Question
Discuss the access, cost, and quality of quality environments, as well as recent quality initiatives (See Chapter 24 and Table 24.1; see attached document for the pdf version the text book). Please reflect on the relationship between quality measures and evaluation and role development. In addition, describe this relationship and note how the role of the APN might change without effective quality measures.
Please make sure to follow these guidelines:
Objective is precise, knowledgeable, significant, and distinguished from alternate or opposing options.
Skillfully arranges evidence to setup premise of the issue.
Persuasively builds the case with supportive evidence.
Elaborates on all key points of the issue.
Skillful recommendations and/or specific action. Suggested action is reasonable.
Conclusion is precise, knowledgeable, significant, and distinguished from alternate or opposing options.
Skillfully implicates impact on nursing practice, patient safety and healthcare quality.
Provides concluding remarks that show analysis and synthesis of ideas.
Solution
Access, Cost, and Quality for Advanced Practice Nurses
The quality of care provided to patients is critical since it determines the outcome of service delivery in healthcare organizations. Standards of quality are well documented in the scope of nursing for Advanced Practical Nurse (APRNs), also they include the expectations for care delivery as they relate to patients in the therapeutic environment. The care environment should be characterized by the principles of access, cost, and quality. Therefore, education and practice for APNs should be based on the ability to achieve the three objectives; which involves, ensuring that people can obtain care or health-related services, the ability to pay for the services, and increase the chances of desired outcomes (Joel, 2017). Although APNs have numerous roles in healthcare settings, they should ensure access, cost, and quality, through the relationship between quality measures, evaluation, and role development, which could change negatively without quality measures.
Nursing, as a caring profession, has always focused on the achievement of quality care provided to patients. The concepts of access, cost, and quality emerge in the attempt to understand expected outcomes in caring for patients. Access involves the possibility of obtaining health care services whenever they are required, while cost is the capacity to pay for the services, and depend on affordability. Access and cost of care lead to quality outcomes, such as improved satisfaction with the services provided to a patient since it is based on the use of the clinical and evidence-based practice. Several initiatives have emerged relating to the quality of care environment, such as the Agency for Healthcare Research and Quality (AHRQ’s), initiative to establish prescribed drugs with the potential to reduce the cost and improve quality outcomes. Another initiative is the evaluation of the quality of services provided to patients by organizations, such as Child and Adolescent Health Measurement Initiative (CAHMI), The American Health Quality Association (AHQA), and the National Qualifications Framework (NQF) (Joel, 2017). The organizations play a critical role in ensuring the provision of quality health care in the United States and that organizations follow the standards to improve nurses’ practice.
Quality measures, evaluation, and role development are essential concepts related to quality healthcare outcomes. APNs take a central place in the quality environment and follow the prescribed standards to improve patient experience through positive outcomes. Their role includes, providing optimal care at the least possible cost to improve access and cost measures of quality. Quality measures, such as access and cost, are designed to provide the direction for APNs to continually improve the quality of care (Reiss-Brennan et al. 2016). They are quantifiable measures that can be used to determine whether they are achieving quality goals. Quality measures are related to evaluation since the process depends on the standards that the evaluator can use to establish whether nurses are working towards optimal care outcomes. Furthermore, the results of the evaluation using the quality measures can be useful in evidence-based developing roles for APNs, which are informed by best practice. Thus, the three concepts are closely related in achieving quality outcomes for patients.
The role of the APN might change without effective quality measures since they would lack the necessary standards to measure the quality of care that they provide. “Nurse practitioners (NPs) are a proven response to the evolving trend towards wellness and preventive health care driven by consumer demand. A solid body of evidence demonstrates that NPs have consistently proven to be cost-effective providers of high-quality care for almost 50 years. Examples of the NP cost-effectiveness research are described below” (AANP, 2013). Therefore, without the means to measure the extent to which they provide cost-effective and quality care, their described role would become invalid. They would still provide care, but meaningless due to the failure to have the standard to evaluate its effects on patients. Besides, it would be easy to deviate from quality requirements and provide substandard care, also they could easily discount the importance of evidence-based care to inform their practice. Thus, APNs require quality measures for practical evaluation to inform the effectiveness of their role in health care.
Health care providers, such as APNs should deliver their services according to quality standards and strive to improve access, cost, and quality outcomes. The nursing care environment is essential due to its influence on the overall quality of care in the entire healthcare system. Nurses working in a practical setting, with proper quality measures and evaluation to inform their practice, operate professionally since they can become engaged in their role, and achieved increased job satisfaction. They can also work better with patients to ensure that they receive better care in an accessible and affordable environment. Eventually, they improve the healthcare environment for patients and other care providers. Therefore, nurse leaders and other managers in the system should ensure compliance with quality initiatives, such as conducting research and using evidence on quality improvement measures, such as access and cost. Generally, health care organizations should evaluate, monitor, and improve the quality environment.
References
AANP (2013). Nurse Practitioner Cost-Effectiveness. Retrieved from https://www.aanp.org/advocacy/advocacy-resource/position-statements/position-statements
Joel, L. A. (2017). Advanced practice nursing: Essentials for role development. Philadelphia, PA: FA Davis.
Reiss-Brennan, B., Brunisholz, K. D., Dredge, C., Briot, P., Grazier, K., Wilcox, A., … & James, B. (2016). Association of integrated team-based care with health care quality, utilization, and cost. Jama, 316(8), 826-834.
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