NURS-6050 Walden University Week 9: Discussion The Role of the RN/APRN in Policy Evaluation
The Role of the RN/APRN in Policy Evaluation
In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?
Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?
In this Discussion, you will reflect on the role of professional nurses in policy evaluation.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.
Review the Resources and reflect on the role of professional nurses in policy evaluation.
By Day 3 of Week 9
Select an existing healthcare program or policy evaluation or choose one of interest to you.
Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
Post
an evaluation topic and a brief description of the evaluation. Discuss how social determinants impact this issue.
By Day 6 of Week 9
Respond
to at least
two
of your colleagues
* on two different days
by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.
*Note:
Throughout this program, your fellow students are referred to as colleagues.
This topic is closed for comments.
PA
Precious Funanya Akaeze
Oct 23, 2024 10:56pm
| Last reply Oct 26, 2024 6:16am
Reply from Precious Funanya Akaeze
Policy Evaluation
Precious Funanya Akaeze
Walden University
NURS-6050N: Policy & Advocacy for Pop Hlth-Fall
Crissy Dodson
October 23rd, 2024
Evaluation of the Policy
A significant healthcare policy evaluation is the Affordable Care Act
(ACA) as it particularly focuses on its Medicaid expansion (Artiga & Damico, 2021). The ACA’s Medicaid expansion policy aimed to provide broader access to healthcare for low income individuals by raising eligibility thresholds for Medicaid (Artiga & Damico, 2021). Evaluating this policy involves looking at criteria such as reduction in uninsured rates, access to care, health outcomes, and cost-effectiveness. The evaluation process also examines how states that adopted Medicaid expansion have progressed in terms of healthcare accessibility and financial stability compared to those that did not progress.
The policy’s success has been mixed based on these evaluations. In other words, states that implemented Medicaid expansion saw substantial reductions in uninsured rates, particularly among minorities and low income groups (Artiga & Damico, 2021). Moreover, these states experienced improved health outcomes, as individuals gained access to timely treatments and preventative services. However, critics argue that the policy’s cost-effectiveness is debatable, as federal support to states is limited, raising concerns about long-term sustainability (Berchick et al, 2019). The evaluation highlights a need to balance increased healthcare access with financial suitability, suggesting that the program’s effectiveness is multifaceted, depending on state level implementation and fiscal health.
Social Determinants of Change
Social determinants of health significantly impact the effectiveness and outcomes of the Affordable Care Act (ACA), especially in terms of health equity, access to care, and overall well-being. Factors such as education, income, employment, housing stability, and geographical location shape individuals’ ability to access and benefit from healthcare services (Jaffe, 2021). For instance, lower income individuals, who are likely to depend on Medicaid, have benefited from the ACA’s Medicaid expansion in states that adopted it, gaining access to primary and preventive care (Jaffe, 2021). Whereas, states that decided not to expand Medicaid, caused millions of low-income people and those in rural areas to remain uninsured, highlighting disparities in coverage due to geographic and policy variations. Additionally, education and health literacy play a significant role in individuals’ ability to navigate the ACA’s complex enrollment processes and in understanding coverage options. This often leaves vulnerable populations, such as those with lower educational attainment, at a disadvantage. Employment status is another determinant, as people in part-time or low-wage jobs often lack employer-sponsored insurance and must depend on marketplace plans, which is still financially burdensome despite subsidies (Jaffe, 2021). Overall, the social determinants of health underscore the fact that while the ACA made strides in expanding access to healthcare, systemic inequities continue to limit its reach for marginalized groups, requiring more targeted interventions to address these disparities.
Reference
Berchick, E. R., Barnett, J. C., & Upton, R. D. (2019). Health insurance coverage in the United States: 2018. U.S. Census Bureau. Retrieved from https://www.census.gov/library/publications/2019/demo/p60-267.html
Artiga, S., & Damico, A. (2021). The impact of the Affordable Care Act on health insurance coverage for low-income individuals. Kaiser Family Foundation. Retrieved from https://www.kff.org/health-reform/issue-brief/the-impact-of-the-affordable-care-act-on-health-insurance-coverage-for-low-income-individuals/
Jaffe, S. (2021). The social determinants of health: A critical issue for the implementation of the Affordable Care Act.
Journal of Health Politics, Policy and Law
, 46(1), 63-86. https://doi.org/10.1215/03616878-8358716 NURS-6050 Walden University Week 9: Discussion The Role of the RN/APRN in Policy Evaluation
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Chhinderpal Kaur
Oct 23, 2024 10:34pm
| Last reply Oct 25, 2024 10:43pm
Reply from Chhinderpal Kaur
Medicaid Expansion under the Affordable Care Act (ACA)
One important part of the Affordable Care Act (ACA) was the Medicaid expansion, which was created to allow low-income people with incomes up to 138% of the federal poverty line to be eligible for Medicaid (Guth et al., 2020
)
. It sought to increase underprivileged communities’ access to healthcare and lower the rate of uninsured people. The main criteria used to evaluate Medicaid expansion include coverage rates, hospital uncompensated care reductions, access to healthcare services, health outcomes, and the financial impact on states (Guth et al., 2020).
Evaluation Criteria
Coverage rate includes new numbers of enrollment under the program in states that expanded Medicaid. This number was meant to increase with the expansion. It was also meant to improve access to quality care as needed by the people (Eguia et al., 2020). The health outcomes would be evaluated using health indicators including rates of chronic disease management, hospital admissions, and overall mortality rates. Also, the cost- effectiveness of the program would be evaluated in terms of funding and expenditures of the expansion. Another measure of the evaluation would be what the program would do to the economy, such as creating jobs for people.
Social Determinants of Health and Medicaid Expansion
The availability of healthcare is greatly impacted by social determinants of health like income, education, and housing security. These are addressed by the Medicaid expansion, which lowers the cost of healthcare for those with low incomes. Disparities still exist, though. For instance, people in states that have not expanded Medicaid or those who make just over the federal poverty level might still be without insurance (Dong et al., 2022). In rural locations, where healthcare professionals may be few, access to healthcare facilities is sometimes restricted, which lessens the advantages of insurance coverage. People with less education may have trouble navigating the healthcare system, which could hinder their capacity to make efficient use of the services. Even if they qualify for Medicaid, people who are homeless or suffering housing instability may encounter difficulties getting regular care (Dong et al., 2022). These social determinants play a key role in how effectively Medicaid expansion achieves its goals of improving health outcomes and reducing disparities in access to healthcare.
References
Dong, X., Gindling, T. H., & Miller, N. A. (2022). Effects of the Medicaid expansion under the Affordable Care Act on health insurance coverage, health care access, and use for people with disabilities.
Disability and Health Journal
,
15
(1), 101180.https://www.sciencedirect.com/science/article/pii/S1936657421001461
Eguia, E., Baker, M. S., Chand, B., Sweigert, P. J., & Kuo, P. C. (2020). The impact of the affordable care act (ACA) Medicaid Expansion on access to minimally invasive surgical care.
The American Journal of Surgery
,
219
(1), 15-20.https://www.sciencedirect.com/science/article/pii/S0002961019307688
Guth, M., Garfield, R., & Rudowitz, R. (2020). The effects of Medicaid expansion under the ACA: updated findings from a literature review.
Kaiser Family Foundation
,
37
(6), 944-50.https://affordablecareactlitigation.com/wp-content/uploads/2020/03/report-the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-1.pdf
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Miriane Meigueu
Oct 23, 2024 10:34pm
| Last reply Oct 26, 2024 9:05pm
Reply from Miriane Meigueu
Healthcare program and policy evaluation
The Hospital Readmission Reduction Program is a program initiative under the Centers for Medicare and Medicaid Services aimed at strategically reducing and addressing hospital readmissions in health facilities (Wadhera et al., 2019). The program is a quality assurance initiative aiming to address negative care outcomes consistent with patient readmissions in hospital facilities and is run under the federal government’s goal of transforming healthcare practice consistent with the value of quality of care. Hospital readmissions remain a huge healthcare quality issue that is indicative of the failure to facilitate patient wellness and enforce the provision of good quality care (Gupta & Fonarow, 2020).
The entire healthcare issue of hospital readmissions is affected by several factors. One of the prominent of these factors encompasses the social and economic factors affecting communities, such as high unemployment rates, which implies that most communities are unemployed and thus unable to afford quality healthcare services (Maddox et al., 2019). High levels of unemployment and consequent poverty also imply that most communities are unable to uphold the recommended standard healthy practices, such as proper diet and nutrition, conducting regular health check-ups, as well as affording quality healthcare services as facilitated by health insurance services (Maddox et al., 2019).
Another social determinant of health affecting hospital readmissions includes the type of diagnosis that the patient is involved in. For example, patients diagnosed with complex health conditions whose onset is associated with multiple factors are highly likely to experience readmissions due to the multifactorial impacts on their health (Gruneir et al., 2020). In actual practice, patients diagnosed with conditions requiring long-term care or a continuum of care through home-based health service delivery are highly likely to fail to adhere to the recommended treatment plan, therefore, prompting them to be readmitted.
Another social determinant of health affecting hospital readmissions includes the patients’ demographic factors, such as age. Studies have established that elderly patients have complex healthcare needs, which implies that they require increased attention and specialized care, which can only be provided in the context of healthcare facilities (Wyman et al., 2019). Elderly patients are also predisposed to complex health conditions, including disease conditions associated with reduced immunity because of physiological aging factors. In practice, this implies that such patients are highly likely to be readmitted due to the recurrence of symptoms and relapse of diseases (Ma et al., 2019).
References
Gruneir, A., Fung, K., Fischer, H. D., Bronskill, S. E., Panjwani, D., Bell, C. M., … & Anderson, G. (2020). Care setting and 30-day hospital readmissions among older adults: a population-based cohort study.
CMAJ
,
190
(38), E1124-E1133.
Gupta, A., & Fonarow, G. C. (2020). The Hospital Readmissions Reduction Program—learning from failure of a healthcare policy.
European Journal of Heart Failure
,
20
(8), 1169-1174.
Ma, C., Bao, S., Dull, P., Wu, B., & Yu, F. (2019). Hospital readmission in persons with dementia: A systematic review.
International Journal of Geriatric Psychiatry
,
34
(8), 1170-1184.
Maddox, K. E., Reidhead, M., Hu, J., Kind, A. J., Zaslavsky, A. M., Nagasako, E. M., & Nerenz, D. R. (2019). Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program.
Health Services Research
,
54
(2), 327-336.
Wadhera, R. K., Yeh, R. W., & Maddox, K. E. J. (2019). The hospital readmissions reduction program—time for a reboot.
The New England journal of medicine
,
380
(24), 2289.
Wyman, M. F., Shiovitz-Ezra, S., & Bengel, J. (2019). Ageism in the health care system: Providers, patients, and systems. In
Contemporary perspectives on ageism
(pp. 193-212). Springer, Cham.
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Qiana Felder
Oct 23, 2024 10:26pm
| Last reply Oct 27, 2024 1:15pm
Reply from Qiana Felder
Evaluation
Policy implementation and outcome evaluation, which examines whether a specific public policy achieves its intended effects once enacted, is a crucial part of the policy process (Whitsel, 2024). The policy I chose to discuss is the impactful Affordable Care Act (ACA). Established in 2010 by the Obama administration, it aimed to increase access to healthcare, improve quality, and reduce healthcare costs (HHS, 2022). A policy such as the ACA is evaluated for its impact on society based on the number of individuals accessing affordable insurance compared to the previous years. For instance, nearly 20 million people in the United States would lose their health insurance, increasing the uninsured rate among nonelderly individuals by over 7 percent without the ACA (Rapagel, 2020). Additionally, the policy can be evaluated by all of the favorable provisions implemented into the policy, such as improving mental health access and protecting people with preexisting diseases from being discriminated against. Evaluating policies offers a comprehensive evaluation of the policy’s impact and can inform responsible decision-making for future policy development.
Social Determinants
The ACA’s continual advocacy to reduce social determinants is impactful, but the reality is that these factors still persist. For instance, in states that have not expanded Medicaid or in rural areas, the issue of limited healthcare coverage remains. In these non-expansion states, a noteworthy number of low-income adults find themselves in a coverage gap, earning too much to be eligible for Medicaid but too little to be eligible for ACA marketplace subsidies (Lantz, 2020). This results in a large number of individuals remaining uninsured, with low-income groups disproportionately affected.
References
Lantz, P. M., & Rosenbaum, S. (2020). The Potential and Realized Impact of the Affordable Care Act on Health Equity.
Journal of Health Politics, Policy and Law
,
45
(5), 831–845. https://doi.org/10.1215/03616878-8543298
Rapfogel, N., Gee, E., & Calsyn, M. (2020, March 23).
10 Ways the ACA has improved health care in the past decade
. Center for American Progress. https://www.americanprogress.org/article/10-ways-aca-improved-health-care-past-decade/
U.S. Department of Health and Human Services. (2022, March 17).
About the affordable care act
. U.S. Department of Health & Human Services. https://www.hhs.gov/healthcare/about-the-aca/index.html
Whitsel, L. P., Honeycutt, S., Radcliffe, R., Johnson, J., Chase, P. J., & Noyes, P. (2024). Policy implementation and outcome evaluation: establishing a framework and expanding capacity for advocacy organizations to assess the impact of their work in public policy.
Health Research Policy and Systems
,
22
(1). https://doi.org/10.1186/s12961-024-01110-0
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Tamika Cheatham
Oct 23, 2024 10:05pm
| Last reply Oct 27, 2024 6:24pm
Reply from Tamika Cheatham
The Mental Health Parity and Addiction Equity Act (MHPAEA) is the policy enacted at the federal level to make mental health and substance use disorders be provided health insurance benefits, like medical benefits. This policy evaluation assesses the extent to which this policy has been achieved by determining the level of realization of fair treatment to patients across the diverse categories by the health care service providers (CMS, 2023). Policies for performance measures include the degree of the insurance plans’ compliance with parity, patient access to care specifics, patient satisfaction, and clinical status improvements concerning mental health disorders ((Hogan & Goldman, 2020). Using these criteria, stakeholders can evaluate the effectiveness of the policy in terms of its goals and objectives and see where changes are needed.
However, the ability of the MHPAEA is affected by many sociodemographic factors, including income, education, cultural practices, and communities. For example, people with low incomes may be able to attend practitioners’ offices because their treatment is paid for by insurance (Presskreischer et al., 2022). However, they cannot afford treatment due to the high cost after insurance rebates. The possible stigma associated with mental health in the culture of several societies will also prevent people with such a condition from seeking treatment. Moreover, it can be found that educational disparities can be blamed for low awareness of rights under the MHPAEA and, therefore, low uptake of mental health care services (Hall et al., 2023). It is thus essential to understand the determinants of these differences to evaluate policy effects among diverse populations.
Thus, the assessment of the MHPAEA plays a crucial part in defining the optimal directions for the development of mental health policy in the United States. The law seeks to address the issue of parity in mental health care services, but despite efforts to right the system, a variety of social factors can narrow or even widen the gaps in its success across socially defined groups. Professional nurses are also critical to this evaluation, as they are on the frontline to help implement and modify policies they deal with daily with the patients. Through both quantitative and qualitative perspectives in conjunction with the contributions of nurses, stakeholders will be better placed to call for policy changes where it will be possible to develop ways to reach and ensure equitable access and positive mental health outcomes among afflicted individuals.
References
CMS. (2023, September 6).
The Mental Health Parity and Addiction Equity Act (MHPAEA) | CMS
. Www.cms.gov. https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
Hall, S., Zivin, K., Dalton, V. K., Bell, S., Kolenic, G., & Admon, L. K. (2023). Association of the Mental Health Parity and Addiction Equity Act and the Affordable Care Act on severe maternal morbidity.
General Hospital Psychiatry
,
85
, 126–132. https://doi.org/10.1016/j.genhosppsych.2023.10.006
Hogan, M. F., & Goldman, M. L. (2020). New Opportunities to Improve Mental Health Crisis Systems.
Psychiatric Services
,
72
(2), appi.ps.2020001. https://doi.org/10.1176/appi.ps.202000114
Presskreischer, R., Barry, C. L., Lawrence, A. K., McCourt, A., Mojtabai, R., & McGinty, E. E. (2022). Factors Affecting State-Level Enforcement of the Federal Mental Health Parity and Addiction Equity Act: A Cross-Case Analysis of Four States.
Journal of Health Politics, Policy and Law
,
48
(1). https://doi.org/10.1215/03616878-10171062
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Christelle Njieukeng Piemba
Oct 23, 2024 9:22pm
| Last reply Oct 26, 2024 8:36pm
Reply from Christelle Njieukeng Piemba
Once a policy has been implemented it is necessary that the policy is reviewed. This shows whether the expected outcomes have been achieved, whether there are tweaks that need to be made to make the program more efficient and whether the interventions that were chosen to have any adverse effects. The evaluation is the process that measures the outcomes of the policy. This is an ongoing process that needs to be completed whether the policy is an intraoffice policy or one approved by federal legislature. The advanced practice nurse is able to advocate for the policy or suggest potential changes based on these findings.
Falls are attributed to increased risks of mortality, disability and depression in the elderly. Social determinants of falls include age and poor living conditions (Quach, 2016). Fall prevention programs are implemented to reduce falls and these associated risks. The evaluation of the fall prevention program typically includes looking at measurable data with a given time frame such as the number of falls, falls with injuries, and interventions used. As an RN/APRN it is important to take the evaluation a step further than just the fall outcomes.
Impact that Falls prevention program had on the patient’s life NURS-6050 Walden University Week 9: Discussion The Role of the RN/APRN in Policy Evaluation
Fall prevention programs often limit patients’ mobility by limiting their movement to a bed or wheelchair. One study found that elderly patients who were ambulatory two weeks prior to admission to the hospital spent an average of 83% of the hospital stay lying in bed (Brown et al., 2009). This has the potential to have long-term consequences such as muscle deterioration, increased risk for blood clots, bed sores and pneumonia (ZaggoCare, 2022). APRNs must look at all aspects of the policy in their implementation and evaluation to best advocate for their patients.
References
Brown, C. J., Redden, D. T., Flood, K. L., & Allman, R. M. (2009). The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatrics Society, 57(9), 1660–1665.
https://doi.org/10.1111/j.1532-5415.2009.02393.x
Links to an external site.
Quach, Lien T., “Social Determinants of Falls: The Role of Social Support and Depression Among Community-Dwelling Older Adults” (2016). Graduate Doctoral Dissertations. 307.
https://scholarworks.umb.edu/doctoral_dissertations/307
Links to an external site.
ZaggoCare. (2022, March 31). Hospital Fall Prevention Programs: Pros and Cons. ZaggoCare. Retrieved October 26, 2022, from https://zaggocare.org/hospital-fall[1]prevention/#:~:text=What’s%20the%20negative%20impact%20of,of%20bed%20on %20their%20own.
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Eric M Arutyunyan
Oct 23, 2024 9:09pm
| Last reply Oct 24, 2024 11:23am
Reply from Eric M Arutyunyan
There are many federal healthcare policies and programs established to improve healthcare provision and patient outcomes, but it is important to assess their efficiency and effectiveness. The efficiency of healthcare policies or programs shows the number of people who can be served through the policy and the effectiveness shows the quality of care and the patient outcome (Kaczmarek & Romaniuk, 2020). After the health policy is implemented, it is necessary to evaluate it to determine if it has achieved the expected results, whether there are need for change to make it more efficient and whether the interventions of the policy have adverse effects. The selected healthcare policy for evaluation is the Affordable Care Act (ACA), which will be evaluated in terms of its impact on access to healthcare and health insurance coverage. The Affordable Care Act is a federal health policy that was established in 2010 to expand health insurance coverage and increase people’s access to healthcare. The focus of the policy was to lower the number of uninsured people in the US through expanding the insurance coverage both public and private, and reduce the healthcare costs for the government and individuals (Neiman et al., 2021). The main provision of the ACA policy includes Medicaid expansion, whereby, states in the US were given the option to expand the eligibility of Medicaid to individuals with income below the federal poverty level, provision of health insurance marketplaces and the set of benefits that all health insurance plans must cover. The measure or the evaluation of the effectiveness of the ACA policy can be based on the following criteria. The first criterion is based on the level of coverage. This entails evaluating the percentage of the population with health insurance coverage in the US before the ACA program and after. According to Ercia (2021), the number of uninsured people in the US has declined significantly since the ACA policy was established. For instance, the number of uninsured people declined from 46.5 million people in 2010 to 25.6 million in 2022 (Damico et al., 2023). The second criterion is affordability, which involves assessing the changes in the cost of premiums, deductibles and out-of-pocket costs. Through ACA, health insurance in the US has been made more affordable, although there are concerns about affordability for some people. The third criterion is access to care, which entails evaluating the number of available physicians, specialists and hospitals in different regions of the country (Neiman et al., 2021). For instance, the ACA policy has enhanced access to healthcare, especially for low-income people and minority races in the US. Finally, ACA is evaluated through the quality of healthcare, which entails examining the healthcare outcomes, patient satisfaction and rate of hospitalizations that can be prevented (Ercia, 2021). ACA has improved the quality of care through providing care such as the prevention of diseases, thus, reducing hospitalization and protecting people against infections acquired in hospitals; thus, enhancing the quality of healthcare. The effectiveness of ACA has been impacted significantly by social determinants of health such as education, income, employment and access to healthcare in different ways. For instance, individuals with low income and those unemployed or with no stable jobs may not be able to pay the health insurance, regardless of the subsidies that the ACA program provides (Lantz & Rosenbaum, 2020). People with low levels of education have low health literacy; thus, they fail to comprehend the options of health insurance and navigating the healthcare insurance system; thus, they may not fully understand ACA like well-educated people. Finally, geographic disparities have limited access to healthcare. Although ACA is determined to increase access to care, many people from rural regions still do not access health facilities and health providers.
References
Damico, A., Drake, P., & Tolbert, J. (2023, December 18).
Key facts about the uninsured population
. KFF. Retrieved October 23, 2024, from
Key Facts about the Uninsured Population
Links to an external site.
Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care: Perspectives from FQHC administrators in Arizona, California and Texas.
BMC Health Services Research
,
21
(1).
https://doi.org/10.1186/s12913-021-06961-9
Links to an external site.
Kaczmarek, K., & Romaniuk, P. (2020). The use of evaluation methods for the overall assessment of health policy: Potential and limitations.
Cost Effectiveness and Resource Allocation
,
18
(1).
https://doi.org/10.1186/s12962-020-00238-4
Links to an external site.
Lantz, P. M., & Rosenbaum, S. (2020). The potential and realized impact of the Affordable Care Act on health equity.
Journal of Health Politics, Policy and Law
,
45
(5), 831-845.
https://doi.org/10.1215/03616878-8543298
Links to an external site.
Neiman, P. U., Tsai, T. C., Bergmark, R. W., Ibrahim, A., Nathan, H., & Scott, J. W. (2021). The Affordable Care Act at 10 years: Evaluating the evidence and navigating an uncertain future.
Journal of Surgical Research
,
263
, 102-109.
https://doi.org/10.1016/j.jss.2020.12.056
Links to an external site.
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Lorrissa Lingen
Oct 23, 2024 8:56pm
| Last reply Oct 26, 2024 9:08pm
Reply from Lorrissa Lingen
The Mental Health Parity and Addiction Equity Act (MHPAEA)
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 is a federal law designed to ensure that health plans and insurers treat mental health and substance use disorder services fairly. This means they can not enforce strict benefit limits on these services than they do for regular medical and surgical care. This includes things such as copays, coinsurance, and visit limits, which need to be fair for mental health services as they are for other medical services (
Mental health parity
). This law also states that there can’t be separate financial or treatment limits specifically for mental health and substance use, which helps prevent coverage discrimination. It also requires health plans and insurers to be transparent and provide important information about these benefits. It’s a large step toward equal treatment for mental health and substance use disorders, ensuring people receive the support they need and deserve (
The Mental Health Parity and Addiction Equity Act (MHPAEA)
2024).
Determinants include income, employment, socioeconomic status, and education, as well as, housing, and social support. Also included are the conditions of communities and the ability to access affordable mental healthcare (Kirkbride et al., 2024). Social determinants include lower-income households, being employed with a small business, and living in rural areas. The Mental Health Parity and Addiction Equity Act (MHPAEA) doesn’t directly apply to small-group health plans, but it’s linked to the Affordable Care Act’s requirements. So, it only influences plans for small employers, it is not a requirement. Small businesses such as 1-50 employees, or states can choose to expand this to 1-100 employees are not required to follow this policy (
The Mental Health Parity and Addiction Equity Act (MHPAEA)
2024). Being in a rural area and working for a small business owner could be an issue since having low numbers of employees can affect the benefits of this policy. Also, the rural area is hard to find mental health services as well as substance support. There are not many facilities, and sometimes long wait times.
References:
Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., & Griffiths, S. L. (2024, January 12).
The social determinants of mental health and disorder: Evidence, prevention and recommendations
. World psychiatry : official journal of the World Psychiatric Association (WPA). https://pmc.ncbi.nlm.nih.gov/articles/PMC10786006/#:~:text=These%20structural%20conditions%20include%20factors,to%20access%20acceptable%20and%20affordable
Mental health parity
. Psychiatry.org – Mental Health Parity. (n.d.).
https://www.psychiatry.org/psychiatrists/advocacy/federal-affairs/health-insurance-coverage-access-to-care/mental-health-parity
Links to an external site.
The Mental Health Parity and Addiction Equity Act (MHPAEA). CMS.gov. (2024, September 10). https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity#Introduction
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Kayla Rena Davis
Oct 23, 2024 8:35pm
| Last reply Oct 26, 2024 7:13pm
Reply from Kayla Rena Davis
Florida’s rapidly increasing population, particularly among older adults, places significant pressure on its healthcare system. With approximately 300,000 new residents annually, the Florida Senate has passed legislation to expand the healthcare workforce and address rising demands (The Florida Senate, 2024). The
Live Healthy Florida Act
aims to bolster healthcare capacity, improve access, and drive innovation, providing Floridians with enhanced opportunities for better health outcomes.
The act targets chronic diseases, such as obesity, diabetes, and cardiovascular conditions, by promoting preventive care measures, including improved nutrition, physical activity, and expanded healthcare access. Additionally, it seeks to reduce healthcare disparities, particularly in underserved populations, through state-funded initiatives and collaborations with private and nonprofit organizations. Evaluation of the act’s effectiveness includes assessments of healthcare access, population health outcomes, cost-efficiency, and its impact on social determinants of health (SDOH).
At the community level, success is measured by access to preventive services, public engagement, and health outcomes. Key initiatives include expanding clinical training in rural areas, improving chronic disease management, and incentivizing healthcare providers to practice in Florida through recruitment and autonomous practice for advanced practice nurses (WQCS, 2024).
State-level evaluations by the Florida Department of Health focus on reducing racial, ethnic, and socioeconomic health disparities, monitoring chronic disease outcomes, and assessing cost savings. The evaluation monitors the act’s ability to improve healthcare access for historically underserved populations and reduce chronic disease complications, including diabetes, hypertension, and cardiovascular conditions.
Although Florida has not expanded Medicaid, the act addresses low-income residents’ needs through grants for free health screenings and the expansion of telehealth services across specialties (Harrell, 2024). Evaluators focus on whether the act narrows health disparities among racial minorities, low-income, and rural populations and on improved access to primary care, preventive services, and health education.
The
Live Healthy Florida Act
is evaluated based on health outcomes, cost-effectiveness, healthcare access, and the reduction of health disparities. It emphasizes the role of social determinants of health, recognizing the influence of income, education, and housing on health outcomes. Through a multi-tiered approach, the act aims to create lasting public health improvements and reduce healthcare costs.
References:
The Florida Senate
. Press Release – The Florida Senate. (2024). https://www.flsenate.gov/Media/PressReleases/Show/4508
Harrell, S. G. (2024).
SB 7018 — Health Care Innovation
. 2024 Bill Summaries – The Florida Senate. https://www.flsenate.gov/Committees/billsummaries/2024/html/3515
WQCS. (2024, March 8).
Florida Senate approves package of “live healthy” bills
. https://www.wqcs.org/2024-03-08/florida-senate-marks-the-passage-of-the-complete-live-healthy-agenda
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Tracy M Chaves
Oct 23, 2024 8:24pm
| Last reply Oct 27, 2024 12:27pm
Reply from Tracy M Chaves
The Affordable Care Act or ACA was established in 2010 and has since had several changes made to it by different presidential administrations (HHS, 2022). The goals of the ACA was to have explained access to care, reduce health care costs, and improve health care quality (Neiman et. al., 2021). This act created the largest expansion of health insurance coverage (HHS, 2022).
Social determinants of health are nonmedical factors that effect an individuals health outcomes (CDC, n.d.) Based off the Affordable Care Act’s goals and interventions implemented, it helps several social determinants of health such as healthcare access, healthcare quality, and economic status.
The ACA increased access to health care by increasing consumers enrolled in health insurance and expanding medicaid, it reduced cost by implementing new care models such as “bundled” payments, and it improved quality by linking payments to quality (Neiman et. al., 2021). An evaluation of this act is completed by using data based of numbers.
When assessing state rates of uninsured individuals Massachusetts, where I live, the rates decreased by 1.4%; however, there were states like California that decreased as much as 11.7% (HHS, 2022). Other positive outcomes by the ACA is coverage for preventive care which improved cancer screenings leading to earlier diagnosis, improved percentage of minorities with insurance coverage, and reduced cost to surgical care (Neiman et. al., 2021). Overall the results of the ACA have been positive.
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John Dulko
(He/Him)
Oct 23, 2024 7:40pm
| Last reply Oct 26, 2024 6:27pm
Reply from John Dulko
Introduction
“SSPs [Syringe Services Programs] protect the public and first responders by providing safe disposal of used needles and syringes. SSPs also prevent outbreaks of other diseases…” (Syringe, n.d.). Services include substance use disorder treatment, vaccination, testing, infectious disease care and treatment, counseling, and access to sterile injection supplies. The goal of these programs is to improve public health by offering treatment to a high-risk community and by making substance use safe for those who are unable or unwilling to stop. Are these SSPs working? How do we know?
Evaluation of the Policy
“Evaluation provides an informed means of feedback, improvement, and justification of expending resources for all health and social programming … Social policy and program evaluation relies on collecting continuous measurements and data points in a cyclical manner (similar to the nursing process) to ensure ongoing qualitative and quantitative programming, to consider innovation, and to engage key stakeholders” (Short, 2022, pp. 178-179). As the scholar stated in
The Importance of Program Evaluation
(2018), “If you can’t measure it, you won’t know if it’s effective or not.” So, what measurements are used to evaluate SSPs? Short (2022) suggested assessing effectiveness (short- and long-term performance measurements), assessing achievement of goals/aims (accountability measures), assessing efficiency (cost-benefit relationship), determining impact (unintended consequences), and establishing future improvements and goals.
According to the US Centers for Disease Control and Prevention (CDC):
“Nearly 30 years of research has shown that comprehensive SSPs are safe, effective, and cost-saving, do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections. Research shows that new users of SSPs are five times more likely to enter drug treatment and about three times more likely to stop using drugs than those who don’t use the programs. SSPs that provide naloxone also help decrease opioid overdose deaths. SSPs protect the public and first responders by facilitating the safe disposal of used needles and syringes … in North Carolina alone, the rate of hospital discharge diagnoses for endocarditis related to drug dependence increased more than 12-fold from 2010 to 2015, with unadjusted hospital costs increasing from $1.1 million in 2010 to over $22 million in 2015.” (Safety, n.d.).
These results would suggest that measurements of SSP effectiveness would include cost reduction of substance-use-related hospital visits, a decrease in illegal drug use, a decrease in crime, a decrease in the rate of blood-borne diseases like viral hepatitis, and HIV, an increase in the number of people participating in drug treatment programs, an increase in the number of people who stop using drugs, and a decrease in the number of opioid overdose deaths. Were these goals achieved? It is difficult to determine because these are challenging data points to collect. Most evaluations have been based on surveys and observations, two methods of data collection where implicit bias cannot be removed. Also, SSPs do not operate in a controlled setting; numerous variables also contribute to the measurements listed above. According to the CDC, the program’s perceived effectiveness has a positive impact on the community. However, the objective data is not there to support the claim because it is the data is challenging to collect objectively with a large enough sample.
Social Determinants of Change
It is a common issue where a policy is approved because there is positive research to support its positive potential, but it is challenging to implement. “This gap between research and practice is the result of several interacting factors, including limited time and resources of practitioners, insufficient training, lack of feedback and incentives for use of evidence-based practices, and inadequate infrastructure and systems organization to support translation” (Glasgow et al., 2003). SSPs have met resistance in implementation because some people feel it tolerates and even encourages drug use. Some feel like more people will start using substances because it is safer and easier to access supplies. For more support of this program, social determinants of change include irrefutable evidence, appropriate funding, training available for stakeholders, and power (relational, dispositional, and structural). “
Relational power
involves the interactions that exist between stakeholders and resources to achieve outcomes.
Dispositional power
refers to the person’s hierarchical position in an organization that gives them legitimacy and authority in sharing knowledge and information as well as in allocating resources …
Structural power
organizes and orchestrates the systemic interactions within and among groups, directing economic and political forces and ideological forces that shape public ideas, values and beliefs” (Short, 2022, p. 133). “…the effectiveness of a particular SEP may differ according to local environmental, social, legal and programmatic factors” (Bastos & Strathdee, 2000).
Conclusion
The policymaking process is like the nursing process: an ongoing process with evaluation affecting new actions. Like with the evaluation of SSPs, new problems are identified, and additional policies are created. For example, Peter Beilenson discussed how Baltimore’s Staying Alive Drug Overdose Program was started in response to complaints that SSPs were making it easier for people with a substance use disorder to access supplies, increasing their likelihood of overdose. He also mentioned training residents of Baltimore in cardiopulmonary resuscitation (CPR), rescue breathing, and Narcan administration to address the need for immediate bystander intervention to increase the chance of survival from overdose before first responders arrive (Walden, LLC, 2018, Peter). Policies should be like our patients’ goals: SMART—specific, measurable, accurate, realistic, and timely. In this way, policies will be routinely (timely) evaluated by determining whether the identified goals (specific, accurate, realistic) were met by assessing objective data points (measurable).
References
Bastos, F., & Strathdee, S. (2000). Evaluating effectiveness of syringe exchange programmes: current issues and future prospects.
Social Science & Medicine
,
51
(12), 1771–1782. https://doi.org/10.1016/s0277-9536(00)00109-x
Glasgow, R.E., Lichtenstein, E., & Marcus, A.C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition.
American Journal of Public Health
, 93(8), 1261–1267. 10.2105/AJPH.93.8.1261.
Safety and effectiveness of syringe services programs. (n.d.). U
.S. Centers for Disease Control and Prevention
. https://www.cdc.gov/syringe-services-programs/php/safety-effectiveness.html
Syringe services programs. (n.d.).
U.S. Centers for Disease Control and Prevention
. https://www.cdc.gov/syringe-services-programs/php/index.html
Walden University, LLC. (Producer). (2018).
The Importance of Program Evaluation
[Video file]. Baltimore, MD: Author.
Walden University, LLC. (Producer). (2018).
Peter Beilenson: Ethics and advocacy
[Video file]. Baltimore, MD: Author.
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Amy Simmons
Oct 23, 2024 5:49pm
| Last reply Oct 26, 2024 8:35pm
Reply from Amy Simmons
Main Post
Hospital-acquired infections (HAIs) are infections patients acquire during their stay in a healthcare facility, which were not present or incubating at admission or soon after discharge. Common HAIs include bloodstream infections, surgical site infections, such as Methicillin Staphylococcus Aureus (MRSA), ventilator-associated pneumonia, and catheter-associated urinary tract infections. These severely threaten healthcare safety (Centers for Disease Control and Prevention, n.d.). HAIs are one of the leading causes of readmissions in the United States.
HAIs started to be recognized in the late 1950s and 1960s when steps started to be implemented in infection control policies. In the 19th and 20th centuries, the new phase in healthcare epidemiology is marked by rising consumer demands for greater transparency and accountability, heightened scrutiny and regulation, and a push for swift decreases in rates of HAIs (Habboush et al., 2023)
Evaluation of the Policy
Many HAI policies have proven successful in reducing infection and readmission rates. For example, using evidence-based protocols for hand hygiene, environmental cleaning, and antibiotic stewardship has led to declines in certain HAIs like
Clostridioides difficile
infections and central line-associated bloodstream infections (CLABSIs). Policies that require public reporting of HAI data (e.g., through the CDC’s National Healthcare Safety Network) promote transparency and accountability among healthcare providers. Infection surveillance systems, UV sterilization technologies, and antimicrobial surfaces enhance infection prevention efforts (Agency for Healthcare Research and Quality, 2019) NURS-6050 Walden University Week 9: Discussion The Role of the RN/APRN in Policy Evaluation
Social Determinants of Change
Several social factors, such as healthcare training, patient socioeconomic status, healthcare facility resources, public awareness, and advocacy, influence HAI policies. Effective healthcare implementation requires staff education on infection control, including regular hand hygiene practices and protocol adherence. Patient socioeconomic status plays a massive part as patients with limited access to healthcare may delay seeking treatment, increasing their risk of complications from HAIs when being admitted. Healthcare facility resources also play a significant factor because some healthcare facilities may struggle with staffing shortages, limited access to advanced infection control technologies, and outdated infrastructure. Growing awareness about HAIs to the public is a must to encourage patients to demand higher standards of care. Strengthening improvements for more robust infection control training, enhanced monitoring, holding accountability, and addressing inequities is the key to decreasing the chances of HAIs.
My Story
Infection control and its importance are very personal to me. Unfortunately, I was one of those patients who fell victim to a terrible case of MRSA, and I will forever pay for it. Here is my story, the short version. In August of 2019, I was nearing the end of my 12-hour shift on a med surg unit; I felt a sharp pain in my left shin; within one week, it was red, warm to the touch, and raised. I thought maybe it was a stress fracture. I saw the doctor, completed x-rays, and had an ultrasound to rule out a blood clot. Nothing was found, but he placed me in a boot anyway to ensure nothing was missed. One month later, I had the worst muscle spasms in my calf. I had never felt spasms like that before, and my back started to hurt on the same side. Fast forward to three months of agony, I finally was ordered an MRI of my back. I got called and was told to go to the emergency room right away; sepsis, arthritis, and osteomyelitis caused by MRSA, originating in the left calf. The 6 months off work, 8 days in the hospital, surgeries, and 2 months with a PICC line with Vanco infusions running every 12 hours will forever haunt me.
References
Centers for Disease Control and Prevention. (n.d.).
About HAI’s
. Centers for Disease Control and Prevention. https://www.cdc.gov/healthcare-associated-infections/about/index.html
Habboush, Y., Yarrarapu, S. N. S., & Guzman, N. (2023, September 4).
Infection control
. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK519017/#:~:text=Infection%20control%20refers%20to%20the,1950s%20in%20the%20United%20States
Agency for Healthcare Research and Quality. (2019, September 7).
Healthcare – associated infections
. https://psnet.ahrq.gov/primer/health-care-associated-infections
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Lailat Andu
Oct 23, 2024 5:06pm
Reply from Lailat Andu
Individual Mandate in Healthcare Assessment (HR 3590)
The Individual Mandate is a core provision of the Affordable Care Act which was designed to increase health insurance coverage by requiring most Americans to have health insurance or pay a penalty. This Bill was introduced in 2010 as it aimed to reduce the number of uninsured patients and mitigate the adverse selection that can occur when only the sick purchase insurance (Pope, 2018). By incentivizing healthy individuals to obtain coverage, the mandate was intended to create a more balanced risk pool, ultimately stabilizing insurance premiums and making healthcare more affordable. Evaluation of the Individual Mandate reveals both successes and challenges. Initially, the mandate contributed to a significant decrease in the uninsured rate, with millions gaining coverage through Medicaid expansion and health insurance marketplaces (Berchick, Barnett, & Upton, 2019). However, the policy faced criticism for its perceived coerciveness, leading to political backlash. In 2017, the Tax Cuts and Jobs Act effectively eliminated the financial penalty for failing to obtain insurance, raising concerns about a potential increase in the uninsured population and a destabilization of the insurance market (Blumberg, Holahan, & Buettgens, 2019). As a result, while the mandate played a crucial role in expanding access, its removal has prompted ongoing debate about the long-term viability of health reform in the U.S.
I personally believe that the individual mandate plays a critical role in improving healthcare access for patients with chronic diseases, as it encourages continuous insurance coverage and preventive care. By requiring patients to obtain health insurance, the mandate helps ensure that those with chronic conditions, such as diabetes, COPD or hypertension, receive regular medical attention, necessary medications, and ongoing management of their health issues (Soni & Malsberger, 2018). Access to preventive services, which are often covered without copayment under the ACA, can lead to earlier diagnosis and treatment, ultimately reducing the long-term healthcare costs associated with unmanaged chronic diseases (Cohen & Yu, 2016). Additionally, by broadening the risk pool to include healthier individuals, the mandate stabilizes insurance premiums, making it more feasible for insurers to offer comprehensive plans that include essential health benefits for those with chronic conditions, thereby promoting better health outcomes across the population.
Social Determinants
This landmark legislation aimed to address the pressing issues of healthcare access, affordability, and quality of care. The passage of the ACA marked a significant shift in U.S. health policy, moving towards a model that prioritized universal coverage and preventive care (Obama, 2016). Despite its successes, the mandate’s implementation has encountered numerous legal and political challenges, particularly from states opposing federal healthcare requirements. Social determinants of health significantly influence the effectiveness of the individual mandate. Factors such as income, education, and geographic location play critical roles in individuals’ access to healthcare and insurance coverage. For example, low-income patients may struggle to afford premiums, even with subsidies, while those in rural areas may face limited options for providers (Artiga & Hill, 2020). These determinants can exacerbate disparities in health outcomes, indicating that while the individual mandate sought to expand coverage, broader systemic issues must be addressed to ensure equitable access to healthcare across diverse populations (Bachrach, Valenzuela, & Lutz, 2019).
References
Artiga, S., & Hill, L. (2020). The impact of social determinants on health disparities. Kaiser Family Foundation.
Bachrach, D., Valenzuela, A., & Lutz, S. (2019). Health insurance coverage and access to care: The role of social determinants. Health Affairs, 38(7), 1149-1155.
Berchick, E. R., Barnett, J. C., & Upton, R. D. (2019). Health insurance coverage in the United States: 2018. U.S. Census Bureau.
Blumberg, L. J., Holahan, J., & Buettgens, M. (2019). The impact of the repeal of the ACA individual mandate. Urban Institute.
Cohen, R. A., & Yu, W. (2016). The role of preventive services in chronic disease management. American Journal of Preventive Medicine, 51(3), 398-405.
Soni, A., & Malsberger, R. (2018). The impact of the ACA on chronic disease management. Health Affairs, 37(1), 112-120.
Obama, B. (2016). The Affordable Care Act: A landmark law that will improve the lives of millions of Americans.
Pope, J. (2018). The role of the individual mandate in expanding health insurance coverage. Journal of Health Politics, Policy and Law, 43(3), 481-500.
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Doreen Pokuaa Yebuah
Oct 23, 2024 12:35pm
| Last reply Oct 25, 2024 7:03pm
Reply from Doreen Pokuaa Yebuah
The Affordable Care Act (ACA), implemented in 2010, has undergone various evaluations at the community, state, and federal levels to determine its effectiveness. Evaluations generally emphasize several critical criteria, such as coverage expansion, affordability, access to care, and health outcomes.
Assessment of the ACA
The US Department of Health and Human Services (HHS) and its Office of the Assistant Secretary for Planning and Evaluation (ASPE) have undertaken a significant evaluation of the Affordable Care Act (ACA). The evaluations have revealed the effectiveness of the ACA in increasing health insurance coverage throughout the United States. By 2024, more than 45 million individuals will have obtained coverage via the ACA’s Marketplaces and Medicaid expansion (Chu et al., 2022). This indicates a significant rise relative to prior years and a marked decrease in uninsured rates across all states and demographic groups.
The criteria employed for the assessment of the ACA are as follows:
Coverage Expansion: The increase in individuals obtaining insurance via ACA Marketplaces and Medicaid expansion.
The influence of premium tax credits and cost-sharing reductions on insurance affordability.
Access to care has improved through enhancements in preventive services and the provision of regular health care.
Health Outcomes: Variations in health status indicators within newly insured populations.
The Influence of Social Determinants on the Affordable Care Act.
The effectiveness of the ACA is significantly influenced by social determinants of health (SDOH). The determinants encompass economic stability, education, social and community context, healthcare access, and neighborhood environment (Alliance for Health Policy, 2023).
Social determinants of health significantly affect the accessibility and quality of healthcare services available to individuals. Individuals with stable employment and income are more likely to afford health insurance premiums, even when subsidies are available. Nonetheless, individuals experiencing poverty or unstable employment may continue to encounter obstacles despite the provisions of the ACA.
Secondly, health literacy influences individuals’ ability to understand and select insurance options under the Affordable Care Act (ACA). Higher education levels are typically associated with improved comprehension and use of accessible health services. NURS-6050 Walden University Week 9: Discussion The Role of the RN/APRN in Policy Evaluation
Discrimination and social cohesion influence mental health and access to care. The ACA contains measures designed to mitigate disparities among racial and ethnic minorities.
Furthermore, access to healthcare is impacted when SDOH comes into play. Lyon et al. (2014) indicate that although the ACA has enhanced access to care for numerous individuals, disparities persist, especially in states that have opted not to expand Medicaid.
Finally, regions characterized by inadequate health facilities may impede the effective use of health services under the ACA.
The ACA has significantly expanded coverage and improved affordability; however, addressing social determinants is essential for enhancing its effectiveness and reducing health disparities among various populations.
Reference
Alliance for Health Policy. (2023, May 11).
Chapter 7: Social Determinants of Health | Alliance for Health Policy
. https://www.allhealthpolicy.org/sourcebook-chapter/social-determinants-of-health
Chu, R., Gonzales, A., & Office of the Assistant Secretary for Planning and Evaluation. (2022). The Affordable Care Act and its Accomplishments. In
Briefing Book
[Report]. https://aspe.hhs.gov/sites/default/files/documents/18cd655222dc3de64866b269143731ce/aca-briefing-book-aspe-03-2022.pdf
In Celebration of 10 Years of ACA Marketplaces, the Biden-Harris Administration Releases Historic Enrollment Data | CMS
. (2024, October 21). https://www.cms.gov/newsroom/press-releases/celebration-10-years-aca-marketplaces-biden-harris-administration-releases-historic-enrollment-data
Lyon, S. M., Douglas, I. S., & Cooke, C. R. (2014). Medicaid expansion under the Affordable Care Act. Implications for Insurance-related Disparities in Pulmonary, Critical Care, and Sleep.
Annals of the American Thoracic Society
,
11
(4), 661–667. https://doi.org/10.1513/annalsats.201402-072ps
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Deco Tanjong
Oct 23, 2024 10:53am
| Last reply Oct 24, 2024 1:41am
Reply from Deco Tanjong
Policy analysis is a technique used in the public administration sub-field of political science to enable civil servants, nonprofit organizations, and others to examine and evaluate the available options to implement the goals of laws and elected officials. Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003).
The Ohio Healthy Program (OHP) provides training, technical assistance, and designation to early care and education professionals to create healthy and active environments in early care and education settings. Ohio Department of Health (n,d). The overall goal of the Ohio Healthy program is to deliver consistent messaging to adults who care for children between the ages of 0 and 5 years to prevent Obesity in early childhood and reduce the risk of physical and mental health in childhood and adulthood. This is done through healthy eating, physical activities, and the modification of screen time. Ohio Department of Health(n,d).
In 2020, OHD, in partnership with a national nonprofit, Wholesome Wave, due to the risk presented by the COVID-19 pandemic, offered nutrition education classes eventually, and participants received vouchers for fresh fruit and vegetables in the mail. At the end of the program, more than $200,000 in fruit and vegetable vouchers were redeemed at the local store and farm markets by approximately 2000 participants and families. Many participants who enrolled in this program experienced a decrease in biometric data, including hemoglobin A1C and Body mass index. Ohio Department of Health (n,d).
70% of household participants who opted to participate in the survey shared their feedback. It was overwhelmingly positive, and they expressed their desire to see the project done again on a large scale.
Reference
Short, N. M. (2019).
Milstead’s health policy and politics: A nurse’s guide
(7th ed.). Jones & Bartlett Learning.
Chapter 8, “Health Policy and Social Program Evaluation” (pp. 177–192)
Early care education program
. Ohio department of health. (n.d.).
Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003).
Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transitionLinks to an external site.
Links to an external site.
.
American Journal of Public Health, 93
(8), 1261–1267.
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Nicole Greco Carl
Oct 23, 2024 2:32am
| Last reply Oct 25, 2024 9:29pm
Reply from Nicole Greco Carl
A healthcare policy in the state of California is the California school immunization law. The law states “children in California are required to receive certain immunizations in order to attend public and private elementary and secondary schools, child care centers, family day care homes, nursery schools, day nurseries, and developmental center” (Health, 2024). If a child’s parents are not able to show proof of vaccination then the school “must exclude the child from further attendance until the child comes into compliance with the requirements” (Health, 2024).
“Despite a growing literature documenting prevention and health promotion interventions that have proven successful in well-controlled research” (Glasgow, 2003), the number of people refusing vaccines is growing. This is now the biggest social deterrent with vaccines, more and more parents do not want to vaccinate their children. “Coverage with nearly all vaccines was lower among children born in 2020 and 2021 than it was among those born in 2018 and 2019, with declines ranging from 1.3 to 7.8 percentage points” (Hill, 2024). However, parents are no longer “allowed to submit a personal beliefs exemption to a currently-required vaccine” (Health, 2024). When a child does not have immunizations that are up-to-date when attending school, staff are to “refer parents to their doctor with a Letter to Parents: Immunizations Needed” (Health, 2024). Children who may be affected by this are foster children, children with families without health insurance, and children in families who are new to the country. The law states that in particular situations, these children can be admitted in conditional circumstances.
References:
Health, D. of P. (2024, August 21).
California law
. California Law. https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/School/laws-california-law.aspx
Hill, H. (2024, September 26).
Decline in vaccination coverage by age 24 months and vaccination inequities among children born in 2020 and 2021 – National Immunization Survey-child, United States, 2021–2023
. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/73/wr/mm7338a3.htm#:~:text=Coverage%20with%20nearly%20all%20vaccines,1.3%20to%207.8%20percentage%20points.
Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transitionLinks to an external site..
American Journal of Public Health
, 93(8), 1261–1267.
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Brandon Grundy
Oct 22, 2024 11:46pm
| Last reply Oct 26, 2024 9pm
Reply from Brandon Grundy
Main Post
Evaluation of the Affordable Care Act (ACA)
Brandon Grundy
College of Nursing, Walden University
NURS-6050N-4: Policy & Advocacy for Population Health
Crissy Dodson
October 22, 2024
The Affordable Care Act (ACA) has been one of the most impactful healthcare reforms in
U.S.
history as the bill has endeavored to expand accessibility to healthcare, reduce costs, and enhance the standard of care. Evaluating its effectiveness requires examining various criteria,
such as access to health services, insurance coverage, and
healt
h outcomes. This evaluation will focus on how the ACA has impacted access to healthcare services, particularly in underserved populations.
Policy Description and Evaluation
The ACA, signed into law in 2010, introduced several reforms designed to expand access to he
alth insurance. Among the key provisions were the improvement of Medicaid, establishing health insurance marketplaces, and providing financial accommodations through subsidies for low- and middle-income households designed to make insurance more affordable. The primary objective was to reduce the number of uninsured Americans and provide them with preven
tive services.
The
evaluation of the ACA can
be conducted
using several criteria, such as the reduction in the number of uninsured individuals, access to primary care, and preventive services.
Studies have shown that the ACA significantly reduced the uninsured rate, particularly among minority and low-in
come populations. However, gaps in access remain due to varying state-level implementations, particularly in states that opted out of Medicaid expansion (Short, 2019) NURS-6050 Walden University Week 9: Discussion The Role of the RN/APRN in Policy Evaluation.
Social Determinants and Impact
Social determinants of health (SDOH), for instance, income, education, and geographic location, play a critical role in the effe
ctiveness of the ACA. For instance, individuals living in rural areas or states that did not expand Medicaid continue to face barriers in accessing healthcare. Additionally, racial and ethnic minorities, who disproportionately experience poverty and unemployment, have benefited from the ACA’s expansion of Me
dicaid and subsidies.
Yet
, these groups still face higher rates of uninsured individuals and disparities in healthcare access compared to white populations (Shiramizu et al., 2016).
The ACA aimed to address these disparities by increasing access to healthcare services, but social determinants such as income inequality and education level still limit th
e policy’s full impact. To further reduce health disparities, policymakers need to address these underlying factors while continuing to expand healthcare access.
Conclusion
The ACA has made measurable gains by improving healthcare access and decreasin
g the uninsured population. However, its effectiveness
is still influenced
by social determinants of health, which affect how different populations experience healthcare services.
As nurses advocate for patient care, they must also
engage in the evaluation of
healthcare policies like the ACA to ensure that all populations benefit equitably from healt
hcare reforms.
References
Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition.
American Journal of Public Health, 93(8), 1261–1267.
Shiramizu, B., Shambaugh, V., Petrovich, H., Seto, T. B., Ho, T., Mokuau, N., & Hedges, J. R. (2016). Leading by success: Impact of a clinical and translational research infrastructure program to address health inequities.
Journal of Racial and Ethnic Health Disparities, 4
(5), 983–991.
Short, N. M. (2019).
Milstead’s health policy and politics: A nurse’s guide
(7th ed.). Jones & Bartlett Learning.
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Mihret Ghebreamlak
Oct 22, 2024 10:10pm
| Last reply Oct 26, 2024 7:49pm
Reply from Mihret Ghebreamlak
The Role of the RN/APRN in Policy Evaluation
Professional nurses supporting the passage of the Treat and Reduce Obesity Act of 2021 (S.596) must recognize the importance of monitoring trends in the effectiveness of such policy on improving obesity among beneficiaries under Medicare and Medicaid. These critical criteria would thrive in measuring such policies in terms of trends of obesity rates, utilization of newly covered services because of intense behavioral therapy and anti-obesity medications, health outcomes, and cost implications. Evaluation must consider individual outcomes and the settings within which the patients are treated; therefore, it is a multilevel approach to policy assessment (Glasgow et al., 2003). During implementation, registered nurses and APRNs are precisely positioned to evaluate this policy in that they witness firsthand its impact on patient care, medication access, and treatment adherence (Short, 2021). Their experience on the front lines can highlight both successes and barriers in the practical application of this policy; hence, their input becomes invaluable in the evaluation process. Through systematic data collection and analysis, nurses can provide critical feedback on whether the policy is meeting or not meeting its intended goals of improving access to obesity treatment services.
The social determinants of health greatly affect the effectiveness of this policy and need to be taken into great consideration. Clinical practice has shown that despite improvements in Medicare coverage, nurses routinely witness how income levels determine access to nutritional food and safe spaces for exercise. Inequalities in education affect patients’ knowledge about strategies for obesity management, and age-related challenges impact treatment adherence among older adults (Shiramizu et al., 2016). These social determinants create complex barriers the policy must address to be effective. Health professionals can document such challenges, collect data about treatment outcomes across demographic groups, and provide evidence-based recommendations for policy improvements. This evaluation function is in full accord with a nurse’s professional responsibility to advocate for comprehensive and equitable healthcare solutions that take both the clinical and social determinants in properly influencing patient health outcomes. In addition, nurse engagement in policy evaluation strengthens the connection between legislative intent and clinical practice to ensure adequate services to diverse patient populations.
References:
Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why Don’t We See More Translation of Health Promotion Research to Practice? Rethinking the Efficacy-to-Effectiveness Transition.
American Journal of Public Health
,
93
(8), 1261–1267.
https://doi.org/10.2105/ajph.93.8.1261
Links to an external site.
Shiramizu, B., Shambaugh, V., Petrovich, H., Seto, T. B., Ho, T., Mokuau, N., & Hedges, J. R. (2016). Leading by Success: Impact of a Clinical and Translational Research Infrastructure Program to Address Health Inequities.
Journal of Racial and Ethnic Health Disparities
,
4
(5), 983–991.
https://doi.org/10.1007/s40615-016-0302-4
Links to an external site.
Short, N. M. (2021). Milstead’s Health Policy & Politics: A Nurse’s Guide. (7th edition). Jones & Bartlett Learning.
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Selina Villanueva
Oct 22, 2024 9:06pm
| Last reply Oct 25, 2024 3:46pm
Reply from Selina Villanueva
An evaluation topic of interest is the Affordable Care Act (ACA), specifically its Medicaid expansion policy. This federal policy aimed to increase healthcare access by expanding Medicaid eligibility to individuals with lower incomes. One of the criteria used to measure the effectiveness of the policy includes the increase in insured individuals, particularly in low-income and minority populations. Evaluations have also examined reductions in healthcare disparities and improvements in health outcomes among those previously uninsured.
Social determinants of health significantly impact this issue, particularly in terms of socioeconomic status, geographic location, and access to resources. For instance, states that did not adopt Medicaid expansion often have higher rates of uninsured individuals, exacerbating health disparities in those communities (Glasgow et al., 2003). Social determinants like poverty, education, and race/ethnicity further influence access to care and overall health outcomes. Programs aimed at addressing health inequities, such as translational research infrastructure programs, have demonstrated success in improving health equity through targeted interventions (Shiramizu et al., 2016). Nurses play a critical role in both the implementation and evaluation of these policies by advocating for equitable healthcare access (Williams & Anderson, 2018).
References
Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness.
American Journal of Public Health, 93
(8), 1261–1267.
Shiramizu, B., Shambaugh, V., Petrovich, H., Seto, T. B., Ho, T., Mokuau, N., & Hedges, J. R. (2016). Leading by success: Impact of a clinical and translational research infrastructure program to address health inequities.
Journal of Racial and Ethnic Health Disparities, 4
(5), 983–991.
Williams, J. K., & Anderson, C. M. (2018). Omics research ethics considerations.
Nursing Outlook, 66
(4), 386–393.
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Romel Suason
Oct 22, 2024 1:27pm
| Last reply Oct 26, 2024 9:02pm
Reply from Romel Suason
The Role of RNs and APRNs in Policy Evaluation
Policy evaluation is a critical strategy that allows nurse practitioners and other stakeholders to advocate for the patients’ and populations’ needs. Even though some may feel uncertain about this area, understanding the significance of policy evaluation involving RNs and APRNs is essential. This is usually due to perceived inadequacy in understanding policy issues or the ability to manage and evaluate policy processes. Nevertheless, nurses are in direct contact with clients; thus, their comparative insight makes them better placed to assess policies within healthcare and patient outcomes (Hajizadeh et al., 2021). Through engagement in policy evaluation, the nurses can guarantee that the formulated policies will meet the patient’s needs and promote optimal utilization of resources.
Nurses as Patient Advocates
Nurses understand patient needs best and are best positioned to design, develop, and evaluate policies that address the underlying needs. These needs are usually more complex and individual in patients and populations, and thus, it is necessary to create and constantly assess policies to achieve the necessary level of healthcare. This advocacy role carries over seamlessly to the assessment of policies as well. American Nurses Association (2020) acknowledges that nurses are in a strategic place to support policies like staffing ratios, resource distribution, staff training, and care for vulnerable populations. Participation in policy development also helps to understand how the policies work in practice rather than simply as ideas that will enhance patient outcomes. Thus, this shift from clinical advocacy for clients to assessing policies to bridge the healthcare delivery gaps that compromise patient care and quality of life.
Overcoming Hesitation
The transition process can experience significant challenges that compromise the capacity of nurses and other healthcare professionals to address the underlying needs. These barriers result in the inefficiency of the health policies and the inability to mitigate the population’s health needs. Thus, addressing these barriers is a critical strategy for enhancing health policy success and ensuring that professionals and stakeholders attain equity, equality, and efficiency in service delivery. Professional organizations provide tools and training on policy analysis and assessment to aid the nurses. Moreover, working with colleagues with prior policy experience can provide guidance and support (Jackson et al., 2022). Furthermore, the formulation of policy opinions can be nurtured by being proactive in the search for avenues of learning coupled with engagement in policy discourse, which can enhance nurses’ confidence in their ability to play an active and meaningful role in policy consideration and evaluation.
The Significance of Evidence-Based Practice
Another essential aspect that can be incorporated into the policy evaluation is the extent to which evidence-based practice was used. Based on the data, APRNs seem competent in assessing research, implementing research findings, and proposing solutions for any deficits. It can, therefore, be applied to evaluate the effects of health policies and health promotion interventions. Thus, using evidence-based research, nurses can segregate policies that positively impact health and those that need further evaluation or alteration (Chiu et al., 2021). Apart from strengthening nurses’ argument to engage in policy-making processes, this evidence-based approach also emphasizes the importance of research when developing appropriate policies in the health sector.
Call to Action
The direct involvement of APRNs and RNs in policy evaluation is the best way to establish whether or not specific policies are as helpful in achieving the intended population health needs in a given population group. As nurses are primarily involved with patient care, they can offer all the necessary information and knowledge for making health policies feasible and effective in addressing patient needs. Nurses can be policy co-creators by dismantling obstacles in policy engagement and looking for ways to be involved and invited as policymakers (Chiu et al., 2021). Therefore, the nursing profession must evaluate policies that have been seen to increase the quality of care and patient treatment outcomes, enabling it to effectively advocate for its patients on a much grander scale.
References
American Nurses Association. (2020).
Ethics and human rights
. American Nurses Association.
https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/
Links to an external site.
Chiu, P., Cummings, G. G., Thorne, S., & Makaroff, K. S. (2021). Policy advocacy and nursing organizations: A scoping review.
Policy, Politics, & Nursing Practice
,
22
(4), 276–296.
https://doi.org/10.1177/15271544211050611
Links to an external site.
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses’ participation in the health policy-making process: A systematic review.
BMC Nursing
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20
(1).
https://doi.org/10.1186/s12912-021-00648-6
Links to an external site.
Jackson, J. J., Maben, J., & Anderson, J. E. (2022). What are nurses’ roles in modern healthcare? A qualitative interview study using interpretive description.
Journal of Research in Nursing
,
27
(6), 174498712110709.
https://doi.org/10.1177/17449871211070981
Links to an external site.
NURS-6050 Walden University Week 9: Discussion The Role of the RN/APRN in Policy Evaluation