appropriate information on the progress of a particular patient.
Implementation Plan
Before the model is rolled out the first step is to present to the community health center workers the underlying concerns that have been raised. Once the caregivers understand the problems facing the facility the solution can then be proposed. Using evidence to present the advantages and how using the collaborative model will benefit the caregivers is vital if the implementation is to succeed (LaBelle, Han, Bergeron, & Samet, 2016; Overbeck et al., 2018). Once there is buy-in from the caregivers, the team will be identified and each team will comprise of caregivers who are in the same line of work, for instance, mental health workers. The team members will be taken through training to teach them how they can be working as a team. Without this training, the caregivers would still be working independently and assuming they are collaborating with each other. Therefore, it is vital that each team member understands what it means to work as a team and what is required of them. Roles will also be determined and each team member will be given a role that is directly related to their qualifications and expertise. Learning how to communicate with each other is also beneficial for the team. This is because the team members will be required to share information with each other on the progress of the patient in order to facilitate treatment. Teams will be discussing treatment plans not necessarily in person. Once each team member is aware and understands what is required of them, then the rollout can begin. Initially, it would be advisable that team members be meeting frequently to ensure that they can communicate and discuss the progress of patients. With time and when they are able to gel with each other properly, they can be sharing information using email.
Roles
For mental health workers team, the roles of the team members will be as follows:
The social worker will be charged with identifying patients who need mental health assistance. The social worker is responsible for following up with the patient and checking on them either at home or at work (Smith et al., 2019). He or she will be responsible for ensuring that the patient does keep his or her appointments. The social worker will coordinate with the team in case they discover that treatment is not having the desired effect.
The psychiatric nurse practitioner will be responsible for diagnosing the patient and prescribing medications (Overbeck et al., 2018). The nurse will formulate healthcare plans, implement patient treatment, and evaluate how the patient is fairing on the short and long term. The nurse will also collaborate with the doctor and make the necessary patient referrals.
The therapist will meet with the patient and offer counseling services to the patient. The therapist will meet weekly with the psychiatric nurse practitioner and social worker to review patient charts and discuss o the progress patients are making. In case it is determined that there is no progress being made then treatment changes can be made.
The psychologist will rarely meet with patients from the community health center. Instead, he or she will review the charts and make recommendations to the psychiatric nurse practitioner.
Potential Barriers to Implementation
Barriers to implementation can be categorized into three. These are clinical, financial, and organizational barriers. According to Sanchez (2017) clinical barriers are any barriers that will interfere with the treatment and adherence of the patient. This could include a lack of provider knowledge. In order to properly treat a patient, the provider needs to have adequate knowledge regarding the patient condition. In case this information is lacking then they would not be able to offer the patient adequate care. Within a team, if one of the team members does not have the necessary knowledge, they might become a hindrance to the other team members. This could be done by blocking suggestions and not offering solutions. Another clinical barrier could include lack of proper communication between the team members. Collaborative care is highly dependent on communication amongst the team members. If the communication link is broken then collaboration will not be possible. To improve patient adherence, there is a need for patient-centered communication. When the patient is aware of the treatment plan, he or she is most likely to follow through with the plan. Without proper communication between patient and provider, treatment will not be possible.
Financial barriers revolve around funding and reimbursement (Sanchez, 2017). Most providers will be concerned with how they will get funding for the projects they implement. Without enough funding, it becomes hard to create a team of professionals. Since most of the professionals will not be working within the community health center they will need to be reimbursed for their time. This will need funding if the model is to succeed. The motivation of the workers is impacted by their pay. If the caregivers are not well paid, they will be unwilling to offer their services and this could be the reason why the health center is not offering the best care to the community. Funding will also ensure that the health center has adequate medications for the patients.
Organizational barriers refer to system-level obstacles. There is fear of leaking privacy information and this prevents the open collaboration or sharing of information (Sanchez, 2017). Primary providers are finding it hard to share information with health specialists mostly due to privacy issues. Patient privacy is highly been pushed and primary care providers are aware of the repercussions that this might have on them if information regarding a patient is leaked or shared with the wrong person. The community health center is faced with a shortage of specialized professionals. This makes it hard for it to create the necessary teams for caring for the patients. Collaborative care model relies heavily on the interaction between different professionals within a team. If there are not specialized professionals within the team, then collaboration becomes hard since the discussions and treatment plan development is not possible.
Policies
The community health center needs to make changes into its own policies that will be aimed at supporting the collaborative care model. One of the policy changes would be eliminating the need for a single caregiver being charged with the responsibility of caring for multiple patients all by themselves. Currently, the focus is mainly on individuality. This means that there is no coordination of activities and a caregiver is charged with seeing the patient from start to the end. Handing off a patient to others is not encouraged and most caregivers will not be willing to handle a patient who is not theirs. There should be a change in policy regarding information sharing. The community health center needs to make it clear to patients that in some instances the center might have to share patient information with other providers in order to support collaborative care. With a change in the data sharing policy, the center can safeguard itself against lawsuits and it can be able to share information freely (Unützer, Harbin, Schoenbaum, & Druss, 2013). While most community health centers receive funding from the government, the center can seek funding from donors. Donations can be well-wishers and other non-profit organizations. This will assist the health center to cater to its needs and those of its caregivers. In order to seek funding, the health center needs to develop a policy for collecting donations and demonstrate how the donations will be used. Communication within the health care facility can also be modified. There is a need to encourage caregivers to discuss with patients on the proposed treatment plan. Sharing information with the patient will improve adherence to the treatment plan.
There are external policies that have been created that encourage and offer support for collaborative care. The community health center can embrace the Patient Protection and Affordable Care Act of 2010. This act encourages for the development of integrated approaches to patient care in order to improve quality of care and reduce costs of care (LaBelle et al., 2016). Implementing this policy will encourage caregivers to collaborate and share information with each other with the aim of improving patient outcomes. To safeguard against the potential of a breach in patient privacy implementing a policy for seeking funding for information technology infrastructure will be vital. Improving upon the IT infrastructure will allow the health center to strengthen its data protection and it can easily be able to securely share information with other external providers. This will eliminate the fear of privacy breaches and only the intended recipients will get access to the data.
References
LaBelle, C. T., Han, S. C., Bergeron, A., & Samet, J. H. (2016). Office-based opioid treatment with buprenorphine (OBOT-B): statewide implementation of the Massachusetts collaborative care model in community health centers. Journal of substance abuse treatment, 60, 6-13.
Overbeck, G., Kousgaard, M. B., & Davidsen, A. S. (2018). The work and challenges of care managers in the implementation of collaborative care: A qualitative study. Journal of psychiatric and mental health nursing, 25(3), 167-175.
Sanchez, K. (2017). Collaborative care in real-world settings: barriers and opportunities for sustainability. Patient preference and adherence, 11, 71.
Smith, S. N., Almirall, D., Prenovost, K., Liebrecht, C., Kyle, J., Eisenberg, D., . . . Kilbourne, A. M. (2019). Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That are Slow to Adopt a Collaborative Chronic Care Model: A Cluster Randomized Implementation Trial. Medical Care.
Unützer, J., Harbin, H., Schoenbaum, M., & Druss, B. (2013). The collaborative care model: An approach for integrating physical and mental health care in Medicaid health homes. HEALTH HOME, Information Resource Center, 1-13.