It is hard to disagree that healthcare plays an essential role in modern society. Although all people require quality, cost-effective, accessible, and timely care, many weaknesses and gaps in this sphere may prevent some patients from receiving it. For example, there is a lack of healthcare providers, including advanced practice nurses (APNs), as well as the lack of necessary resources. Thankfully, government agencies and healthcare organizations are trying to address these problems and increase access and quality, and various initiatives gradually contribute to enhancing the situation. The purpose of this paper is to discuss the access, cost, and quality of quality environments and evaluate some recent initiatives aimed at improving these factors. Additionally, the relationship between quality measures and evaluation and role development will be explored, and the way the role of advanced practice nurses may change without effective quality measures will be explained.
Access, Cost, and Quality
It is possible to state that modern healthcare provision is much better than it was decades ago. Many problems were successfully addressed by professionals, and now people can get an extended number of medical services and become satisfied with the overall process and outcomes. Nevertheless, there is still the need for development and improvements. Access, cost, and quality are considered the key factors of quality environments and healthcare in general.
First, it is necessary to define the mentioned terms and then explain their significance. According to Joel (2018), access is the “ability to obtain care or health and related services (also defined as use or insurance coverage)” (p. 370). These medical services may include diagnosis, prevention, management, and treatment of various conditions, disorders, and diseases. Since patients need to receive proper services and procedures across the continuum of care because their health status depends on it, it is required that healthcare is accessible. In turn, it also means that it has to be convenient and affordable (Joel, 2018). Unfortunately, there are many people who cannot get access to adequate and quality medical services since they have no insurance and not enough money. Therefore, since the number of these persons in the U.S. is high, it is not possible to say that there is proper access to quality environments.
There are numerous barriers to providing patients with adequate access. For example, they lack primary care physicians, poverty, no convenient transportation for some clients, long waiting times, and the lack of education for nurses and needed resources. Further, Joel (2018) also notices that “although payment mechanism is often discussed as an issue of access to insurance for the uninsured and the underinsured, it is not sufficient to improve outcomes” (p. 371). Therefore, it is essential to discuss the cost of quality environments.
Cost refers to the amount of money a patient pays for services, or the provider spends on producing them. What is more, it is possible to consider cost nationally, or from the society’s perspective, and define it as the total costs of medical care (Joel, 2018). According to researchers, “global expenditures include provider services, insurance, goods and supplies, pharmaceuticals, research, education, core public health services, and institutional costs for delivering healthcare services” (Joel, 2018, p. 371). Therefore, the cost of quality healthcare is a severe concern that has a different impact on both consumers and employers, including healthcare organizations.
Thus, for employers, a percentage of expenditures required for their business includes the loss of productive work time, insurance costs, and healthcare programs administering. Concerning medical providers, their “focus is on expenditures, such as costs for personnel, administration, physical plants, and supplies and equipment, to produce services for groups of patients” (Joel, 2018, p. 371). Finally, as for individual clients, they have to spend a severe portion of their budget on insurance and pharmaceutical costs.
Finally, quality refers to the level of the provided services and their contribution to the achievement of the desired outcomes. Unfortunately, now there are some deficiencies that exist in the care of persons with chronic conditions, oral healthcare services, and mental healthcare services (Joel, 2018). Together with access and cost issues, problems with quality have rather negative effects on the quality environments and the services that patients receive.
Recent Quality Initiatives
In order to improve quality and shape the future of the healthcare system, it is vital to create various approaches and programs that may help address the situation. Thankfully, there is currently a growing number of national quality initiatives that are likely to help. Overall, quality efforts a considered an essential factor in addressing the issues. According to Joel (2018), “to ensure quality and cost-effective care, quality must be defined; performance expectations specified; and performance and outcomes measured” (p. 371). For example, the following are some of the healthcare quality measurement objectives:
- Collection and analysis of data to inform quality improvement efforts;
- Assessment of objects and individual indicators in accordance with established standards;
- Comparison of different providers to ensure the clients are aware of the choice;
- Identification of the best practices;
- Meeting communities’ health care needs (Joel, 2018).
Therefore, the demand for quality requires that government agencies need to be informed about the quality of healthcare to guide program decision-making and their policy. For instance, the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS) are known for their major focus on quality. The former has various educational initiatives and research programs that can help improve the outcomes of healthcare. This government agency is aimed at reducing costs, enhancing access to efficient services, and addressing patient errors and safety (Joel, 2018). Thus, one of their recent initiatives is a synthesis of the available research to find out which prescriptive drugs can improve outcomes and reduce costs (Joel, 2018). This agency also evaluates some projects that encourage and reward those healthcare professionals who provide their patients with high-quality and convenient services. Additionally, AHRQ creates collections of measures and guidelines for clinicians to establish their own quality and performance measurements.
Further, as for CMS, this provider must make sure that its cost-effective and quality care is delivered to its program beneficiaries. It is possible to say that any of its efforts and initiatives will be far-reaching and essentially effective. For instance, Joel (2018) states that “among its initiatives are programs to assess quality and performance in hospitals, home care, and long-term care” (p. 372). What is more, the CMS tries to improve quality in nursing homes by disseminating information about quality in Medicaid- and Medicare-certified long-term care facilities. Considering the effectiveness of these government agencies, their efforts are not enough to address all the weaknesses and issues, which is why there are also many other initiatives and activities.
Thus, the Child and Adolescent Health Measurement Initiative (CAHMI) is an example of the role of the private sector. The main focus of the CAHMI is on assessing the performance of the health system for children covered by private insurances and Medicaid and then identifying gaps (Joel, 2018). It helps both kids and their parents learn about the factors that should influence their choices and decisions.
Quality Measures and Evaluation and Role Development
When discussing the relationship between quality measures and evaluation and role development, it is essential to define the former. Thus, quality measures are used to measure various factors that can affect the capacity and ability of healthcare providers to deliver high-quality services (Joel, 2018). These factors include outcomes, organizational structures, patient perceptions, and different procedures. Overall, the purpose of the quality measures is to evaluate the healthcare processes efficiency and address the costs, safety, and outcomes of the patients. Therefore, there is a strong relationship between quality measures and evaluation since the former is used to make sure that the latter is informative enough to be used for healthcare quality improvement (Joel, 2018). As for role development, after the quality measures help identify problems in providers’ work, some corrections can be introduced to their roles. Since APNs are responsible for making sure that the services provided by them are high-quality and can also measure the results, they are the primary factor of successful outcomes.
The Role of the APN Without Effective Quality Measures
As mentioned above, the role of advanced practice nurses cannot be over-evaluated. They are responsible for taking proper care of patients, addressing all their needs, improving care continuity, and preventing deterioration. Precisely the efforts and conscientious work of nurses can contribute to the reduction of costs and increased access to high-quality services. Therefore, they play a significant role in following the quality measures, which, in turn, define their responsibilities.
Consequently, if there are no effective quality measures, the role of the APN can change. For example, they will not be able to take initiatives that improve the quality of health services. These initiatives include developing clinical guidelines and protocols, implementing evidence-based practice, conducting the necessary research, and maintaining the quality of services (Joe, 2018). Advanced practice nurses will not have a clear guideline to help them organize all of their activities and then evaluate their effectiveness.
Joel, L. A. (Ed.) (2018). Advanced practice nursing: Essentials for role development (4th ed.). F.A. Davis Company.