Overused Healthcare Interventions and ACA

Overused Healthcare Interventions

• Common overused interventions include prescription drugs, antibiotics, lab tests, imaging, and procedures like back surgery and prostatectomy, as well as end-of-life treatments.
• Identified as overused in 2008 by the National Priorities Partnership.
• Examples include antibiotic treatment for colds, spinal fusion, and pacemakers.
• Causes of overuse include fee-for-service payment, diagnostic fear, provider beliefs and expectations, patient expectations, clinical competence and skills.
• Strategies to reduce overuse include the Choosing Wisely Campaign and encouraging conversations between providers and patients. Public reporting of hospital-specific information (LeapFrog) is also used.
• "Marinated Mind" describes the idea that more treatment is better, leading to a rushed workflow.

Affordable Care Act (ACA)

• Goal is to increase access to healthcare by expanding coverage, incentivizing quality and efficiency, and providing the best care at the right price.
• Three main goals are cost, quality, and access, achieved through accountability, transparency, performance measurement, public reporting, and value-based purchasing.

Value-Driven Healthcare

• Improves care quality while lowering costs.
• Links affordable care with quality.
• Examples include performance measurement (e.g., Nursing Quality Indicators) and public reporting, which empowers consumers and incentivizes quality care. Maine and Colorado require nurse reporting.

Using Research to Influence Policy

• Research uptake into policies is often slow (can take up to 20 years).
• Difficulties include financial consequences for industries related to healthcare research, potential controversy in data collection, and research being influenced by sponsors.
• Positives include the ability to understand policies and potential opponents, consider study limitations, and refer to related research.
• Negatives include assuming policymakers are interested in research methods, biased writing, exaggerating effects, citing unreliable research, and failing to see research as one aspect of policy.

Types of Literature Reviews

• Systematic Reviews: Focus on experimental studies, precise searches, and duplicates, aiming to reach conclusions on a topic.
• Literature Reviews: Summarize relevant literature, descriptive without analysis, ideal for background knowledge, starting reading lists and searches.
• Integrative Reviews: Often include non-experimental studies (case studies, observational), precise criteria for selection, analyzing instead of summarizing literature.

Nurse-Patient Ratios and State Policy

• First US legislation was in 1999 in California.
• Most states have guidelines for nurse staffing plans, public disclosure of staffing levels, and minimum staffing ratios. California is the only state with minimum ratios. New York mandates reporting.
• The only federal regulation directly referencing nurse staffing is 42 CFR 482.23(b), requiring Medicare-participating hospitals to have adequate RNs.

Workplace Cultures

• Complex systems can be managed through a framework for change.
• Three types of workplace cultures: Union/collective bargaining, Magnet, and nondesignated.
• Union culture is declining, with success relying on distrust in management. Management must work with union leaders.
• Magnet culture (397 hospitals) has decentralized decision-making, transformational leadership, new knowledge and innovation.
• Nondesignated culture (5723 hospitals) is guided by CEO management philosophy, relying on a high level of trust.

John Kotter's 8 Stages of Change

• Establish urgency; create a guiding coalition; develop strategy/vision; communicate vision; empower action; generate short-term wins; consolidate gains; anchor new approaches in culture. Framework for change.

Reproductive Health Policy

• Issues surrounding control over a pregnant woman's body, sexual health, and religious beliefs.
• The ACA mandates women's preventative care, including contraception without copays.

Patient-Centered Care

• Eight dimensions include respecting values, information/education, access to care, emotional support, family involvement, continuity/transitions, physical comfort, and care coordination. Patient-centered care is comprehensive care (whole person - mind, body, soul).

Nurse-Managed Health Clinics

• Run by advanced practice nurses (APRNs), these clinics provide primary care to underserved populations.
• About 250 in the US, primarily serving low-income, uninsured patients.
• Focuses on chronic disease management through patient education, lifestyle changes, and counseling.

Nursing Homes and Quality of Care

• Nursing homes often have poor quality of care.
• State surveys and certifications address compliance, but enforcement is weak, staffing is inadequate, and corporate ownership is a factor.

Veterans Health Administration (VHA) Policy

• Serves 8.3 million service members, retirees, and families.
• Large integrated system (152 medical centers, 1400+ outpatient clinics).
• Policy issues include PTSD assessment/treatment, sexual assault investigation, suicide prevention, access to care.

International Council of Nurses (ICN)

• Policy on ethical nurse recruitment and retention.
• International organization for health professionals, representing over 130 countries. Founded in 1899. Works to ensure high quality care, sound policies, advanced nursing knowledge, and a satisfied nursing workforce. Partners with WHO, UNAIDS, UNICEF.