Health Care Delivery Models and Nursing Practice
Examine changes introduced to reform or restructure the U.S. health care delivery system. In word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.
Include the following:
1. Outline a current or emerging health care law or federal regulation introduced 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.
2. 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.
3. 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.
4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.
Reforms to Healthcare Delivery and Nursing Practice
The American healthcare delivery system is in dire need of reforms. Changes in legislation and regulation would grant providers a more conducive environment to deliver quality and safe care in diverse settings. Furthermore, a shift in professional roles, such as nursing leadership, would improve clinical outcomes. Therefore, understanding the current legislative framework, service models, roles, and emerging trends would allow healthcare providers, particularly nurses, to prepare for a future where healthcare delivery is more effective.
Amendment 4 to the PREP Act
Towards the end of 2020, the United States Department of Human and Health Services (DHHS) published an amendment to the Public Readiness and Emergency Preparedness (PREP) Act. The change in regulation permitted qualified healthcare professionals to offer telemedicine services across state lines without requiring additional licensure (Federal Register, 2020). The amendment followed earlier regulatory revisions, including the authority to use commercial teleconferencing platforms, such as Skype, instead of HIPAA-compliant ones (Office of Civil Rights, 2021). These changes to telemedicine regulation provide a glimpse of what telehealth could be in the near future and how it will impart nursing and nurses’ roles and responsibilities.
A broader practice scope will allow nurses to implement care continuity for long-term patients. If a caregiver has a patient who travels to another state, they can continue attending to the needs remotely without administrative restrictions. Hence, they will offer consistent services to patients regardless of their physical location. The expanded practice will accrue additional responsibilities for nurses. For instance, they must protect patient data. They can achieve this by using secure communication platforms, verifying recipients before sharing information with other caregivers, and protecting their telehealth equipment from unwarranted access. Thus, this additional data protection responsibility will require training and keeping up to date with cybersecurity trends.
Quality Measures and Pay for Performance
Quality measures are the criteria that healthcare providers use to assess the overall effectiveness of healthcare services. They can be structural, procedural, or outcome-related (Jazieh, 2020). On the other hand, pay for performance (P4P) is a healthcare service delivery model that attaches financial incentives to value-based healthcare outcomes (NEJM Catalyst, 2018). For example, healthcare facilities receive a higher reimbursement rate if they deliver better patient outcomes, such as low readmission rates for non-chronic illnesses.
P4P and quality measures enhance patient outcomes since caregivers are more diligent. For instance, being thorough prevents misdiagnosis, maltreatment, and eventual sentinel events. Therefore, patients recover quicker and spend less money on healthcare. Administrators of healthcare facilities are also vigilant to ensure they have adequate resources to meet patient needs (NEJM Catalyst, 2018). Thus, patients are more likely to have all their health needs met in a facility, reducing delayed or missed care cases.
There is also discernible change in nursing practice since stakeholders pay more attention to self-care. Nurses must find ways to address performance hindrances such as exhaustion, emotional burnout, and compassion fatigue. Furthermore, leaders establish ways of making nursing more efficient by incorporating technology and other emerging practices. Hence, P4P and quality measures have established evidence-based practice as a stronghold of modern nursing.
In the near future, the focus on P4P and quality measures will redefine nursing roles, mainly to integrate technology. Nurses will have extra duties to ensure that they can handle different technological infrastructures in diverse healthcare settings. Therefore, concepts like data management, cyber security, and telehealth will become requirements for all nurses.
Emerging Nursing Leadership/Management Roles
Some key emerging nursing leadership and management roles involve care coordination and healthcare navigation. A care coordinator helps patients attain better outcomes from the services they receive (Faller, 2017). Their duties include sorting out insurance issues, patient education, and emphasizing adherence. Meanwhile, nurse navigators offer general services such as arranging appointments. Both roles are essential to modern nursing management since they allow caregivers to focus on the clinical aspects (Faller, 2017). Hence, they are more thorough, resulting in improved care quality. The assistance also helps patients avoid crucial medical errors, enhancing safety.