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4 pages/≈1100 words
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Health, Medicine, Nursing
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Health Care Delivery Models and Nursing Practice (Essay Sample)


Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.
Include the following:
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.
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.
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.
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.
You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.


Health Care Delivery Models and Nursing Practice
Student’s Name
Healthcare Delivery Models and Nursing Practice
Current healthcare law
The enactment of the Affordable Care Act (ACA) saw a significant shift in many aspects of US healthcare. Through the legislation, the country took huge steps towards improving the quality of care and controlling rising healthcare costs. According to Salmond and Echevarria (2017), the legislation sought to increase coordination of care to improve care quality and reduce costs attributed to multiple prescriptions, repeated diagnostic testing, and unnecessary hospitalizations. The authors point out that nurses are positioned to lead and be part of these changes that occur in the healthcare sector. As the sector shifts from fee-for-service, provider-based system to patient-centered care, nursing practice as well as nurse roles and responsibilities are changing to conform to the new paradigm.
Value-Based Purchasing (VBP), Pay for Performance (P4P), and Shared Savings Arrangements are some of the approaches supported by ACA (Salmond & Echevarria, 2017). The implementation of these approaches aimed to transform the country’s healthcare to one that is affordable, high-quality, and patient-centered. As informed by Salmond and Echevarria (2017), the new models focus on systems that reward providers depending on measurable quality outcomes and the experiences of patients. Therefore, nursing practice as well as roles have to change to deliver the outcomes. As pointed out by Salmond and Echevarria (2017), the changes in the healthcare sector need a new or enhanced skill set on population care and wellness. Furthermore, nursing practice must renew its focus on care coordination, quality improvement, data analytics, and patient-centered care (Salmond & Echevarria, 2017). Nurses are also expected to partner with patients and their families to understand their social environment and consequently attain patient-defined health outcomes. It is evident, therefore, that as a result of the legislation, nurses have to assume roles and responsibilities to improve care and advance the health of members of the population.
Quality Measures and Pay for Performance (P4P)
Some of the key aspects associated with the transformation in the healthcare sector are quality measures and P4P. According to Mendelson, et al. (2017), through the P4P programs, healthcare providers are provided with financial rewards or penalties depending on their performance on quality measures. The authors note that proper design and implementation of the programs would drive healthcare systems to reduce unnecessary hospitalizations as well as to improve the quality of care. However, it has not been conclusively proven that quality measures and P4P programs improve patient outcomes.
While P4P programs have been shown to improve process-of-care outcomes modestly, they have little impact on patient outcomes (Mendelson, et al., 2017).  Therefore, the study, alongside many others found that P4P programs are not consistent in improving patient outcomes. In another study by Shih, Nicholas, Thumma, Birkmeyer, and Dimick (2014), it was found that financial rewards to hospitals that showed improvements did not decrease adverse outcomes. Chatterjee and Joynt (2014) found that quality measures for improving patient outcomes are not clear. Therefore, there is no conclusive evidence to show that

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