The Evolution of Nursing and Patient Care Delivery
Tree Princess Jones
Trends in Nursing Practice
The Evolution of Nursing and Patient Care Delivery
With the enactment of the Affordable Care Act (ACA) and the influx of complex patients expected to accompany it, nurses will soon be taking on a more active role in patient care. This paper will discuss how the role of nurses’ in the evolving health care system will be crucial in post ACA era in providing quality care across the continuum across the nation. Patient-Centered Medical Home
Currently primary care leans more towards treatment of acute and periodic illnesses with management of chronic conditions, rather than preventative care for the patient and their families (Bleser, et al., 2014). One model that has been introduced with the changing needs of healthcare is the Patient-centered medical home (PCMH). In 2010 US studies found that the PCMD model improved quality of care and patient experiences as well as reducing hospital and emergency department visits (Bleser, et al., 2014). The main concept of the PCMH models is that patient populations are followed through a continuum of healthcare needs focusing on prevention and wellness in the communities, as well as chronic disease management. Health concerns of the community and environment are addressed among the populations in the hopes to decrease the incidences of disease and prevent unnecessary hospitalizations by involving community businesses, schools and social services. This model will require a large amount of team work and collaboration among various multidisciplinary team members to ensure that all aspects of patients’ care and treatments are addressed in a timely and efficient manner. Nurses will need to be well versed on community health care, immunizations, prevention programs and collaboration techniques to assist patients and their families to effectively assume self-care practices and how to navigate through the new complex evolving healthcare system.
Accountable Care Organization
Studies have shown that 50-60% of health behaviors are responsible for increasing health care costs in the US and in order to change health behaviors it will be necessary to engage in activities that reach beyond the clinical setting and into the community and public health arena (Hacker & Walker, 2013). With population health being a top goal in the changing healthcare system, Accountable Care Organizations (ACO) will need to be more directly linked to the public health system. While PCMH models will focus on transforming primary care with improved delivery systems that will address the whole patient, including their health and social needs, ACO’s will be held responsible for improving the quality of care and reducing costs across the health continuum (AM J Health-Syst Pharm, 2013). Promoting continuity of patient care will require communication among health care professionals to ensure patients are treated in the most cost-effective locations to avoid unnecessary hospitalizations and readmissions by focusing on chronic and preventative care (AM J Health-Syst Pharm, 2013). The new paradigm with ACO’s will require a change in health-system leadership from personnel having narrowly defined responsibilities to team members being well equipped to assume additional responsibilities (AM J Health-Syst Pharm, 2013) and It will be imperative that nurses and APRN’s are utilized to their full extent of skills and education to assist in primary care and prevention services to meet the demands of increased patient loads within the communities. Nurse Managed Clinics
Another new aspect with the enactment of the ACA will be nurse managed clinics. Nurse managed clinics were originally initiated in the 1970’s in response to meeting the increased health needs of the US (Paterson, Duffett-Leger, & Cruttenden, 2009). There are still several of these clinics today within North America that are, in most cases, operated by...
References: AM J Health-Syst Pharm. (2013). Report of the 2012 ASHP Task Force on Accountable Care Organizations. American Society of Health-System Pharmacists, Inc.
Bleser, W. K., Miller-Day, M., Naughton, D., Briker, P. l., Cronbolm, P. F., & Gabbay, R. A. (2014). Strategies for Achieving Whole-Practice Engagement and Buy-in to the Patient Centered Medical Home. Annals of Family Medicine.
Burke, E., & Schwartz, E. (2012). Nurse Managed Clinics-Sheridan Health Services a Prime Colorado Model. Colorado Nurses Association.
Hacker, K., & Walker, D. K. (2013). Achieving Population Health in Accountable Care Organizations. American Journal of Public Health.
Paterson, B. L., Duffett-Leger, L., & Cruttenden, K. (2009). Contextual Factors Influencing the Evolution of Nurses ' Roles in a Primary Health Care Clinic. Public Health Nursing.
Van Houdt, S., Heyman, J., VanHaecht, K., Sermeus, W., & De Lepeleire, J. (2013). Care Pathways across the Primary-hospital care continuum: Using the multi-level framework in explaining care coordination. BMC Health Services Research.
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