Principal Investigator(s)Rosemary L. Hoffmann, PhD, RN
One of the most important aspects of the patient centered medical home (PCMH) is care coordination. It is the necessary foundation to achieving improved patient experience of care (quality, access and reliability), improved population health, and per capita cost control. According to the ANA, care coordination is (a) a function that helps ensure that the patient’s needs and preferences are met over time with respect to health services and information sharing across people, functions, and sites; and (b) 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. The need to document and measure the impact of nurse lead care coordination on financial and systemic incentives is imperative as the country moves forward with the PCMH model. Dr. Rose L. Hoffmann is analyzing the role and capabilities of the clinical nurse leader (CNL), a master prepared nurse generalist. Previous studies of CNLs demonstrate that implementation results in improved quality, patient satisfaction, and outcomes while maintaining or enhancing efficiency. Dr. Hoffmann is comparing the CNL’s capabilities with the care coordination requirements for the PCMH and will then make recommendations about the potential role of the CNL in the PCMH model.