NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

Name

Capella university

NURS-FPX 6030 MSN Practicum and Capstone

Prof. Name

Date

Problem Statement (PICOT)

Patients with mental health illnesses have poor quality of life, a condition related to compromised patient’s cognitive abilities. It entails mood disorders, substance misuse, psychotic issues, extreme anxiety, and depression. Mental Health America (MHA) reported that this is a severe and prevalent issue in the United States; in 2022, 23.1% of Americans suffered a mental illness, which equates to roughly 60 million population (MHA, 2024). This capstone project addresses mental healthcare through a care coordination intervention to promote patient results. PICO(T) Question

In individuals with mental health issues ages 18 and above (P), does implementing care coordination emphasizing interprofessional team communication (I), compared to standard care practices lacking emphasis on care coordination (C), improve symptoms management, reduce hospital readmissions, enhance medication adherence, and improve patients’ quality of life (O) within six months?

• Population (P): Adult individuals with ages 18 and above diagnosed with mental issues 
• Intervention (I): Care coordination with improved interprofessional team communication
• Comparison (C): Standard care practices without focusing on care coordination
• Outcome (O): Enhancing symptom control, drug compliance, quality of life, and reducing readmissions.
• Time (T): Within six months 

Problem Statement

Need Statement

The capstone project is related to the effective management of mental illness and improving the health of patients with ages 18 and above. Addressing this need is vital as mental health illness is a severe issue worldwide, specifically in the USA; 18.1% of adults with Substance Abuse Disorder (SAD), 5.1% of adults have suicidal thoughts, and one in every four adults suffering from psychological distress (MHA, 2024). The endeavor fulfills the need to enhance coordinated care with improved interdisciplinary communication in mental care services.

Addressing mental illness issues through care coordination is crucial as such patients have unique needs that can be fulfilled by offering integrated care approaches through the involvement of interprofessional teams, including nurses, clinical staff, psychologists, and medical resident staff, controlling illness symptoms and continuation of care.  The goal is to enhance symptom management and drug compliance among patients, boosting the standard of life and reducing readmission reduction with care coordination and improved interdisciplinary communication. Solving this need is critical as without a coordinated practice, mentally ill patients may experience fragmented therapy, which can cause higher readmission and low living standards due to poor symptom control.

Gandré et al. (2020), asserted that care coordination is crucial for mental illness patients as they have complicated chronic illnesses with long-term negative implications that require diverse care like particularized care, social assistance, and primary care. The assumption is that coordinated care approaches with improved communication will be efficient in managing mental illness patients’ symptoms management and reducing hospitalizations. It is also assumed that care coordination enhances the continuity of care and addresses the diverse needs of adult patients with mental illness, improving outcomes.

Population and Setting

 For this project, the target population is mental health issues patients aged 18 and above. This age group is vulnerable to mental wellness issues and faces difficulties with symptom management, which often leads to greater rates of recurrence and hospitalization. Evidence showed that young adults aged between 18 and 25 years have a higher severe mental illness rate, 11.7%, as compared to the older population (3.1%). There are 15.5 million adults in the US over 18 who have a severe medical ailment,  6.1% of all American adults. (National Institute of Mental Health, 2022).

Several patients in this demographic struggle to control their disease symptoms and acquire effective care, contributing to poor health outcomes and rising hospital readmissions. The necessity of meeting the needs of this age group is heightened by the fact that adult mentally ill patients face concerns like social exclusion, suicidal thoughts, poor standard of life, depression, and cognitive issues, demanding integrated care.  By focusing on a care coordination approach for offering care and improved communication, the project intends to promote mental patient outcomes by controlling the relapse rate and disease signs.

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

The setting for this project is an inpatient mental health unit at the University Medical Center (UMC), which offers services to varied patient groups with mental health issues, including mood disorders, substance misuse, psychotic issues, extreme anxiety, and depression. This setting is crucial because many mentally ill patients face difficulties such as limited access to personalized care, poor drug compliance, and high rates of uncontrolled disease symptoms, leading to frequent readmissions. It focuses on offering coordinated care with optimized interdisciplinary communication and collaboration to provide services like patient education, recreational therapy, and psychological assistance for effective disease care.

It is a suitable setting for executing the care coordination intervention program for mentally ill patients. Care coordination intervention boosts patient care by targeting this population in an inpatient health setting. It is effective in enhancing adult psychiatric patients’ accessibility to care, medical results, and their experiences (Hynes & Thomas, 2023). Possible challenges involve Stigma and differences in language and culture among patients and staff, which can hamper the intervention. Solving these problems is critical for successful intervention and meeting people’s needs.

Intervention Overview

Coordinated care focusing on improved interdisciplinary communication is the primary intervention to fulfill the needs of mentally ill patients ages 18 or older. Research also supports this intervention. Storm et al. (2020), asserted that the gap in medical results for patients with severe mental illness underscores the need for a coordinated, multidimensional strategy that extends beyond typical mental treatment. This plan integrates interprofessional teams, including nurses, psychologists, social staff, psychiatrists, and medical resident staff, who offer comprehensive care to mentally ill patients.

Each team member has a distinct role. For example, nurses offer guidance and education regarding medication and aid in boosting drug compliance. Psychologists and psychiatrists collaboratively analyze patients’ mental conditions, offer psychological support, and counsel patients about coping practices for managing symptoms and reducing relapses (Biringer et al., 2020). Social staff offer support by connecting patients with community groups. Effective interprofessional communication is vital to improve mental care practices and continuity of care. It entails using an Electronic Health Record (EHR) system to improve communication and share patient data. It keeps all teams engaged and up-to-date, improving care efficiency (Kariotis et al., 2022).

Building communication channels through scheduled meetings with the interprofessional team ensures that mental illness patients’ issues are extensively addressed, avoiding readmissions. The intervention suits the inpatient mental health unit setting by aligning with its focus on effective mental care for adult patients. It improves patient outcomes through coordinated care, allowing for patient education, counseling, regular monitoring, and follow-ups. By providing coordinated care interventions, the program empowers patients to manage their symptoms and drugs and boosts quality of life by including a multidisciplinary team. The intervention’s limitations include potential difficulties in cultural or interpersonal variables, which limit communication, and economic restrictions that can restrict intervention execution.

Comparison of Approaches

Using care coordination intervention with improved team communication instead of standard care without improved communication is an appropriate strategy for offering integrated care and improving young adult mentally ill patients’ outcomes. Lack of care coordination has severe concerns. For instance, lack of coordinated care, inability to address the unique needs of mentally ill patients from diverse backgrounds, and failure to address all aspects of care. Lack of coordination and poor communication can cause fragmentation in care, impacting patients’ outcomes and experiences.

It causes adverse impacts on patients, like poor drug compliance, increased relapses, and readmissions. Coordinated and cooperative treatment approaches are more effective than conventional treatment models for treating anxiety and mood disorders. It also reduces medical gaps in patients from different demographic and cultural backgrounds, boosting care access and outcomes (Ee et al., 2020). Standard care practices without focusing on team communication are unable to adhere to the standard guidelines for the care of mentally ill patients, leading to adverse complications.

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

In comparison, care coordination for mental enables interprofessional teams to communicate and interact effectively to offer services to patients with mental issues, managing their condition through counseling and psychological therapy.  This approach fits the targeted population and setting as these populations demand integrated services to manage their symptoms and adhere to medication regimens. Consideration of interprofessional alternatives, such as the multidisciplinary care model, in a targeted setting provides an exciting approach to enhancing patient outcomes by offering patient-centered care to mentally ill patients and managing symptoms effectively. Nurses, doctors, psychologists, and health educators work together to address mental illness, ensuring that all variables that cause mental illness are properly treated.

Multidisciplinary collaboration enhances patient well-being and medication compliance, decreases suicides and medical mistakes, increases professional fulfillment, lowers hospitalization, and minimizes stays (Durand & Fleury, 2021). The approach can employ a telehealth platform to conduct virtual collaborative conversations, enabling real-time patient data review and developing personalized care strategies, improving care coordination. However, a coordinated care strategy based on telehealth could require more assets, such as personnel, infrastructure, and expertise in technology. It offers the benefit of targeted and coordinated therapy, which improves mentally ill patients’ results.

Initial Outcome Draft

The intervention’s initial outcomes entail a 30% improvement in symptom management, reducing relapses, and improving drug compliance (35%) among mentally ill patients ages 18 and above over six months by executing a care coordination intervention plan. The other goal is to reduce the hospital readmission rate by 40%, improving patient disease management and quality of life. Enhancing communication between interdisciplinary teams will optimize the care process and offer comprehensive care, including patient education, counseling, and regular follow-ups.

This outcome exhibits the purpose of the intervention, which is offering consistent and holistic care that causes improved symptom management and enhanced patient outcomes, complying with the project’s goal of boosting mentally ill patients’ outcomes. Improving drug compliance and symptom management is crucial to lowering the relapse rate and avoiding complications and readmissions. Owusu et al. (2022), asserted that appropriate and successful inpatient therapy, coordinated mental care, and drug management after release are critical to minimizing the likelihood of readmission.

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

The criteria for measuring the outcomes include relapse rate, patient satisfaction, and drug compliance rate. Further, the readmission rate can measure outcomes such as a continuum of therapy and follow-up care (Owusu et al., 2022). The outcomes of this intervention will be measured using the Plan-Do-Study-Act (PDSA) cycle. It will assess the care coordination program’s impact on adult patients’ symptom control and drug compliance and make any necessary changes according to follow-up clinical records and patient input. Applying the PDSA cycle ensures that the intervention plan is feasible and can enhance adult mental health patient results.

This intervention emphasizes the desire to improve patient outcomes, as symptom management and medicine compliance allow individuals to self-manage their mental illness effectively, promoting the standard of life. The outcome also establishes a framework for improving the standard of care, security, and experience by showing actual progress in managing the symptoms of mental illness. These outcomes promote long-term beneficial adjustments in inpatient mental health care. It outlines a benchmark for improving the treatment of related medical issues by adopting such an approach in clinical settings.

Time Estimate

The estimated time frame for formulating and executing the care coordination intervention focusing on interdisciplinary communication is about six months. The initial phase of the first two months is based on formulating the intervention that entails needs evaluations, analyzing the targeted patients’ needs, and gaps in current care coordination practices. Further, an interprofessional team should be established, including nurses, psychologists, psychiatrists, social staff, and other medical staff. Formulating the intervention strategy includes identifying and delegating particular duties and roles to each team member.

The next three to four months are based on creating communication protocols and approaches for improving team interaction and offering interdisciplinary training to boost communication and coordination. This period is reasonable because it enables interdisciplinary collaboration. However, possible issues include organizing schedules and assuring all teammates are on board with the intervention targets. The last phase, the implementation phase, comprises the fifth and sixth months; coordinated care-based mental health services, including patient education, counseling, social assistance, and psychotherapy to boost outcomes, will be provided to adult patients to improve outcomes.

This timeline is reliable because it allows for improving patient outcomes via coordinated methods and plan adjustments as necessary. However, issues like patient engagement, supply of resources, and staff compliance can impede the adoption process. Uncertainties like unique patient reactions to the intervention, scheduling issues, and resource uncertainty can alter the intervention’s success and timeframe.

Literature Review

Current evidence strongly supports the need for improved care coordination in the management of mental health disorders, especially for adults aged 18 and above. According to the National Institute of Mental Health (2022), mental health disorders such as depression, anxiety, and substance use disorders are prevalent in this demographic, 23.2% of USA adults, contributing to substantial disability and healthcare costs. These conditions often necessitate the provision of multifaceted care to ensure efficient symptom management and improvement of patient outcomes.

According to Trivedi et al. (2022), coordinated care can minimize fragmentation, facilitate better control of symptoms, and prevent readmissions for patients suffering from complex mental disorders. Biringer et al. (2020), also concluded that nurses and professionals must enhance communication, mutual respect, shared goals, and information sharing for effective interaction and coordination. It can boost the care provision for patients with complex mental illnesses. Reist et al. (2022), showed that effective communication and collaboration among providers in inpatient mental health settings can lead to better patient outcomes.

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

In primary care environments, about 50% of patients have a mental illness, patients have threats of readmissions, and collaboration enhances cost-effective mental care access, improving patient satisfaction by addressing stigma than conventional care. Leveraging EHR for actual-time communication between care teams can boost care coordination. According to Kariotis et al. (2022), EHR systems help improve the integration and care continuum, ensuring that vital patient information on mental disorders is available for sharing between providers. Streamlined care processes help eliminate fragmented treatments. Alonso et al. (2020), asserted that EHRs contribute to communication and collaboration and improve mental patient outcomes.

A review by Aragonès et al. (2022), suggests that several barriers, such as workloads, unclear roles, staff resistance to change, and high staff turnover, can affect the collaboration and need for efficient coordination towards successfully managing mental health disorders. A more recent study by Otis et al. (2022), revealed that integrated care models, particularly those that address young adults with mental health disorders, have reduced relapse rates, readmissions, and length of stay in hospitals. Ee et al. (2022), highlighted that collaborative management of chronic mental health disorders through coordinated care improves care access by addressing cultural and social aspects.

It leads to enhanced symptom control and patient satisfaction. However, there are problems in the effective implementation of care coordination. Lastly, Baker and Naidu (2020), deliberated that despite the advantages of integrated mental care, challenges exist like insufficient infrastructure, poor associated mental services, poor communication, and extended wait times. Poorly trained staff can hinder the potential of coordinated care in mental health settings. Additional training is required to improve coordination or communication.

Evaluation and Synthesis of Relevant Health Policy

Policies on health can influence the approach to meeting the mental health care needs of the populace. The Mental Health Parity and Addiction Equity Act (MHPAEA) is a form of policy regarding care coordination. This law mandates health insurance companies to include mental health services with other general health services to encourage care integration. MHPAEA aims to provide equal coverage for mental health (Block et al., 2020). That way, such coordinated care interventions like in this project can increase patients’ access to mental health services. The Affordable Care Act (ACA) has extended mental health services through essential benefits of health insurance plans. This policy allows the integration of mental services into coordinated care models, improving patient access to services and meeting the complex needs of patients. Combining intervention with MHPAEA and ACA will yield better patient outcomes.

The Health Insurance Portability and Accountability Act (HIPAA) gives guidelines for care coordination, especially if execution is via EHRs. This often renders how interdisciplinary teams share patient information secure while preserving data privacy (Alder, 2020). These regulations involve all the care coordination models, implying that EHRs must maintain strict compliance with privacy regulations; thus, it is necessary to establish communication protocols between healthcare workers to ensure their confidentiality. However, lack of financial support and poor human resources are some of the hindrances to the effective execution of care coordination models. There is a need for policies on funding and staffing health care to support such interventions and improve outcomes.

Conclusion

Performing care coordination in inpatient mental health units through improving interprofessional communication is vital in improving adults aged 18 years and above with mental illnesses, their symptoms control, medication compliance, and overall life satisfaction. The intervention approach reduces the rate of rehospitalizations and helps promote healing through symptom management. Mental ill patients get more extensive, integrated support to address their particular needs and receive integrated care. 

References

Alder, S. (2020). HIPAA privacy rule changes proposed to improve care coordination and patient rights. The HIPAA Journal. https://www.hipaajournal.com/hipaa-privacy-rule-changes/

Alonso, C. M. do C., Lima, A. N. de , Oggioni, B. de M. P., Teixeira, M. R., Oliveira, E. P., Couto, M. C. V., & Duarte, F. J. C. M. (2020). Contributions of activity ergonomics to the design of an electronic health record to support collaborative mental care of children and youth: Preliminary results. Work, 65(1), 187–194. https://doi.org/10.3233/wor-193048

Aragonès, E., Cortacans, G. L., Cardoner, N., Pires, C. T., Casteràs, D. P., Palao, D., Bellerino, E., Cavero, M., Aguilar, E., Subirà, M., Caballero, A., Casaus, P., Monreal, J. A., Sola, V. P., Cirera, M., Loren, M., & Palacios, L. (2022). Barriers, facilitators, and proposals for improvement in the implementation of a collaborative care program for depression: A qualitative study of primary care physicians and nurses. BioMed Central Health Services Research, 22(1), 446. https://doi.org/10.1186/s12913-022-07872-z

Baker, N., & Naidu, K. (2020). The challenges faced by mental health care users in a primary care setting: A qualitative study. Community Mental Health Journal, 57(2), 285-293. https://doi.org/10.1007/s10597-020-00647-y

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

Biringer, E., Hove, O., Johnsen, Ø., & Lier. H. O. (2020). “People just don’t understand their role in it.” Collaboration and coordination of care for service users with complex and severe mental health problems. Perspectives in Psychiatric Care, 57(2), 900–910. https://doi.org/10.1111/ppc.12633

Block, E. P., Xu, H., Azocar, F., & Ettner, S. L. (2020). The Mental Health Parity and Addiction Equity Act evaluation study: Child and adolescent behavioral health service expenditures and utilization. Health Economics, 29(12), 1533–1548. https://doi.org/10.1002/hec.4153

Durand, F., & Fleury, M.-J. (2021). A multilevel study of patient-centered care perceptions in mental health teams. BMC Health Services Research, 21(1), 44. https://doi.org/10.1186/s12913-020-06054-z

Ee, C., Lake, J., Firth, J., Hargraves, F., M. de Manincor, Meade, T., Marx, W., & Sarris, J. (2020). An integrative collaborative care model for people with mental illness and physical comorbidities. International Journal of Mental Health Systems, 14(1), 1-16. https://doi.org/10.1186/s13033-020-00410-6

Gandré, C., Beauguitte, L., Lolivier, A., & Coldefy, M. (2020). Care coordination for severe mental health disorders: an analysis of healthcare provider patient-sharing networks and their association with quality of care in a French region. BioMed Central Health Services Research, 20, 1-15. https://doi.org/10.1186/s12913-020-05173-x

Hynes, D. M., & Thomas, K. C. (2023). Realigning theory with evidence to understand the role of care coordination in mental health services research. International Journal of Care Coordination, 26(2), 55–61. https://doi.org/10.1177/20534345231153801

Kariotis, T. C., Prictor, M., Chang, S., & Gray, K. (2022). Impact of electronic health records on information practices in mental health contexts: Scoping Review. Journal of Medical Internet Research, 24(5), e30405. https://doi.org/10.2196/30405

MHA. (2024). The state of mental health in America. Mental Health America.org. https://mhanational.org/issues/state-mental-health-america

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

National Institute of Mental Health. (2022). Mental illness. National Institute of Mental Health.gov. https://www.nimh.nih.gov/health/statistics/mental-illness

Otis, M., Barber, S., Amet, M., & Nicholls, D. (2022). Models of integrated care for young people experiencing medical emergencies related to mental illness: A realist systematic review. European Child & Adolescent Psychiatry, 32(12), 2439-2452. https://doi.org/10.1007/s00787-022-02085-5

Owusu, E., Folajinmi Oluwasina, Nnamdi Nkire, Lawal, M. A., & Vincent. (2022). Readmission of patients to acute psychiatric hospitals: Influential factors and interventions to reduce psychiatric Readmission Rates. Healthcare, 10(9), 1808–1808. https://doi.org/10.3390/healthcare10091808

Reist, C., Petiwala, I., Latimer, J., Raffaelli, S. B., Chiang, M., Eisenberg, D., & Campbell, S. (2022). Collaborative mental health care: A narrative review. Medicine, 101(52), e32554. https://doi.org/10.1097/MD.0000000000032554

Storm, M., Fortuna, K. L., Gill, E. A., Pincus, H. A., Bruce, M. L., & Bartels, S. J. (2020). Coordination of services for people with serious mental illness and general medical conditions: Perspectives from rural northeastern United States. Psychiatric Rehabilitation Journal, 43(3), 234–243. https://doi.org/10.1037/prj0000404

Trivedi, R. B., Rossi, F. S., Javier, S. J., Greene, L., Singer, S. J., Vanneman, M. E., Goldstein, M., & Zulman, D. M. (2022). Association between mental health conditions and outpatient care fragmentation: A national study of older high-risk veterans. Journal of General Internal Medicine, 37(16), 4071-4079. https://doi.org/10.1007/s11606-022-07705-z

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