Assignment: Topic 2 Health Care Delivery Models and Nursing Practice/NRS 440

Assignment: Topic 2 Health Care Delivery Models and Nursing Practice/NRS 440

Assignment: Topic 2 Health Care Delivery Models and Nursing Practice/NRS 440

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

Outline a current or emerging health care law or federal regulation introduced within the last 5 years to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.

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Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.

Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.

Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years in response to upcoming trends or predicted issues in health care.

Health Care Delivery Models and Nursing Practice – Rubric

Current or Emerging Health Care Law or Federal Regulation and E ect on Nursing Practice, Role and R

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24.75 points

Criteria Description
An outline of emerging health care law or federal regulation and a description of the effect on nursing practice and the nurse role, and responsibility.

Quality Measures Pay for Performance, Patient Outcomes, and E ect on Nursing Practice

33 points

Criteria Description
A discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role.

A discussion of professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.

Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years in response to upcoming trends or predicted issues in health care.

Communicates reason for writing and demonstrates awareness of audience.

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

Evidence 9.9 points
Criteria Description
Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

Total 165 points

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Health Care Delivery Models and Nursing Practice

While the U.S. remains the only developed nation without the universal health coverage (UHC) model, its healthcare system continues to undergo radical changes aimed at empowering patients and consumers by impacting quality, safety, and delivery, and reducing the cost of care. Recent legislation, especially at the federal level, is necessitating the development and implementation of healthcare delivery models that enhance care provision while also impacting the nursing practice in significant ways (Rice et al., 2020). The purpose of this paper is to discuss actions and decisions through laws and policies to reform and restructure the healthcare system and the role of nurses in this transforming environment.

Current or Emerging Health Care Law or Federal Regulation

The federal government through Congress has introduced multiple legislations in the last five years to reform and restructure the healthcare delivery system after the landmark enactment of the Patient Protection and Affordable Care Act in 2010. These legal instruments and policies primarily guide healthcare professionals throughout their practice to deliver quality, and affordable care to patients. The Sustaining Excellence in Medicaid Act of 2019 (HR 3253) was signed into law on August 6, 2020. This law aimed to restructure Medicaid by proposing an extension within the current provision. Among the proposals was the expansion of the appropriation of Medicaid until 2024. The National Association of Counties (NACO) (2020) asserts that the law reauthorizes coordinated care programs that are essential in delivering healthcare that meets consumer demands. The law enhances federal support for state Medicaid programs that transition individuals in long-term care facilities back into community-based settings. Through the bill, 43 states and the District of Columbia have developed infrastructure to assist older adults and people living with disabilities to stay in the settings of their choice while attaining lower institutional admission rates and cost savings for the Medicaid program.

The enacted legislation means that nursing practice improves to adequately cater to the expanded care delivery, not just for older patients in such facilities but for all areas of care provision (Prentice et al., 2022). The law expands Medicaid programs in states to increase access to care for various cadres of patients. Therefore, nursing practice must develop effective interventions to cater to this population, especially through culturally competent care and evidence-based practice (EBP) interventions (Rice et al., 2020). Nurses’ roles and responsibilities also expand as they cater to new patients implying the need for advanced education, training, and specialization. Nurses and nursing practice should focus on delivering quality and affordable care while improving accessibility for all patients.

Quality Measures & Pay-for-Performance, Patient Outcomes

Quality measures and Pay-for-Performance incentivize providers to offer quality care and get compensated based on patient outcomes. Developed by the Centers for Medicare and Medicaid Services (CMS), pay-for-performance stresses quality over quantity of care. The model allows healthcare payers to allocate funds to encourage best clinical practices and promote positive health outcomes. Quality measures and pay-for-performance are part of a national strategy to transition healthcare to value-based medicine as it ties reimbursements to metric-centered outcomes, proven best practices, and patient satisfaction (Duong et al., 2021). Therefore, these metrics align payment with value and quality for patients. These measures and performance-centered requirements improve patient outcomes as providers and healthcare organizations focus on quality as opposed to quantity (Waters et al., 2022). The organizations and providers also seek better interventions to ensure they deliver value-based care to patients and improve their outcomes.

Given that quality measures affect patient outcomes, they equally have certain effects on nursing practice and changes to their roles and responsibilities based on expectations. These measures mean that nursing practice should focus on quality interventions through evidence-based practice and patient-centered care. For instance, quality measures will ensure that nurses develop better interventions like culturally sensitive care to improve patient outcomes (Rice et al., 2020). The expectations and responsibilities of the nursing role include advancing training and competencies to cater to diverse patients and increasing care needs, expanding access to care through specialization, and working in collaboration with other providers and inter-professional and multidisciplinary teams to deliver patient-centered care.

Professional Nursing Leadership and Management Roles

The rising changes in healthcare due to legislation affect nurse leaders and managers based on new roles and responsibilities. The move to value-based care requires nurses to be equipped with better competencies and skills; implying that they should enhance their training and education to attain better approaches and understanding of healthcare issues and possible yet effective interventions (Waters et al., 2022). These leadership and managerial roles ensure that they provide better supervision and focus on patient needs. Increased leadership positions give nurses a vital role in improving patient care and reducing costs. Nurses are now patient and health advocates who promote wellness within and outside health facilities and independent nurse-managed care organizations (Oldland et al., 2020). Nurses are now becoming critical administrators to improve healthcare coordination and implementation of based practices for better patient outcomes.

New nursing job roles and care models will emerge as healthcare transforms to meet the changing and increasing demands emanating from an aging population and diversity. These changes implore nurses to move from a controlling directive style to becoming more engaging, empowering, and recognizing of efforts by subordinates while improving care coordination through interdisciplinary teams (Prentice et al., 2022). Both nurse leaders and nurse managers must work collaboratively as their roles interplay and align based on their healthcare settings and similarities in patient care demands.

Emerging Trends

Several critical trends are emerging to enhance care delivery. These include the increasing role of technologies in healthcare, diversity in the nursing workforce, and integration of healthcare teams through collaborative working. Healthcare technologies like artificial intelligence will alter nursing practice and roles as nurses leverage this resource to enhance their competencies and lead teams to improve care delivery (Martinez-Ortigosa et al., 2023). AI analyzes patient conditions and improves diagnosis, helping nurses attain better patient outcomes and make effective decisions. AI can transform nursing roles by emphasizing nurse informatics and ensuring that nurses are well-equipped to use and manage AI systems and related technologies to improve their decisions in patient care management (Rony et al., 2024). Nurses can leverage this technology and others to improve care provision through providing patient-centered care.

Conclusion

The transforming healthcare system in the U.S. is focusing on improving patient outcomes, lowering costs, and enhancing quality care. Current policies and legislation are essential to attain these goals based on the transformation of the system and focus on patient-centered care. Care delivery models like pay-for-performance affect nursing practice and nurse roles as they emphasize value and quality over quantity to improve patient outcomes. Therefore, nurses must leverage technologies like artificial intelligence to improve decision-making and attain accurate diagnoses for different medical and healthcare conditions among patients and health populations.

References

Duong, N. E., Kim, D., Hernandez, F. A., Heizman, L. M., Zahn, J., Ball, T., & Stathakos, K.

(2021). Value-Based Pay-for-Performance Gaps in the Care Delivery Framework for a

Large-Scale Health System. Population health management, 24(6), 691–698.

https://doi.org/10.1089/pop.2021.0024

Martinez-Ortigosa, A., Martinez-Granados, A., Gil-Hernández, E., Rodriguez-Arrastia, M.,

Ropero-Padilla, C., & Roman, P. (2023). Applications of Artificial Intelligence in Nursing Care: A Systematic Review. Journal of Nursing Management, 2023. https://doi.org/10.1155/2023/3219127

National Association of Counties (2020). President signs Medicaid bill reauthorizing

coordinated care programs important to counties. https://www.naco.org/blog/president-signs-medicaid-bill-reauthorizing-coordinated-care-programs-important-counties

Oldland, E., Botti, M., Hutchinson, A. M., & Redley, B. (2020). A framework of nurses’

responsibilities for quality healthcare—Exploration of content validity. Collegian, 27(2), 150–163. https://doi.org/10.1016/j.colegn.2019.07.007

Prentice, D., Moore, J., Fernandes, B., & Larabie, E. (2022). Nursing care delivery models and

Intra-professional collaborative care: Canadian nurse leaders’ perspectives. SAGE Open Nursing, 8, 23779608221133648. https://doi.org/10.1177/23779608221133648

Rice, T., Rosenau, P., Unruh, L. Y., & Barnes, A. J. (2020). United States: Health System

Review. Health systems in transition, 22(4), 1–441.

file:///C:/Users/ADMIN/Downloads/HiT-22-4-2020-eng.pdf

Rony, M. K. K., Kayesh, I., Bala, S. D., Akter, F., & Parvin, M. R. (2024). Artificial intelligence

in future nursing care: Exploring perspectives of nursing professionals-A descriptive qualitative study. Heliyon, 10(4). https://doi.org/10.1016/j.heliyon.2024.e25718

Waters, T. M., Burns, N., Kaplan, C. M., Graetz, I., Benitez, J., Cardarelli, R., & Daniels, M. J.

(2022). Combined impact of Medicare’s hospital pay for performance programs on quality and safety outcomes is mixed. BMC health services research, 22(1), 958. DOI: https://doi.org/10.1186/s12913-022-08348-w