Preliminary Care Coordination Plan Essay Example


Preliminary care coordination manages patient care activities from several physicians to offer appropriate care to individuals. The main reason for designing a preliminary care coordination is to evaluate services that health care providers offer to patients. It allows patients to avoid unnecessary procedures. It is essential for individuals suffering from chronic health problems. Moreover, creating care coordination helps to ensure health care providers meet all patient needs as well as avoiding fragmented care. Individuals can establish preliminary care coordination when all stakeholders, including patients, family, and nurses, create an appropriate care delivery. Successful care coordination helps to minimize hospital admissions and also enhances patient outcomes.


According to CDC, many people in the United States are suffering from a stroke. The impacts of this desease depend on the part of the brain the stroke happened. Additionally, individuals who survive a stroke will often experience different visual and cognitive impairments (Mohd Zulkifly et al., 2016). The impairments may cause the need for special services from health care providers. However, stroke patients can achieve greater recovery results through the appropriate preliminary care coordination and special resources. The extent of the stroke determines the kind of services required by patients.

Care coordination of stroke is associated with the evaluation of patient’s needs after their discharge from hospitals. After the discharge from the hospital, patients experience chronic medical conditions, recovery objectives, and various new medications. Some patients who recover from stroke may be discharged without any deficits. Other patients may have to take part in a rehabilitation model or visit an advanced health facility (Rowe, 2017). After participating in the rehabilitation program, patients may require long-term services, but depending on the impairment they are facing. Comprehensive post services for patients need bridging acute care involving primary care management and access to community resources.

Specific Goals to Address Stroke

The rehabilitation therapy process involves speech therapy, occupational and physical therapy. In detail, occupational therapy helps individuals understand how to manage daily living activities to address an emerging deficit (Hong & Yoo, 2017). An occupational therapist trains patients on how to apply adaptive mechanisms to enhance their independence level. Moreover, physical therapists coordinate with patients to improve their cognition on performing physical activities like walking and sitting. If there is a need to have equipment such as a wheelchair, the therapist’s objective is to train patients on how to use the equipment effectively. 

Additionally, speech therapy helps patients suffering from swallowing and cognitive issues. The goal associated with speech therapy is to acquire back the speaking ability and understand other different communication methods. Moreover, speech therapies also emphasize swallowing methods and techniques. Speech therapy often involves coordination with a dietician for affected textures of food for stroke patients. The Speech, occupational and physical therapists coordinate and allow stroke patients to gain the appropriate independence level. Additionally, they enable patients to have a better quality of life. According to Whitehead & Baalbergen (2019), stroke patients who received advanced coordination care improved mortality and morbidity. It is recommendable to involve a caregiver that would provide care for stroke patients after their discharge. Additionally, the caregivers will assist in all activities at home.

However, there other individuals associated with coordination care for stroke apart from therapists. They include dieticians, psychologists, rehabilitation physicians, and nurses. Therapists have to coordinate with healthcare providers to establish a care plan and determine the appropriate equipment and services required by stroke patients after discharge (Whitehead & Baalbergen, 2019). Coordination of this care involves providing patients with appropriate medical equipment before their discharge, providing educational stroke programs, and planning for home health services. Moreover, patients have to coordinate with their families and seek the best health facility if they are unable to return home.

Available Community Resources

Community resources are essential for patients who overcome stroke to continue recovery once the facility discharges them. Additionally, community services also help the caregivers when they need to attend work activities. For instance, adult day care programs are some of the resources associated with stroke. These programs enable the caregivers to take some rest from the full-time care of their patients. Other community services include meals and wheels, and they help those patients that are unable to cook for themselves after a stroke. Stroke support groups are another group of community services, and they offer a safe environment. Additionally, individuals are able to participate in addressing different issues, establishing support channels for caregivers, and understanding much about community resources (Hartford et al., 2019). The last community service available for stroke patients in stroke education. It offers stroke patients information about the symptoms of stroke and how to manage the disease. Stroke education performs an essential role in the prevention of the disease.


The preliminary purpose of designing a primary care coordination is to evaluate services that health care providers offer to patients. Stroke patients can achieve greater recovery results through the appropriate preliminary care coordination and special resources. The Speech, occupational and physical therapists coordinate and allow stroke patients to gain the appropriate independence level and have a better quality of life. Available community resources include adult day care programs, meals and wheels, stroke support groups, and stroke education programs.


Hartford, W., Lear, S., & Nimmon, L. (2019). Stroke survivors’ experiences of team support along their recovery continuum. BMC health services research19(1), 1-12.

Hong, D. G., & Yoo, D. H. (2017). A comparison of the swallowing function and quality of life by oral intake level in stroke patients with dysphagia. Journal of physical therapy science29(9), 1552-1554.

Mohd Zulkifly, M. F., Ghazali, S. E., Che Din, N., Singh, D. K. A., & Subramaniam, P. (2016). A review of risk factors for cognitive impairment in stroke survivors. The scientific world journal2016.

Rowe, F. J. (2017). Stroke survivors’ views and experiences on impact of visual impairment. Brain and Behavior7(9), e00778.

Whitehead, S., & Baalbergen, E. (2019). Post-stroke rehabilitation. South African Medical Journal109(2), 81-83.

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