Who is Going to Provide Care for the United States?

1. Who is Going to Provide Care for the United States? NU 670 Senior Project Washburn University School of Nursing Diane Morris BSN, RN Stephanie Kimbrel BSN, RN

2. INTRODUCTION Providers of health care Individuals needing health care

3. PURPOSE Utilization of Advanced Practice Nurses to the fullest extent of their qualifications and competencies to meet the increased health care needs of Americans.

4. SIGNIFICANCE The significance of this project is to increase the stakeholders of health care awareness through the development of a video that helps describe the health care that an APN can provide and delineate APNs from other health care providers.

5. OBJECTIVES

6. BACKGROUND: Research

7. Having access to health care means timely use of personal health services to achieve the best health outcomes. BACKGROUND: Health Care Access

8. BACKGROUND: Health Care Access Rate of prevention of disease and disability Number of preventable deaths Rate of detection and treatment of health conditions Patients quality of life Life expectancy

9. BACKGROUND: Health Care Access

10. BACKGROUND: Barriers

11. BACKGROUND: Barriers- State Regulations and Legislation

12. BACKGROUND: Barriers- Identity Advanced Practice Nurse encompasses all advanced practice nurses who include but are not limited to: Nurse Practitioner (NP), Clinical Nurse Specialists (CNS), Certified Nurse Midwife (CNM) Certified Nurse Anesthetist (CRNA).

13. BACKGROUND: Barriers-Identity Nursing Model Medical Model Focus on defect or dysfunction Identify specific disease/condition Treatment of specific disease/condition • Patient centered • person relating to the environment holistically; • nursing care is formulated on the basis of a holistic nursing assessment of all dimensions of the person (physical, emotional, mental, and spiritual) that assumes multiple causes for the problems experienced by the patient. • Nursing care then focuses on all dimensions, not just physical

14. BACKGROUND: Barriers- Efficacy of Advance Practice Nurses More than 100 studies indicate that APNs can provide high quality, cost-effective health care that produces outcomes equivalent physicians.

15. Spring of 2012 into the summer of 2012 • The databases and resources searched include: • Cumulative Index to nursing and Allied Health Literature (CINAHL) • PubMed, • MEDLINE, • Ovid SP, • National Guideline Clearing house, • Cochrane Collaboration’s systematic reviews • as well as online searches in GOOGLE search. • Keywords used determined by the ROL performed. • Restrictions applied to the search included articles published in the last ten years, must be peer reviewed, in English, and in full text. REVIEW OF LITERATURE Two extensive Reviews of Literature were performed Advanced Practice Nurses, efficacy of practice, and health come outcomes Advanced Practice Nurses and Health Care Access

16. REVIEW OF LITERATURE: Efficacy/Health Outcomes • A seminal study done in 1981 by the Office of Technology Assessment conducted an extensive case analysis of Nurse Practitioners practice and reported that NP’s provided equivalent or improved medical care at a lower cost than primary care physicians. This study also showed that Nurse Practitioners decreased the cost by one-third to one-half per hour when seeing patients independently rather than in collaboration with a physician. • Another study done by a large HMO found that adding an NP to practice could virtually double the typical patients seen by a physician, approximately $1.65 million per 100,000 enrollees per year • Researchers show that in 2009 APNs provided care equivalent to that as physicians at a lower cost, while achieving high levels of patient satisfaction and providing more disease prevention counseling, health education and health promotion activities than physicians. • Chenoweth, Martin, Pankowski and Raymond showed in 2005 and 2008 that APNs had significant savings, improved benefit-to-cost ration and lower per patient costs. In addition to these savings other factors such as illness prevention, health promotion and outcomes were improved and are important to health care cost-effectiveness. • Naylor and Kurtzman (2010) showed the value of Advanced Practice Nurses in delivery primary care and care provided by APN’s is equivalent to care provided by physicians with higher satisfaction rates in patient follow-up, consultation time, satisfaction and screening, assessment and counseling. • U.S. Agency for Healthcare Research and Quality’s Consumer Assessment of HealthCare Providers and Systems qualitative study of patient satisfaction concluded that nurse practitioners were more likely to have higher patient satisfaction versus physicians.

17. REVIEW OF LITERATURE: Health Care Access Doty, How, Osborn, Peugh, and Schoen (2008) found that patients from the United States with chronic conditions have the most negative access, coordination, and safety experiences when compared with seven other industrialized countries. Abelson, Bourgeault, Bryan-Lukosius, Carter, DiCenso, Donald, Kaasalainen, Kilpatrick, and Martin-Misener @2010) qualitative study on analyzing two novel approaches to NP integration designed to address the gap in patient access to primary health care found that NP-led clinics had higher level of patient satisfaction and in areas where there were physician shortages this increased available providers thus increasing access. Coffman, Grumbach, Hart, Mertz and Palazzo (2003) cross-sectional analysis study compared the geographic distribution and patient populations of physician and non-physician primary care clinicians found that non-physician primary care clinicians and family physicians have a greater propensity to care for underserved populations than do primary care physicians in other specialties. Barrow, Beaty, Belman, Crane, Kempe, Steiner, and Stokstad (2005) evaluation of the effect of State Children’s Health Insurance Programs on health care outcome measures in Colorado’s children found that first time enrolled families dramatically increases access to health care, decreases financial barriers to care and improves the overall quality of care. Ferrer’s (2007) study examines the current use of primary and specialty care across the US population for policy-relevant subgroups, such as disadvantaged populations and persons with chronic illness main and secondary outcome measures were the estimates of the proportion of Americans who accessed different types of primary care and specialty physicians and midlevel practitioners. Family physicians constitute the only clinician group that does not show income disparities in access. Multivariate analyses show that patterns of access to family physicians and nurse-practitioners are more equitable than for other clinician types.

18. NURSING THEORY: Kurt Lewin’s Crystallizing & adaptation of ownership of the new “as is” Recognize the need for change The transition which can lead to developing new behaviors, values, & attitudes, sometimes through organizational structure & process of changes & development techniques.

19. VIDEO PRODUCTION Script created using evidence-based information regarding APN’s and their practice Dr. Monica Scheibmeir PhD, APRN, FAANP, and Dean of the School of Nursing at Washburn University Interviews: Julie Hoskins Melissa Perry Chasitiy Filion Production of video: Erik Eberhart, MBA

20. IMPLEMENTATION

21. THANK YOU Questions????