Evolving Practice of Nursing and Patient Care Delivery Models

Instructions:-

Write an informal presentation (500-700 words) to educate nurses about how the practice of nursing is expected to grow and change. Include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics. 2.Share your presentation with nurse colleagues on your unit or department and ask them to offer their impressions of the anticipated changes to health care delivery and the new role of nurses in hospital settings, communities, clinics, and medical homes. 3.In 800-1,000 words summarize the feedback shared by three nurse colleagues and discuss whether their impressions are consistent with what you have researched about health reform.

Solution

Evolving Practice of Nursing and Patient Care Delivery Models

Informal Presentation: Evolving Practice of Nursing and Patient Care Delivery Models

Health care costs in the United States are exceptionally high, the quality is arguably lower than expected, and divided rendition of care exists. The Patient Protection and Affordable Care Act  (PPACA) of 2010 describes a plan “to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations” (Islam, et al, 2015).  The health care reform involves transforming nursing practice and the creation of new patient care delivery models, which includes financial incentives for those who deliver quality care and decreased healthcare costs. To deliver the care necessary for our diverse, aging population with multiple co-morbidities, nurses are expected to be involved in improvement of care, enhancement of  health outcomes, and participation in active roles in health education, chronic disease management, transitional care, prevention activities, and quality improvement (Reinhard & Hassmiller, 2012). Patient-centered care delivery models were established which include Accountable Care Organizations (ACOs), Medical or health homes, and Nurse-managed Health Clinics (NMHCs).

Accountable Care Organization (ACO)

An ACO commits to a different process of organizing care along a continuum from a physician to a hospital setting, which is required by the new health care reform law (Longworth, 2011).  An ACO is “a collaboration among primary care clinicians, a hospital, specialists and other health professionals who accept joint responsibility for the quality and cost of care provided to its patients” (ANA, 2010). The ACO can be led by an “ACO professional” who can be physicians, Nurse Practitioners, Clinical Nurse Specialists or Physician Assistants. Nurse involvement can include promoting patient engagement, utilizing evidence-based practice, and coordinating care. There is a considerable opportunity for ambulatory care registered nurses (RNs) in contributing and developing increased roles in patient education, advocacy, and care coordination to patients using evidence-based practice protocols The use of telehealth and other appropriate advanced technologies is also promoted in ACO. Nurses are encouraged to create individualized plan of care and accurate caregiver assessments in order to provide patient-centered care.

Medical Home

Another patient care delivery model is a medical home. This model is constructed to enhance care coordination done by primary care providers.  The primary physician has the responsibility to coordinate care with other health care specialists across all settings.  Research shows that there is a disconnect between patients and medical providers, physicians of different specialties, public and private services, what healthcare providers teach and what patients learn or need.  Easier and constant accessibility is an important component of this delivery method. Access may include use of electronic devices which decreases the dependent use of emergency rooms and eventually avoidable hospital admissions (ANA, 2010).

Nurse-managed Health Clinics (NMHCs)

NMHCs were also established to provide extensive wellness and primary care to susceptible people and who receive inadequate services.  NMHCs are nurse driven led by advanced practice nurses (APRNs). Nurses must be affiliated with a “school, college, university or department of nursing, federally qualified health center, or independent nonprofit health or social services agency” (ANA, 2010). Nurse practitioners have the necessary skills and are capable of restructuring the delivery of primary care. Nurse practitioners will be responsible for immediate care, educate, promote wellness, manage chronic diseases and conditions, and integrate care. These interventions will enhance patient outcomes.

Evolving Practice of Nursing and Patient Care Delivery Models

As different organizations, health care professionals, and private sectors are working toward the implementation of health care reform law, the success necessitates numerous changes of the health care delivery including nursing practice and roles of nurses. The Patient Protection and Affordable Care Act (PPACA) pursues to enhance the use of patient care delivery models, which include Accountable Care Organizations (ACO), medical or health homes, and Nurse-managed Health Clinics (NMHCs), to incorporate cost-effective  quality care . Studies show that the methods “can return substantial benefits to both patients and providers by increasing access to primary care services, reducing administrative hassles and burdens, and facilitating coordination across the continuum of care” (Davis, et al, 2011). The transformation also comprises of boosting nursing practice, upgrading nursing education, and promoting nurses in leadership roles. There are financial incentives for those who deliver quality care and decreased healthcare costs. This paper will include the concepts of continuum of care, summary of the patient care delivery models, and the feedbacks of three colleagues who were presented an informal presentation on the developing approaches in nursing and health care delivery.

Continuity or Continuum of Care

The transformation to a value based healthcare, with the demand to counter chronic health care conditions are forcing health care workers to support progressive approaches, policies, and procedures combined with clinical integration (Karash & Larson, 2016). According to Karash & Larson, “Clinical integration requires closed coordination and cooperation among hospitals, physicians, nurses, pharmacists, and other clinicians” (2016).  It takes a multidisciplinary team to take care of a patient across the continuum. Nursing care, medical treatments, and additional emotional and social interventions involve numerous people who can assist the patient in the course to wellness. A network of professionals need to collaborate in order to provide the best and most appropriate care for a particular patient in the right setting or environment at the right time. The services and transitional care programs, under the PPACA of 2010, “help hospitalized patients with complex chronic conditions-often the most vulnerable-transfer in a safe and timely manner from one level of care to another or from one type of care setting to another” (Naylor, et al, 2011). With the cooperation of health care professionals, under the various patient care delivery models, fragmented care should be eliminated promptly.

Accountable Care Organization

ACOs are “legally defined entities that allow healthcare organizations, providers, and insurers to share financial risk and rewards to provide quality care at fixed or bundled prices” (Ridge, 2011) An ACO can also comprise of a group of health care professionals, including nurses,  who collaborates and accepts shared responsibilities and accountability to provide quality and cost-effective care to patients. To address today’s healthcare demands, the process of communication and collaboration needs to be enhanced. According to Haas (2011), to improve cost efficiency and quality, an ACO requires the ability to

1. Care for patients across the continuum of care, in different institutional settings as well as the home

2. Plan, prospectively, for budgets and resource needs

3. Effectively use evidence-based protocols and comparative effectiveness research

4. Develop and support comprehensive, valid, and reliable measurement of performance.

Medical Homes

            A method to provide extensive primary care to patients at various phases of life is called the patient-centered medical home (PCMH) (Cabral & Johnson, 2015). The primary physician has the responsibility to coordinate care with other health care specialists across all settings. Medical homes are “promoted through a capitated payment or other financial incentive to providers to encourage preventive care and chronic care management, as well as reduce reliance on specialist and emergency care” (ANA, 2010). This type of integrated delivery model has also showed cost-savings, improved allocation of resources, and better quality of care (Longworth, 2011).  Previous studies revealed that there is a disconnect between patients and medical providers, physicians of different specialties, public and private services, what healthcare providers teach and what patients learn or need.  Easier and constant accessibility is an important component of this delivery method (ANA, 2010). In addition, “Such access, even if only through telephonic or electronic means, helps reduce reliance on emergency rooms and resultant preventable hospitalizations” (ANA, 2010). Such intervention reduces “hospital admissions and visits to the emergency department” (Longworth, 2011).

Nurse Managed Health Clinics (NMHCs)

The establishment of NMHCs was to implement comprehensive wellness and therapeutic regimen to disadvantaged, vulnerable individuals or those who receives deficient assistance, under the leadership of advanced practice nurses (APRNs).  An affiliation with school, college, university, or nursing department, federally qualified health center, or independent nonprofit health or social services agency, must exists (ANA, 2010). Nurses will adjust to the practice settings and will receive adequate funds and instructions to be able to better serve the communities (Reinhard, Hasmiller, 2012). This type of patient care delivery model prepares future nurse practitioners to be leaders in the health care system. There is an opportunity to advance the nursing practice and increase the primary care personnel (Sutter-Barett, et al, 2015). APRNs  have the capability of reestablishing the impartment of primary care and nurse practitioners (NPs) have the compelling education to acquire needed skills and be able to manage the clinics. NPs will be in charge of integration of care, education, promotion of wellness, and handling  of chronic diseases, which will overall enhance patient outcomes. 

Conclusion

The successful implementation of the PPACA creates favorable circumstances for health care providers. Current healthcare is fragmented so establishment of the integrated care delivery models plus dispensing savings to appropriate professionals and organizations will attempt to “restore health care resource allocation while rewarding quality of care over volume of care” (ANA, 2010) . With the support and cooperation from members of ACOs, NHMCs, and medical homes, they will be compensated for rendering high quality and “patient-centered primary care” (Davis, et al, 2011). The positive consequences can also motivate more supportable layers of health expenditure for most people in America.

Nursing Colleague Feedback

Colleague 1

Nurse Marilyn is a Registered Nurse (RN) who works in Burn Intensive Care Unit.  She has been a passionate RN for 15 years and is involved in shared governance committees.  As a Staff Nurse III of the Clinical Ladder Program, she is familiar with leadership roles in different areas of nursing. Nurse Marilyn believes in professional and personal growth so she is currently working on obtaining her Bachelor’s Degree of Science in Nursing. She stated that “as health care professionals, nurses need to regularly attend continuing education classes or national conferences to receive updates on future of nursing, current trends or evidence-based practices, and learn the current advancement in the healthcare system.” She has been taking care of patients with complex medical conditions and she knows the importance of coordination of care across the continuum.  Nurse Marilyn stated that burn patients require increased support, multiple medical services and treatment, and proper discharge planning to obtain desired patient outcomes. She added that the burn unit team requires collaboration and effective communication to address all physical, psychological, and other issues related to the injuries. Burn care nurses work with therapists (speech, occupational and physical), case managers or social workers, registered dietitian, pharmacist, surgeons, medical doctors, and various specialists. At the center of burn care team are nurses who are there 24/7. Nurse Marilyn also expressed that nurses are the coordinator of most patient care activities.

Nurse Marilyn was not familiar with the names of the approaches to patient care delivery but is definitely aware of the courses of action that are involved especially on ACO and NMHC. Burn nurses have the knowledge and experience on burn care that can be used in NHMC, research, and education of other health care professional on burn management. She was delighted when the facility started using electronic medical record (EMR) few years ago and realized that EMR requires constant upgrading. She is now working on enhancing the electronic care planning process.

Colleague 2

Nurse Nichole started her nursing career as a hospice nurse two years ago after she received her master’s degree in Nursing. She transitioned to rehabilitation nursing so she is enlightened by the different roles or settings that a nurse can embark on.  She verbalized her motivation about the healthcare transformation as this would allow nurses the full participation and opportunities in leadership, management, and even politics.  She liked the fact that ACOs are working on reducing patient costs and enhancing the quality of patient care, as she is aware of the increasing cost of healthcare insurance. Resembling her current nursing practice in rehabilitation unit where patient-centered care is promoted, she believes that the patients in medical homes with chronic diseases will enable nurses to provide the same care. She is aware that people from different agencies, organizations, leaders, and experts are working on removing barriers that restrict nurses from leading the necessary changes for the successful implementation of health care reform.  Nurse Nicole trusts that some nurses have the scientific knowledge, competence, and skills to perform the primary care roles of physicians.

Nurse Nichole also shared studies based on the patient care delivery presented. One study is by Holmström et al., 2016, who concluded that using mobile devices was beneficial in communicating care to the elderly population because it allowed easy access to a health care provider as well as improved patient safety and satisfaction. The use of electronic devices to deliver immediate care is encouraged in medical homes. She stated that the availability of an adequate patient provider is imperative to the overall health care of our patients and is invaluable to the quality of care that we can give. She added that a nurse is most capable of using a phone and providing crucial information that can safely direct the patient’s care, and decrease possible risks, such as unwanted ER admissions. Another study nurse Nichole mentioned was about the properly  implementation of  Telehealth as a technology that can be utilized by patients,  provide several benefits, such as cost and time savings, and  more rapid access to specialist’ services (Knight et al., 2016). She believes that the services mentioned provide substantial benefits to patients.

Colleague 3

 Nurse Maryann is the third colleague who I presented the information on patient care delivery models and evolving nursing practice.  She graduated nursing in 1975 but recently received her Bachelor’s Degree in Nursing about 6 months ago.  She shared her experiences and various roles in nursing practice from not having to do physical assessment as a new graduate to being a nurse supervisor, and nurse manager at a Skilled Nursing Facility in a hospital setting.  She is glad to go through numerous transformations in health care for the better. She expressed that the changes are not only for cost savings but most importantly, saving patients’ lives.   She recalled the times when patients were hospitalized for a number of days compared to today’s same-day surgery.  Back then, patients were not encouraged to get out of bed after three days and now nurses have to get patients up on day of surgery.  Evidenced- based studies reveal that early postoperative ambulation decreases patients’ complications (Kibler, et al, 2012). She stated that patients are now “sicker” compounded with chronic health problems, require complex health care needs with shorter length of hospital stay.

            When presented about the models of patient care delivery, she expressed her unfamiliarity with ACO, NHMC, and Medical homes. But Nurse Maryann is knowledgeable with the processes that are involved with the models such as pay-for-fee services, cost-savings methods, and collaboration among health care workers throughout the continuum of care. She believes that health care professionals who share their own expertise, skills, and knowledge with one another can enhance patient satisfaction and outcomes. She likes the idea of preventative health care and the evolving roles in leadership of nurses.

Conclusion

The feedbacks from nursing colleagues identify that some nurses are still not knowledgeable of the patient care delivery models. They are acquainted though of the processes   involved. Two out of three have advanced their education and one is currently pursuing a higher degree. Improvements in patient outcomes and patient satisfaction through collaboration and effective communication have been encouraged in their current nursing practice and settings. 

The evolving practice of nursing, the participation of nurses and other health care professionals in the patient care delivery models, and the interventions related to improving health and wellness can result in more desirable patient outcomes. Nurses need to be knowledgeable about the current trends in nursing to help transform health care in the nation. Nurses must also grow into adjustments to restructuring the health care system as nurses are integral part of patient care and nurses are indispensable to the fulfillment of the developing delivery models in patient delivery.

References

ANA. (2010). New Care Delivery Models in Health System Reform: Opportunities for Nurses & their Patients. Retrieved from http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Care-Delivery-Models.pdf

Cabral, L., & Johnson, C. (2015). GENERATING STAFF BUY-IN FOR THE PATIENT-CENTERED MEDICAL HOME. Physician Leadership Journal, 2(5), 64-67

Davis, K., Abrams, M., & Stremikis, K. (2011). How the Affordable Care Act Will Strengthen the Nation’s Primary Care Foundation. Journal of General Internal Medicine, 26(10), 1201–1203. http://doi.org/10.1007/s11606-011-1720-y

Haas, S. A. (2011). Health reform act: new models of care and delivery systems. AAACN Viewpoint, 33(2), 11-12.

Holmström, I. K., Nokkoudenmäki, M. B., Zukancic, S., & Sundler, A. J. (2016). It is important that they care–older persons’ experiences of telephone advice nursing. Journal of clinical nursing, 25(11-12), 1644-1653.

Islam, N., Nadkarni, S. K., Zahn, D., Skillman, M., Kwon, S. C., & Trinh-Shevrin, C. (2015).

Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation. Journal of Public Health Management and Practice : JPHMP, 21(1), 42–50. http://doi.org/10.1097/PHH.0000000000000084

Karash, J. A., & Larson, L. (2016). Clinical Integration Managing across the care continuum. Hospitals & Health Networks / AHA, 90(6), 26.

Kibler, V.A., Hayes, R.M., Dana E. Johnson, D.E., Anderson,  L.W., Just, S.L., Wells, N.L.(2012). Early Postoperative Ambulation: Back to Basics: A quality improvement project increases postoperative ambulation and decreases patient complications. American Journal of Nursing: 112.( 4). pp 63,69. doi: 10.1097/01.NAJ.0000413460.45487.ea

Knight, P., Bonney, A., Teuss, G., Guppy, M., Lafferre, D., Mullan, J., & Barnett, S. (2016). Positive clinical outcomes are synergistic with positive educational outcomes when using telehealth consulting in general practice: a mixed-methods study. Journal of medical Internet research, 18(2).

Longworth, D. (2011). Accountable care organizations, the patient-centered medical home, and health care reform: What does it all mean? Cleveland Clinic Journal of Medicine;78(9):571-582. Doi:10.3949/ccjm.78gr.11003

Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The importance of transitional care in achieving health reform. Health Affairs, 30(4), 746-54. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.proquest. com.lopes.idm.oclc.org/docview/864026150?accountid=7374

Reinhard, S.,  Hassmiller, S. (2012). The Future of Nursing: Transforming Health Care. Retrieved from http://journal.aarpinternational.org/a/b/2012/02/The-Future-of-Nursing-Transforming-Health-Care

Ridge, R. (2011). Future of Nursing Special. Practicing to Potential. Nursing Management. Volume :42(6), p 32- 37

Sutter-Barrett, R. E., Caroline J. Sutter-Dalrymple, C.J.., Dickman, K. (2015). Bridge Care Nurse-managed Clinics Fill the Gap in Health Care.The Journal for Nurse