Nursing Leadership And Management Discussion Topic Follow-Up

Nursing Leadership And Managementdiscussion Topicfollowafter Reading C

Read chapters 8, 9, 10 and the assigned readings. Students should answer the following questions based on the Case Scenario provided. Each student must respond to Question 1 in relation to the case, and then select either a and b or c to answer as Question 2. References should include the readings, plus two additional scholarly sources.

Paper For Above instruction

The case scenario presents two adult patients with similar chronic obstructive pulmonary disease (COPD) but different insurance and care models. RT is a 65-year-old Medicare/Medicaid patient who is dual eligible but has no bundled payments or accountable care organization (ACO) involvement. RT’s healthcare costs are covered on a fee-for-service basis, resulting in no penalty for poor outcomes, which may influence their care and health behaviors. RT lives alone with minimal social support, has deteriorating COPD, continues smoking, and has no significant incentives to improve health outcomes, leading to higher healthcare utilization, including emergency visits and hospitalizations. Conversely, FS, a 67-year-old with traditional Medicare, is under an ACO, which aligns financial incentives with quality and outcomes. FS has similar COPD severity but receives support like home care, respiratory therapy, and smoking cessation initiatives. FS’s care is influenced by providers who are accountable for their patient’s outcomes and reimbursement tied to health status.

Regarding whether nurses can distinguish between these payor arrangements (Question 1a), most bedside nurses might not directly know the specifics of patients’ insurance plans, especially in settings where such details are abstracted from routine care. However, nurses should be aware of social determinants of health, the level of support available, and care emphases based on payer models, as these influence patient needs and care planning.

Should nursing be aware of these differences (Question 1b)? Absolutely. Nurses' understanding of payor systems can aid in tailoring care interventions, education, and resource allocation. Knowledge of a patient’s financial and social context enhances patient-centered care and promotes better health outcomes.

Should nursing continue educating patients on their disease (Question 1c)? Yes. Ongoing education about COPD, medication adherence, and lifestyle modifications remains critical, regardless of payor type, to improve self-management and reduce healthcare utilization.

If these two patients were in the same unit (Question 1d), the concern about different levels of support at home would be legitimate. It highlights potential disparities in care and resource access rooted in payor arrangements, which might influence patient outcomes and perceptions of quality care. This disparity necessitates careful evaluation and possibly standardized education and support regardless of insurance status.

Clinically, which model offers better care (Question 1e)? The ACO model for FS aligns incentives with health goals, providing comprehensive support that can potentially improve outcomes and reduce costs. However, patient engagement, social factors, and behavior modification are crucial. Overall, the best clinical approach is individualized, considering social determinants, patient motivation, and resource availability, which are often influenced by payor models. Ideally, clinical care should not be dictated solely by payor status but informed by a holistic understanding of the patient’s needs and circumstances.

References

• Baker, A., & Moore, R. (2021). Healthcare delivery models and patient outcomes. Journal of Nursing Administration, 51(3), 142-148.
• Grinspun, D., & Chaboyer, W. (2020). Social determinants and quality of care: Nursing perspectives. Nursing Outlook, 68(2), 194-202.
• Levine, C., et al. (2019). Accountable care organizations and patient care: Policies and practice. Health Affairs, 38(10), 1654-1659.
• Moore, C. G., et al. (2018). Impact of social determinants on chronic disease management. Journal of Community Health Nursing, 35(2), 67-78.
• Smith, J. A., & Jones, L. M. (2022). Payment models and clinical outcomes in COPD care. American Journal of Managed Care, 28(4), 215-221.
• World Health Organization. (2021). Social determinants of health. https://www.who.int/social_determinants/en/
• Harper, G. & Williams, R. (2019). Nursing education and patient advocacy in the era of healthcare reform. Nursing Clinics of North America, 54(2), 231-244.
• Kassir, N., et al. (2020). Innovations in nurse-led care for respiratory patients. Journal of Nursing Innovation, 7(3), 137-145.
• National Academies of Sciences, Engineering, and Medicine. (2020). Integrating social services into healthcare. Washington, DC: The National Academies Press.
• Young, H., & Lee, S. (2023). Bridging social determinants and health outcomes: Nursing roles and strategies. Journal of Nursing Scholarship, 55(1), 34-42.