NUR 514 Topic 1 DQ 1 Discuss how the shift to value-based health care has impacted delivery of care and the role and responsibilities of the advanced registered nurse

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Topic 1 DQ 1

Sep 29-Oct 1, 2022

Consider the evolution of the U.S. health care system. Discuss how the shift to value-based health care has impacted delivery of care and the role and responsibilities of the advanced registered nurse. Project what major evolving trends in the health care delivery system will affect nursing practice and how advanced registered nurses will influence the direction of health care.

REPLY TO DISCUSSION

Jamie Buchanan

Oct 4, 2022, 10:40 AM

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Class:

The development of advanced practice nurses (APNs) internationally has progressed significantly in numerous regions in the world. Review the descriptions of country progress and interpretation of APN listed. What surprised you about certain areas? What didn’t surprise you? What did you learn about the authority of leaders within local, national, and institutional settings that ultimately drives policy impacts the APN role and the manner in which the APN practices?

Thank you for sharing!

Take care,

Dr. B

Evelyn Pierre

replied toJamie Buchanan

Oct 4, 2022, 5:36 PM

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The concept of Advanced Practice Nurse (APN) is acknowledged by many countries; however, the presents of active APNs is not as prevalent in these countries. Most countries are supposable to the APN role because of the need for qualified healthcare workers in rural areas and the shortage of physicians (Schober, 2018). However, this concept has not been fully utilized by many countries because of the role confusion and the lack of appropriated policies to govern the profession. Countries like New Zealand and Singapore, where APNs are prevalent, there are policies and procedures in place to govern the profession. Nurses are required to meet certain educational milestones and work within specified role guidelines.

Reference

Schober, M. (2018). Global emergence of nurse practitioner/advanced practice nursing roles. Journal of the American Association of Nurse Practitioners, 30 (4), 182-184. doi: 10.1097/JXX.0000000000000029.

Jamie Buchanan

Oct 3, 2022, 5:24 AM

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Class:

As a country and as health care providers, we can no longer support ever-escalating health care costs and too-slow (despite our best efforts) progress in improving patient safety, patient satisfaction and clinical outcomes. It is also clear that reimbursement is increasingly being tied to quality and cost outcomes, and patient assessments of their care experiences. The Hospital Consumer Assessment of Healthcare Providers Survey (HCAHPS), developed by the Agency for Healthcare Quality at the request of the Centers for Medicare & Medicaid services (CMS), has been collecting and disseminating a great deal of information in this regard for years!

To be competitive in the evolving health care world, the need to shift from volume-driven to value-driven practice has been evidenced. In order to do this, we need to understand the meaning of value, how to measure and achieve it, and how volume will continue to play a critical role in achieving excellent outcomes but will not be the driving strategic imperative nor the driving reimbursement metric.

To do so, more emphasis will be on the clinical leader. Professional shared governance, shared decision making, and shared interaction will then become the framework for structuring delivery of the healthcare services in a much different way. The nurse leader must put value at the center of practice. Why? Please share your thoughts!

Take care,

Dr. B

LaChrisa Ginn

replied toJamie Buchanan

Oct 3, 2022, 5:11 PM

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Frank’s team should consist of himself, the medical doctor following this patient, a social worker, a nurse, possibly PT or OT therapy, a home health agency liaison, the patient, and if necessary a responsible party (caregiver / decision maker)

The services needed post hospital discharge may be a nurse to come into the home to show the patient / pt. family how to use a glucometer, PT/OT to evaluate safety measures in the home and guidelines for the MD orders to be continued. A nurse from a home health agency to go into the patient’s home and do a physical assessment, see if they are managing their diabetes within the range for this patient.

The nurse if the patient’s closest advocate and she sees more than the MD, social worker or discharge planner. She is an integral part of this team because she has spent the most time performing direct patient care.

Keli Selberis

replied toJamie Buchanan

Oct 4, 2022, 9:06 AM(edited)

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When I was reviewing our reading, this quote really stood out to me:

Although U.S. health care is often called a system because it has various features, components, and services, it may be misleading to talk about the American healthcare delivery system because a true, cohesive system does not exist. Indeed, a major feature of the U.S. healthcare system is its fragmented nature, as different people obtain health care through different means (DeNisco & Barker, 2019, p.178).

This observation emphasizes the importance of moving from a volume-based practice to a value-based practice model. To accomplish the goal of a more cohesive, and collaborative healthcare delivery system, shared decision making, governance and interaction must be considered key elements of the system. While overall patient volume is considered when developing collaborative strategies to improve patient outcomes, it should no longer be the sole consideration. In U.S. health care, reimbursement often drives initiative to improve patient care outcomes by impacting financial returns. Major insurance providers, such as Medicare and Medicaid, drive organizational innovation to improve care delivery and patient outcomes. These government program models strongly influence other major insurance carrier policies, and healthcare delivery organizations, as a result. While not required to align with these governmental organizations, many do under the principle that the studies leading to these policies will result in reduced expenditure by improving outcomes. Through these financially driven changes, advanced practice nurses are positioned to provide high quality reduce cost care. By viewing patients wholistically and developing systems thinking nurse leaders can innovate to improve patient safety, satisfaction, and outcomes.

Reference

DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124

Jamie Buchanan

Oct 1, 2022, 6:05 AM

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Hello class:

Review the Scenario in Chapter 9 of Leadership in Nursing Practice: Changing the Landscape of Health Care. It is located under the

NUR 514 Topic 1 DQ 1 Discuss how the shift to value-based health care has impacted delivery of care and the role and responsibilities of the advanced registered nurse

Elements of a New Kind og Structure section. Answer the following discussion questions from the book:

Because this task will require interdisciplinary team deliberation and decision making, who should be at the table? How do those individuals reflect the continuum of care for this patient population?
Because Frank and his team are building a continuum of care service structure for a specific patient population, which services will be provided for that population? How do they reflect the continuum of care for this population?
What is the specific role of the nurse both in development of this continuum of care model and in its coordination, facilitation, and integration once the team has designed and formulated their desired approach for this population?

Thank you for sharing!

Dr. B

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