Fragmentation of Care, Care Coordination and Challenges On community Health centers

 



Fragmentation of Care, Care Coordination and Challenges
On community Health centers


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Background
United States’ health care is often described as being fragmented. Fragmentation spans across all levels of health care, from the national level to the outpatient clinics and also within confined system care. Fragmentation has been cited as one contributor towards the poor state of the nation’s health care. This has led to several effects resulting from fragmentation gaining permanency within the health care system. One of the effects is the exponentially increasing number of patients who visit different healthcare settings and their needs are not met. This has resulted to a trend of worry and frustration. The collapse of communication has made accountability difficult. Unaccountability and ambiguity in assessment of quality is harmonious to increased medical errors and duplication. It also implies that the costs of health care are in an exponential upward ascendancy. In this regard, it is fundamental to realize that fragmentation affects both financing and health care provision.
Abstract
This paper will lay focus on healthcare provision. It is instrumental to review the existing care coordination models and assess how well they counter the key problems brought about by fragmentation of care in community health centers. Community health centers are designed to serve a populace with limited income and/or education, and are faced by language and cultural barriers. They also serve several uninsured people. These elements aggravate the problems caused by fragmentation and decrease quality of care. The paper will review the available knowledge on care coordination models and challenges that a primary care provider encounters. It will assist in the conceptualization of a customized model that targets intrinsic problems of fragmentation. 

Introduction
Fragmentation in health care can be defined as the aspect of having multiple decision makers in making decisions that involve health care (Michael, 2004). This means that fragmentation views individual decision making as incapable of screening all the dimensions of the decisions that need to be made. The individual decision makers are responsible for only one fragment of health care and may lack the power to take all the necessary action given that they know information regarding their fragment only. Fragmentation can also be defined as a concept that brings inputs together, delivery administration and association of services in relation to diagnosis, treatment, care, remedy and health promotion. Fragmentation is a means that aims improving service delivery in regards to accessibility, quality and patient satisfaction but so far it has failed in doing so.
Discussion
Fragmentation can take several dimensions when it comes to health care provision. One of the narrowest dimensions could be fragmentation in treatment of a certain illness during a single stay in a hospital. There could be a lack of coordination between nurses which could lead to misunderstandings. For example, a patient could inform one nurse that he/she is allergic to a particular kind of medication. If the nurse fails to inform the nurse in the next shift, the latter will give that particular medication to the patient. A broader conceptualization of fragmentation may come into play on fragmentation in treatments for a patient at a given time, such as lack of coordination between the health care providers he/she visits. For example, a surgeon could use a high-sugar intravenous injection on a diabetic patient if he/she did not consult with the diabetic specialist treating that patient. Additionally, fragmentation could be worried about if an insurer underfunds preventive care just because Medicare will bear the responsibility later. 
Care coordination is a term that can be used interchangeably with case management, disease management and care management (Fero, 2011). There are several variations of care coordination. All the variations intend to improve care, reduce unnecessary service utilization and promote independence. Coordination occurs along a scale from social to medical in a range of settings that embrace independent care coordination organizations, provider organizations, health systems, integrated networks and group practices. Care coordination models include social models, medically oriented models and integrated models. Social models address and authorize residential, institutional and in-home care services. Medically oriented models coordinate medical treatments for high-cost receivers, pharmacy management and disease management. Integrated models bridge the medical and social models. There is professional agreement on the constituents of most care management models but implementations of the models vary considerably. These variations arise due the location from which the case management is presented. The case managers