See file.
Please reply to
William Polanco- Rowland
Please note minimum of 200 words. Please cite one scholarly source. In-text citation should be included.
The cost of healthcare and the associated dollar signs connected to it has kept a certain number of patients away from seeing a doctor when needed. The creation of Managed Care Organizations exists to deal with the exorbitant prices associated with seeing a healthcare provider and actually decreasing costs while increasing the level of care (Nikitas et al, 2020). The common thread is the network of providers that exists within each network that agrees to provide care for the policy holders for an agreed price. Among the Managed Care Organizations are three plans known as Health Maintenance Organization (HMOs), Preferred Provider Organization(PPOs), and Point-Of-Service Plan (POS). The structure of HMOs exists as a network of hospitals, doctors and providers that usually only pay for care in the network visits. These have lower premiums the insured must use a provider within the network that is their Primary Care Physician (PCP). In addition, referrals must be obtained from the PCPs for visits to specialists within the network (healthy.kaiserpermanente.org, 2022) Membership is generally required in the form of employment or one who lives in the area of coverage. With an associated higher cost is the PPOs. They will allow for visits to in or out of network providers as well as cost of fee coverage for visiting those out of network providers, generally covered by the increased monthly premiums and out of pocket costs (healthy.kaiserpermanente.org, 2022). The third plan being mentioned here is the Point-Of-Service Plan (POS). This is considered a hybrid of plans which allows for the insured to make decisions to see who they want as a provider without first obtaining prior approval. With regard to a plan that works best for the consumer, the HMO plan is one where the nurse within the system is most connected to the providers and the case files allowing for a seamless connection with provider to facility. The other two plans have steps between each provider and information can be lost in the shuffle. The position of nurses working within the healthcare system allows them an opportunity to help keep health costs down via means of self auditing, review of case files and review of the facilities that they are employed at. A nurse can self audit and review the cases they are in charge of and ones they are assigned for audit. They can view the necessity of tests and the frequency of them, sounding the alarm on unneeded exams. They can use their knowledge of billing to review charts to discover errors that might result in costly mistakes to patients and/ or facilities. Lastly, patients can take lessons for nurses in the form of education to learn about proper diet and eating habits, ways to manage lifestyle changes and means to schedule healthcare screenings, to improve long term outcomes.
HMO vs. PPO Plans-What are the Differences? Retrieved Oct 26, 2022, from
https://healthy.kaiserpermanente.org/southern-california/learn/hmo-vs-ppo-advantages
Nickitas, D.M., Middaugh, D.J., & Feeg, V.D. (2020)Policy and politics for nurses and other health professionals: Advocacy and action.Jones and Bartlett Learning. 3rd Edition.
Please reply to
Linda Miller
Please note minimum of 200 words. Please cite one scholarly source. In-text citation should be included.
Managed care represents a healthcare system whose main aim is to manage cost, utilize resources and provide quality. Therefore, under the system, there is better efficiency which allows high-quality care delivery at standardized healthcare costs. Various healthcare providers are contracted which may include hospitals, physicians, or nurse practitioners and further provide care to various beneficiaries of the system at reduced costs (Gordon et al., 2018). The healthcare professionals contracted are also responsible for creating the plans of action to ensure the standardization of costs is achieved. Managed programs examples include Health Maintenance Organizations (HMOs) and Point of Services (POS).
Private insurers also play a role in the transformation of healthcare. They primarily include health insurance plans which are not offered by the federal government. The private insurers hence develop various initiatives. One is the value-based purchasing strategy. It is a strategy that is adopted towards basing decisions regarding coverage and payment of policies on the value of treatments and services provided compared with the underlying costs of the treatments (Vlaanderen et al., 2019). Therefore, the healthcare providers are held accountable for both the cost and quality of care provided. Best-performing care providers further receive better compensations and rewards.
The second is pay by performance. It is adopted by private insurers to improve the quality, efficiency, and overall value of health care (Vlaanderen et al., 2019). The performance is measured through the use of noted evidence-based standards Therefore, quality of care is improved among providers with high-performance levels. Moreover, the strategy provides a basis for healthcare providers to improve on their care provision which is also subject to incentives.
Nurses also play various roles to improve quality patient outcomes tied to healthcare reimbursement. First includes increased accountability and responsibility in the areas of transitional care and care coordination (Nickitas et al., 2019). Primarily, the shift from a fee-for-fee service system to a more progressive outcomes-based payment system enhances the need for nurses to take up responsibility and accountability roles towards meeting the needs of the patients. The achievement of improved outcomes provides a basis for accessing better incentives which encourages better effort on their part.
Moreover, nurses may engage in strategies such as reducing wastage towards advocating for healthcare consumers and reduce the increasing cost of healthcare. This is through utilizing resources efficiently where every department remains on budget. The quality of care is therefore enhanced since every resource provided is effectively directed to meeting patient needs in turn reducing the overall cost of healthcare.
References
Gordon, S. H., Gadbois, E. A., Shield, R. R., Vivier, P. M., Ndumele, C. D., & Trivedi, A. N. (2018). Qualitative perspectives of primary care providers who treat Medicaid managed care patients.BMC Health Services Research,18(1), 1-8.
https://doi.org/10.1186/s12913-018-3516-9
Nickitas, D. M., Middaugh, D. J., & Feeg, M. D. (2019).Policy and politics for nurses and other health professionals: Advocacy and action.(3rd ed.). Jones and Bartlett Publishers.
Vlaanderen, F. P., Tanke, M. A., Bloem, B. R., Faber, M. J., Eijkenaar, F., Schut, F. T., & Jeurissen, P. P. T. (2019). Design and effects of outcome-based payment models in healthcare: A systematic review.The European Journal of Health Economics,20(2), 217-232.
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30 assignment 2
Topic of interest: Diabetes
Assessment 2 Instructions: Determining the Credibility of Evidence
and Resources
Develop a 2-4 page scholarly paper in which you describe a quality or safety issue, or a chosen diagnosis, and then
identify and analyze credible evidence that could be used as the basis for applying EBP to the issue.
Introduction
The goal of using evidence-based research findings is to enhance safety and quality of patient care and ensure
optimal outcomes are achieved. It is not uncommon to hear a nurse say, “why change it as weve always done it this
way.” However, this is no longer acceptable in today’s practice environment. The profession of nursing has evolved,
and the expectation is that the professional nurse has a scientific foundation to support the care that is provided. As
the profession of nursing continues to evolve and engage in health care transformation, baccalaureate-prepared
nurses are expanding taking on leadership roles that include incorporating EBPs. To be able to do this, the nurse
needs to understand the criteria and makes a resource credible, as this is crucial when deciding if the research is
valid and reliable for implementation into health care settings. The nurse will need to incorporate the use of
evidence-based practice models. EBP models are designed to assist the nurse in developing a plan to gather
evidence to answer a practice problem or question. It is a systematic approach to direct the user to incorporate
scholarly findings into current practice. These EBP models lead the nurse through the decision-making process of
evaluating the literature to determine the best practice evidence for the practice issue or question.
It would be an excellent choice to complete the Vila Health Determining the Credibility of Evidence activity prior to
developing the report. The activity is a media simulation that offers an opportunity to review a scenario and work on
determining the credibility of presented evidence. These skills will be necessary to complete Assessment 2
successfully. This media simulation is one potential source of context on which to base your assessment submission.
This will take just a few minutes of your time and is not graded.
Professional Context
As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly
resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement
skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing
practice outcomes are positively impacted.
Scenario
For this assessment, you may choose from the following options as the context for the quality or safety issue or
chosen diagnosis/health issue for researching and completing this assessment:
The specific diagnosis/health issue you identified in your previous assessment.
The simulation Vila Health: Determining the Credibility of Evidence.
A personal practice experience in which a sentinel event occurred.
Course Navigation
Ka
COACH
2
Instructions
The purpose of this analysis is to better understand what constitutes credibility of journal articles as well as websites.
The role of the baccalaureate-prepared nurse in incorporating evidence-based research continues to growth in
clinical practice. As quality improvement (QI) measures to reduce safety risks continue to be emphasized, the need
for evidence-based models and evidence-based templates is growing. This type of systematic approach to
incorporating evidence-based findings allows nurses to make clinical and operational decisions based upon the best
available evidence. When the most up-to-date evidence-based findings are utilized, patient-centered care improves
outcomes and enhances the patient experience.
Below is a quick review table of several well-known Evidence-Based Practice Models used to guide exploration:
Evidence-Based Practice Models
Iowa Model of Evidence-Based Practice
Stetler Model
Ottawa Model
PARiHS (Promoting Action on Research Implementation in Health Services) Model
ACE (Academic Center for Evidence-Based Practice) Star Model
ARCC (Advancing Research and Clinical Practice Through Close Collaboration) Mode
John Hopkins Model
KTA (Knowledge-to-Action) Model
For this assessment:
Explain the criteria that should be used when determining the credibility of journal articles as well as websites.
Support your explanations with references to the literature or research articles that describe criteria that
should be used to determine credibility.
Your identification and determination of credibility should be done within the context of your chosen
scenario for this assessment. For example, if you choose to use the provided Vila Health scenario, your
initial identification of resources should be of resources that will best help address the presented issue.
However, if you are locating resources to help provide evidence-based care for the diagnosis/health
care issue you identified in the first assessment, you may want to begin your literature and evidence
search from the databases that were identified. Any of the three scenario options are acceptable. So,
pick the one that most interests you.
Be sure to address the following in this assessment, which correspond to the grading criteria in the scoring guide.
Please study the scoring guide carefully so that you will know what is needed for a distinguished score.
Describe a quality or safety issue, or a chosen diagnosis, that could benefit from an evidence-based
approach.
Explain criteria that should be considered when determining credibility of resources such as journal articles
and websites.
Analyze the credibility and relevance of evidence and resources within the context of a quality or safety issue,
or a chosen diagnosis.
This is where you are selecting the specific resources to help address the issue in your chosen scenario.
Identify the Evidence-Based Practice model and explain the importance of incorporating credible evidence
into the EBP model used to address a quality or safety issue, or a chosen diagnosis/health care issue. Review
the literature below and choose the appropriate model for your diagnosis/health care issue.
Selecting a model for evidence-based practice changes. [PDF] and Evidence-Based Practice Models
help explain the various evidence-based nursing models.
Communicate using writing that is clear, logical, and professional with correct grammar and spelling using
current APA style.
Additional Requirements
Your assessment should meet the following requirements:
Length of submission: 2-4-page scholarly paper, this does not include the APA-formatted title page and
reference list.
Number of references: Cite 3-5 sources of scholarly or professional evidence that support your findings and
considerations. Resources should be no more than five years old.
APA formatting: References and citations are formatted according to current APA style.
Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you
complete the final capstone course.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies
through the following assessment scoring guide criteria:
Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
Explain criteria that should be considered when determining credibility of resources such as journal
articles and websites.
Analyze the credibility and relevance of evidence and resources within the context of a quality or safety
issue, or a chosen diagnosis.
Competency 3: Apply an evidence-based practice model to address a practice issue.
Identify an evidence-based practice model (such as Iowa, Stetler, John Hopkins, etc.) and explain the
importance of incorporating credible evidence into an EBP model used to address a quality or safety
issue, or a chosen diagnosis/health care issue.
Competency 4: Plan care based on the best available evidence.
Describe a quality or safety issue, or a chosen diagnosis, that could benefit from an evidence-based
approach.
Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on
evidence.
Organize content so ideas flow logically with smooth transitions; contains few errors in
grammar/punctuation, word choice, and spelling.
Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA
format.
SCORING GUIDE
https://www.kau.edu.sa/Files/0004020/Subjects/EBP%20Changes%20project.pdf
https://connect.springerpub.com/content/book/978-0-8261-2759-4/back-matter/bmatter1
Use the scoring guide to understand how your assessment will be evaluated.
VIEW SCORING GUIDE 8
https://courserooma.capella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/220100/Scoring_Guides/a02_scoring_guide.html Determining the Credibility of Evidence and Resources Scoring Guide
CRITERIA NON-
PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Describe a quality or
safety issue, or a
chosen diagnosis,
that could benefit
from an evidence-
based approach.
Does not
describe a
quality or safety
issue, or a
chosen
diagnosis, that
could benefit
from an
evidence-based
approach.
Lists a quality or
safety issue, or a
chosen diagnosis,
that could benefit
from an evidence-
based approach.
Describes a quality or
safety issue, or a
chosen diagnosis,
that could benefit
from an evidence-
based approach.
Describes a quality or
safety issue, or a chosen
diagnosis, that could benefit
from an evidence-based
approach. Provides a
specific rationale for the
importance or benefit of
applying an evidence-based
approach. Uses literature to
support discussion.
Explain criteria that
should be considered
when determining
credibility of
resources such as
journal articles and
websites.
Does not
explain criteria
that should be
considered
when
determining
credibility of
resources such
as journal
articles and
websites.
Lists criteria that
should be considered
when determining
credibility of
resources such as
journal articles and
websites.
Explains criteria that
should be considered
when determining
credibility of
resources such as
journal articles and
websites.
Explains criteria that should
be considered when
determining credibility of
resources such as journal
articles and websites. Notes
one or more ways the
criteria could be applied to
a specific resource.
Analyze the credibility
and relevance of
evidence and
resources within the
context of a quality or
safety issue, or a
chosen diagnosis.
Does not
analyze the
credibility or
relevance of
evidence or
resources.
Describes the
credibility or
relevance of evidence
or resources, but
does not offer a
complete analysis.
The specific context
of a quality or safety
issue, or a chosen
diagnosis may be
unclear as well.
Analyzes the
credibility and
relevance of evidence
and resources within
the context of a
quality or safety
issue, or a chosen
diagnosis.
Analyzes the credibility and
relevance of evidence and
resources within the context
of a quality or safety issue,
or a chosen diagnosis.
Additionally, identifies the
most useful evidence or
resource based upon the
analysis.
Identify an evidence-
based practice model
(such as John
Hopkins, Stetler,
Iowa, etc.) and
explain the
importance of
incorporating credible
evidence into an EBP
model used to
address a quality or
safety issue, or a
chosen
diagnosis/health care
issue.
Does not
identify an
evidence-based
practice model
used to address
a quality or
safety issue, or
a chosen
diagnosis/health
care issue.
Identifies an
evidence-based
practice model used
to address a quality
or safety issue, or a
chosen
diagnosis/health care
issue. Does not
explain the model or
the importance of
incorporating credible
evidence.
Identifies an
evidence-based
practice model and
explains the
importance of
incorporating credible
evidence into an
evidence-based
practice model used
to address a quality
or safety issue, or a
chosen
diagnosis/health care
issue.
Explains the importance of
incorporating credible
evidence into an evidence-
based practice model used
to address a quality or
safety issue, or a chosen
diagnosis/health care issue.
Notes specific examples of
how the model could help
improve the chosen issue
or diagnosis/health care
issue.
CRITERIA NON-
PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Organize content so
ideas flow logically
with smooth
transitions; contains
few errors in
grammar/punctuation,
word choice, and
spelling.
Does not
organize
content for
ideas. Lacks
logical flow and
smooth
transitions.
Attempts to organize
content with some
logical flow and
smooth transitions.
Contains several
errors in
grammar/punctuation,
word choice, and
spelling.
Organizes content so
ideas flow logically
with smooth
transitions; contains
few errors in
grammar/punctuation,
word choice, and
spelling.
Organizes content with a
clear purpose. Content
flows logically with smooth
transitions using coherent
paragraphs, correct
grammar/punctuation, word
choice, and free of spelling
errors.
Apply APA formatting
to in-text citations
and references
exhibiting nearly
flawless adherence to
APA format.
Does not apply
APA formatting
to headings,
intext citations,
and references.
Does not use
quotes or
paraphrase
correctly.
Attempts to apply
APA formatting to in-
text citations,
headings and
references
incorrectly, detracting
noticeably from the
content.
Inconsistently uses
headings, quotes
and/or paraphrasing.
Applies APA
formatting to in-text
citations and
references exhibiting
nearly flawless
adherence to APA
format.
Exhibits strict and flawless
adherence to APA
formatting of headings,
intext citations, and
references. Quotes and
paraphrases correctly.