NURS 6565: Synthesis in Advanced Practice Care of Complex Patients in Primary Care Settings | Week 3

quality of health care provided by NPs is under constant scrutiny. Many physicians are hesitant of NPs ability to provide quality and cost-effective care. It is critical for NPs to see themselves as full partners in health care. NPs are challenged to improve the quality and measurement of health care delivery and patient health outcomes. NPs must be recognized for the care that they provide. Thus NPs must constantly ask the question, how do we ensure measurement of the care that we provide?

Ongoing monitoring and continuous improvement is vital for all practicing NPs to ensure patients receive safe, competent, and quality health care (Hamric, Hanson, Tracy & Grady, 2014). It is imperative for advanced practice nurses to have strategies to measure, report, and reward excellence in health delivery. Advanced practice nurses are well situated to provide quality, cost effective, and patient-centered care (IOM, 2015). This week, as you examine quality measures, consider how standards of care are developed and implemented.

Learning Objectives – NURS 6565: Week 3: Care of Complex Patients in Primary Care Settings

By the end of this week, students will:

• Analyze importance of quality measures
• Evaluate the use of incentive payment for care
• Analyze external motivators for incentive payment for care
• Apply comprehensive knowledge of nurse practitioner practice

Learning Resources

This page contains the Learning Resources for this module. Be sure to scroll down the page to see all of this module’s assigned Learning Resources.

Required Readings

Buppert, C. (2018). Nurse practitioner’s business practice and legal guide (6th ed.). Sudbury, MA: Bartlett & Jones Learning.

• Chapter 15, “Measuring Nurse Practitioner Performance” (pp. 463-468)

This chapter will cover standards of care, and measures of nurse practitioner performance

Hain, D., & Fleck, L. M. (2014). Barriers to NP practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Evidence-Based Practice. In Advanced Practice Nursing: An Integrative Approach (5th ed.) (237-262). St. Louis, MO: Elsevier Saunders.

This chapter will cover a historical perspective of evidence and current best evidence, steps of the evidence based process, tips for achieving meaningful changes in practice based on current best evidence.

Rhodes, C. A., Bechtle, M., & McNett, M. (2015). An Incentive Plan for Advanced Practice Registered Nurses: Impact on Provider and Organizational Outcomes. Nursing Economics, 33(3), 125-131.

Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., . . . Weiner, J. P. (2013). The Quality and Effectiveness of Care Provided by Nurse Practitioners. Journal for Nurse Practitioners, 9(8), 492-500. doi:10.1016/j.nurpra.2013.07.004

Thomas, A. C., Crabtree, M. K., Delaney, K. R., Dumas, M. A., Kleinpell, R., Logsdon, C.,…Nativio, D. G. (2012). Nurse Practitioner Core Competencies. Retrieved from http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/competencies/npcorecompetenciesfinal2012.pdf

Wilkinson, K. (2015). Legal Nuts and Bolts for PNPs in Today s Healthcare Environment [PowerPoint slides]. Retrieved from http://docplayer.net/5760521-Legal-nuts-and-bolts-for-pnps-in-today-s-healthcare-environment-karen-wilkinson-mn-arnp-lnc-wilkinson-legal-nurse-consulting.html

Required Media

Institute of Medicine. (2015, December 7). Assessing Progress on the Implementation of the Recommendations of The Future of Nursing[Video file]. Retrieved from https://www.youtube.com/watch?v=sMOjACA2ats

Note: The approximate length of this media piece is 1 hour.

Optional Resources

This is an optional resource that students should be familiar with as advanced practice nurses.

Discussion: Quality and Cost Measurements

As nurse practitioners continue to expand their role in delivering health care, it is imperative for NPs to provide the data and evidence to demonstrate the impact of NP care on patient outcomes. There are several challenges that advanced practice nurses face to provide quality care and meet productivity goals of an organization. This week it is important to explore the connection of quality care and performance measures. Some questions to consider as we discuss this topic are:

• Why are quality measures important?
• What is the difference between quality measures and performance indicators?
• What performance measures are used for NP productivity?
• Why are incentive plans used in clinical organizations?

To prepare:

• Read the article, An Incentive Plan for Advanced Practice Registered Nurses: Impact on Provider and Organizational Outcomes, by Catherine A. Rhodes, Mavis Bechtle, and Molly McNett (2015)
• Explore quality measures and identify at least one clinical performance measure, such as the Agency for Healthcare Research and Quality (AHRQ)

By Day 3

Post an explanation of the importance of quality measures using the clinical performance measure you identified as an example. Then, identify the performance measures used for NP productivity in Rhodes, Bechtle, and McNett (2015) article. Finally, share your opinion on incentive payment for care, including external motivators and at least one business model.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who shared a different perspective than you did. Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. NURS 6565: Week 3: Care of Complex Patients in Primary Care Settings

 

 

 

ADDITIONAL INFORMATION 

Care of Complex Patients in Primary Care Settings

Introduction

Complex care is a growing challenge in primary health care. In the United States, nearly one-third of hospitalizations and almost 40% of nursing home admissions are for patients with complex needs1. As these patients grow older and more frail, they face an increased risk for medical complications and institutionalization due to high costs associated with their care2. These challenges have prompted many healthcare providers to search for innovative ways to improve their ability to provide appropriate care2.

Care of Complex Patients in Primary Care Settings

The care of complex patients is not just about the patient, it’s also about the family. Complexity of care is not just about the disease, it’s also about social determinants of health (e.g., homelessness and unemployment).

A Proposed Model for an Intensivist-Based Transitional Care Unit in a Primary Hospital

Hospital discharge planning is a vital part of the primary care continuum of care. The role of the intensivist in hospital discharge planning has been well established, however there is no standardization or agreement on how to implement this process. One way to improve this situation would be to introduce an Intensivist-based TCU in a primary setting where patients are cared for by non-physician clinicians with input from physicians who can offer additional expertise and guidance (e.g., an attending physician).

In order for this model to work effectively, there must be clear guidelines regarding what types of data should be collected during patient management and how these data should be used in determining appropriate follow-up arrangements for both patients as well as providers involved with their care.

Hospital Discharge from the Transitional Care Unit to Community Services

You should work with your patient and family to develop a plan for discharge from the Transitional Care Unit. This plan should include:

• A discharge plan, which includes medications, follow-up appointments, and any other services needed to ensure a safe transition to home.

• Copies of all medical records (including labs), as well as copies of any therapy notes or treatment plans created during hospitalization.

Improving Hospital Transitions for Complex Patients

When you’re working with a complex patient, it’s important to have a multidisciplinary team in place. The team should include not only the primary care physician and nurse but also one or more members from the hospital or rehabilitation facility.

In addition to having these specialists work together as a cohesive unit, communication between them is also imperative for success. If there are any concerns about your patient’s condition during their stay at the hospital or rehabilitation center, let everyone know so they can address them immediately—and make sure everyone knows what those concerns are! This way you can ensure that all of your needs are addressed before leaving the hospital and improve outcomes even further when returning home after discharge (or wherever else they end up).

Community-Based Nursing Services for Complex Patients

Community-based nursing services are a vital component of the primary care system. In many ways, they are the building blocks of health care practice. They provide patients with access to a wide range of quality health care services, including physical exams and tests, counseling sessions, mental health services and dental work.

Community nurses play an important role in ensuring that complex patients receive appropriate treatment for their conditions or illnesses. Community nurses also help people manage chronic diseases such as diabetes through education about lifestyle changes and medications; manage stress or other mental health issues; secure referrals for other specialists when needed; assist with transportation needs related to medical appointments; arrange for transportation home after discharge from hospital or clinic visits (for example).

Takeaway:

• The takeaway is a summary of the article, which can be written in one sentence.

• It should be easy to remember and relevant to the article.

• It should be written in the same tone as the article.

Conclusion

The model is a starting point for discussion. It can be refined, and the resources can be better targeted to serve patients with complex needs. The goal of this model is to improve access to care for these patients through coordination across primary and specialty care services. This will result in more seamless transitions between hospitalization and community services, which should benefit both patients and health care providers alike by reducing patient burden and improving quality of life.