Discussion: Role of the RN APRN in Policy Evaluation Essay

Primary opportunities for Rto effectively participate in policy review are through professional associations and the work place. RNs and APRNs belong to a variety of professional organizations such as the American Nurses Association (ANA), Emergency Nurses Association and the American Academy of Nursing. These organizations work as a support system for nurses and they make sure that the policies enforced are beneficial for the nurses.

Secondly, through the workplace as professionals have the responsibility and opportunity to influence policies that would enable them promote quality patient care. RNs and APRNs are professionals who can influence policies that would be effective in their work environments.They can provide a written request for a policy to be reevaluated if a policy does not promote quality patient care.

Some challenges that these opportunities may present are not being knowledgeable and updated about implemented policies, not being part of any professional organization due to the complexity of registration and lack of unity, initiative and leadership (American Nurses Association, 2010).

A strategy to better advocate for or communicate the existence of these opportunities are informing in a timely manner about policy changes, nurses need to work together, be united in order for their voices to be heard. Nurses should be provided adequate training to understand their roles, responsibilities and work environment in order to be effective professionals.

Opportunities should be provided for all RNs and APRNs to develop their leadership skills and involving them in the policy review process and professional organizations having a well-defined, simple registration system for nurses to follow when joining professional organizations.

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References

American Nurses Association. (2010). Nursing’s social policy statement: The essence of the profession. Nursesbooks. org.

Milstead, J.A & Short, N.M. (2019). Health policy and politics: A nurse’s guide. (6th ed.). Burlington, MA: Jones & Barlett learning

The Role of the RN/APRN in Policy Evaluation

There are many ways in which nurses can be involved in policy evaluation. The two ways are collaborating with elected officials and joining professional associations. Nurses can gather data and information that can help policy evaluation (Milstead & Short, 2017). Nurses can reach out to local and federal legislators. They can work with their elected representatives to advocate for a review of policies that will help better the nursing profession and patient care. They can share their experiences and evidence, assisting in policy evaluation by checking impact and effectiveness (Scott & Scott, 2020). Challenges that nurses may meet may be their inability to contact legislators and different opinions that may arise. If they cannot contact their elected representatives, nurses can form a relationship with policymakers who can help set up meetings.

Nurses also have opportunities for policy evaluation by joining professional nursing associations at the state and national levels. By joining professional associations, nurses can have the opportunity to learn policy making and evaluation. They can attend conferences, network with other members and lobby on behalf of nurses (Morin, 2021). Even though professional nursing associations have benefits, they also present challenges. One challenge of this route is the complex registration process and high membership fees required to join these organizations.

There are several strategies to communicate these opportunities for nurses. The first strategy is to have meetings with healthcare professionals and educate them on the importance of nurses in policy advocacy and policy review. Nurses can also be educated that joining professional organizations may have additional benefits. They can also be taught how they can be involved in these organizations.

References

Milstead, J. A., & Short, N. M. (2017). Health policy and politics. Jones & Bartlett Learning.

Morin, K. H. (2021). Editorial: Contributions of professional nursing organizations. Journal of Advanced Nursing, 77(6).

Scott, S. M., & Scott, P. A. (2020). Nursing, advocacy and public policy. Nursing Ethics, 28(5), 723-733.

By Day 3 of Week 9

Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

Evaluation is a familiar term to the nursing profession. One of the first things that a nurse is taught is the nursing process which includes assessment, planning, implementation, and evaluation. Program or policy evaluation is no different, the same theory applies to assess the effectiveness of a specific program or policy (Milstead & Short, 2019). This evaluation is a vital part of policy development to determine the long-term effects of policy on populations, however it is sometimes overlooked (Laureate Education, 2018).

RN’s and APRN’s have a responsibility to their profession to advocate for health policy (Laureate Education, 2018). One way for them to become involved in evaluation of health policy is to form relationships with and educate political leaders so they understand the wealth of knowledge that an RN or APRN holds related to health policy. “The challenging work of the NP political advocate is to educate and demonstrate to powerful policy makers that supporting and advancing policies that promote better health and health care is in the best interest of the larger community” (Kostas-Polston, Thanavaro, Arvidson, & Taub, 2015).Gaining the trust of a political leader can help one gain access to become involved in policy evaluation. As the relationship grows between the nursing advocate and the political leader, the nurse will be recognized as a trusted source of impartial information and evaluation (Kostas-Polston et al., 2015).

Another way to get involved in policy evaluation is to join a professional organization, such as the American Nurses Association (ANA). During policy evaluation processes, many professional organizations, such as the ANA, are involved in providing data to lawmakers (Milstead & Short, 2019). Nurse advocates are frequently the voice of these healthcare reforms. Staying current on health-care policies and issues will allow the nurse to step in and advocate for the nursing profession, as well as patient safety and access to care.

Nurses must be prepared for the difficulties that come with policy evaluation. Accessing political leaders may be difficult due to their hectic schedules. When requesting a meeting with a legislator, the nurse may be meeting with a legislative staff member. However, legislative staff members continue to wield power, and their job is to advise legislators on research and issues (Kostas-Polston et al., 2015). The nurse should present her evaluation of the health policy to the legislative staff member and provide them with a written evaluation. An additional challenge for policy evaluation is eliciting community feedback on the evaluation’s findings. Evaluations can sometimes bring to light additional issues that must be addressed, altering the course of the political agenda.

Incorporating health policy into all nursing education is one strategy I would recommend. Currently, health policy is not included in the ADN curriculum; however, I believe that the groundwork should be laid here. Another strategy for educating nurses about health policy and advocacy would be for nursing leaders to take the initiative with their employees and teach them about health policy and advocacy. It could be part of a clinical ladder program or a yearly education requirement for health care organizations. Political advocacy must be promoted by knowledgeable nurses. Nurses should be involved in all stages of health care policy development, and they should be encouraged to use their expertise and critical thinking to evaluate health policy for the benefit of society.

Reference

Kostas-Polston, E. A., Thanavaro, J., Arvidson, C., & Taub, L.-F. M. (2015). Advanced practice nursing: shaping health through policy. Journal of the American Association of Nurse Practitioners, 27(1), 11–20. https://doi-org.ezp.waldenulibrary.org/10.1002/2327-6924.12192

Laureate Education (Producer). (2018). The Importance of Program Evaluation[Video file]. Baltimore, MD: Author.

Milstead, J. A. & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6^thed.). Burlington, MA: Jones & Bartlett Learning.

Good job on your post!

The American Association of Colleges of Nursing (AACN) mandates that policy is part of baccalaureate, masters, and doctoral nursing programs. Baccalaureate nursing programs usually focus on a basic understanding of how policy affects health care (Staebler, Campbell, Cornelius, Fallin-Bennet, Fry-Bowers, Kung, LaFevers, & Miller, 2017). My undergraduate program incorporated policy into its curriculum, but it was not a separate class. The class combined ethics, law, economics, and health policy, so you can imagine how much focus was on health policy. Nursing education is vital to develop a nurse’s political understanding and to promote political advocacy (Pery & Emory, 2017). I agree with you that health policy should start at the ADN level. Perhaps if a solid foundation was built in my lower-level courses, then some assignments in this class wouldn’t have seemed so overwhelming.

References

Perry, C., & Emory, J. (2017). Advocacy through education. Policy, Politics, & Nursing Practice, 18(3), 158-165. doi:

Staebler, S., Campbell, J., Cornelius, P., Fallin-Bennet, A., Fry-Bowers, E., Kung, Y., LaFevers, D., & Miller, J. (2017). Policy and political advocacy: Comparison study of nursing faculty to determine current practices, perceptions, and barriers to teaching health policy. Journal of Professional Nursing, (33)5, 350-355. doi:

SAMPLE 2

RE: Discussion – Week 9

Primary opportunities for RNs and APRNs to effectively participate in policy review are through professional associations and the work place. RNs and APRNs belong to a variety of professional organizations such as the American Nurses Association (ANA), Emergency Nurses Association and the American Academy of Nursing. These organizations work as a support system for nurses and they make sure that the policies enforced are beneficial for the nurses.

Secondly, through the workplace RNs and APRNs as professionals have the responsibility and opportunity to influence policies that would enable them promote quality patient care. RNs and APRNs are professionals who can influence policies that would be effective in their work environments.They can provide a written request for a policy to be reevaluated if a policy does not promote quality patient care.

Some challenges that these opportunities may present are RNs and APRNs not being knowledgeable and updated about implemented policies, not being part of any professional organization due to the complexity of registration and lack of unity, initiative and leadership (American Nurses Association, 2010).

A strategy to better advocate for or communicate the existence of these opportunities are informing RNs and APRNS in a timely manner about policy changes, nurses need to work together, be united in order for their voices to be heard. Nurses should be provided adequate training to understand their roles, responsibilities and work environment in order to be effective professionals.

References

American Nurses Association. (2010). Nursing’s social policy statement: The essence of the profession. Nursesbooks. org.

Milstead, J.A & Short, N.M. (2019). Health policy and politics: A nurse’s guide. (6th ed.). Burlington, MA: Jones & Barlett learning

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.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

RE: Discussion – Week 9

Good job on your post. Being a member of a professional organization is a great place to have a voice in policy making and evaluation since there is strength in number. This means that from now on, we must strive to be voices that will be counted in and join as dues paying members of these organizations. The evaluation process begins as the policy is been crafted as the efficiency and effectiveness of the policy must be measured (Laureate education, 2018).

Challenges are part of any task that we embark on in real life. It is not different on a professional platform. Apart from challenges with political leaders, we may also face challenges with other professionals as noted with some states restricting APRNs’. To overcome such challenges, nurses must always remember that we are all fighting for a common purpose and remain focused on the goal.

Charity they say begins at home. Not many nurses advance to graduate program and not many nursing programs either at associate or bachelor degree level lay strong emphasis on advocacy thereby loosing a significant number of nurses who desire to but do not have the educational background and insight as to what to do. Nursing advocacy I believe starts with us and our nursing schools. Not surprisingly, literature is scanty on teaching advocacy in nursing school.

References

Abood, S. (2007, Jan. 31). “Influencing Health Care in the Legislative Arena”. OJIN: The Online Journal of Issues in Nursing. 12(1), Manuscript 2.

Laureate Education (Producer). (2018). The Importance of Program Evaluation [Video file]. Baltimore, MD: Author.

*Note: Throughout this program, your fellow students are referred to as colleagues.

RE: Discussion – Week 9

References

American Nurses Association. (2010). Nursing’s social policy statement: The essence of the profession. Nursesbooks. org.

Milstead, J.A & Short, N.M. (2019). Health policy and politics: A nurse’s guide. (6th ed.). Burlington, MA: Jones & Barlett learning

The Role of the RN/APRN in Policy Evaluation.

Evaluation of a process or policies helps hold nurses and politicians accountable (Laureate Education (Producer, 2018). Without evaluating a process, it’s difficult to tell if its effective or not for the intended use. During evaluation, it gives opportunity us the opportunity to go back to the drawing board to know why a process failed or what need to be added to make it work.

Nurses influence on health policy through policy evaluation, protects the quality of care by access to required resources. Access to healthcare policy helps nurses to be aware of the happenings in healthcare policy including within their State (Laureate Education, 2018). This kind of knowledge will help nurses to provide effective feedback to employers or Government to help provide good shape for health policies and programs. For example, a nurse can book appointment with their local legislators to present an evaluation report on a program/policy with a focus on measurable outcomes and the policies effectiveness while offering their expert opinion on the policy.

While these opportunities give nurses upper hand in policy review, they can present challenges to the nurses. Some of the challenges faced during the process on policy review are to a large extent under the control of researchers, reviewers, and funding organizations (Glasgow R. et.all 2003). For example, the RN’S/APRN’s may find it difficult to obtain required or comparative resources for a policy or program that has been implemented, particularly when it’s a new policy that lack appropriate data for comparison (Milstead & Short, 2019). Nurses also face challenges of limited resources to complete the evaluation of a program/ Policy. These challenges can make it difficult to evaluate the outcome and impact of a policy or program.

Nurses can try to find evidence-based data and information related to policy or conduct new studies to combat such lack of Data. The nurse can also request for funding / scholarship to enable them to get enough resources to conduct policy evaluation.

As an RN, I will recommend the incorporation of health policy advocacy/evaluation as a course in the nursing curriculum that nursing students should complete before getting their licenses.

Secondly, I may consider using social media platforms to run the campaign on the opportunities available on the opportunities available for nurses to participate in policy evaluation. Campaigns and advertisements can be carried out on social media platforms such as twitter, Instagram, Facebook, LinkedIn, YouTube and blogs. Additionally, nursing associations and organizations can also use their websites, online-chat platforms or webinars to advocate for these opportunities among nurses and inform nurses of the policies and programs that need to be evaluated so that nurses can provide the individual expert opinion on the policies and programs.

References

Laureate Education (Producer). (2018). Program Policy and Evaluation [Video file]. Baltimore, MD: Author.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

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.

Holly , I am in agreement with you that Advocacy for nurses, and also campaigning. I never thought of campaigning. Great recommendation.

Nurses can be advocates to inform, educate citizens how to be proactive in their communities. Many organizations are strengthening internal multiple disciplines/departments, and external nontraditional partners, community-based organizations partnerships to identify social needs and invest in communities (Byhoff et al., 2017).

Identifying, and recognizing key factors to inform how policy process are crucial for nurses, and APRN’s. According to World Health Organization.

An important landmark document for the future planning for nursing will be the release of the 2020 State World’s Nursing report by the World Health Organization. This report will describe how nurses can contribute to the achievements of the Sustainable Development Goals and Universal Health Coverage and will be a seminal document for policy development for the next three to five years. (WHO 2019)

References

Byhoff, E., Cohen, E., Hamati, M.C., Tatko, J., Davis, M.M., & Tipirneni, R. (2017). Screening for social determinants of health in Michigan health centers. Journal of the American Board of Family Medicine, 30(4), 418-427. doi:10.3122/jabfm.2017.04.170079

World Health Organization (2019) State of the World’s Nursing and State of the World’s Midwifery. WHO: Geneva. Available at: (accessed 10 July 2019)

Hi Sasha

The community of nurses is so vast and powerful we as nurses can do a lot when it comes to policy making. Nurses can participate in policy reviews by attending policy conferences, and organized policy meetings. Nurses can also attend meetings specifically for policy change directed at health care. Nurses can also plan and organize their own meetings and rallies and open invite members of policy boards to get the purpose of policy change and agenda heard. Joining professional organization would be a good start to a nurse that is new to the idea of policy making. Nursing organizations can provide insight and direction and help improve idea outcomes of nursing policy change. According to Myers (2020) Nurses need to actively embrace strategies to improve population health outcomes and reduce health and other disparities. As a main component in health care, nurses provide the most direct level of care. Nurses are able to see the patient whole level of care therefore are the best advocates for the patient. As stated by Wichaikhum et al. (2020) Nurses’ participation in public health policy development is essential to developing and maintain an efficient, high-quality healthcare system.

References

Myers, R.C. (2020). Promoting population health: nurse advocacy, policy making, and use

of media. Pub Med.Gov, 55(1), 11-20. http://doi.org

Wichaikhum, O., Abhicharttiburta, K., Nantsupawat, A., Kowitlawakul, Y., & Kunavikitkul, W.

(2020). Dweveloping a strategic model of participation in policy development for nurses.

Pub Med. Gov, 67(1), 11-18. http://doi.org10.1111/inr.12571

Name: NURS_6050_Module05_Week09_Discussion_Rubric

	Excellent	Good	Fair	Poor
Main Posting	Points Range: 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	Points Range: 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness	Points Range: 10 (10%) – 10 (10%) Posts main post by day 3.	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%) Does not post by day 3.
First Response	Points Range: 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Response is effectively written in standard, edited English.	Points Range: 15 (15%) – 16 (16%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response	Points Range: 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Response is effectively written in standard, edited English.	Points Range: 14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation	Points Range: 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days.

Total Points: 100

Name: NURS_6050_Module05_Week09_Discussion_Rubric

RE: Discussion – Week 8

For healthcare legislation to be successful and be evidenced based it is imperative that RNs and APRNs be involved in the policy-making process. By being involved in the initial stages of policy-making, nurses advocate for improvements that benefit both themselves and patients, i.e., policies that increase the scope of practice for APRNs to increase patient access to primary care providers (Milstead & Short, 2019).

One avenue that nurses can use to be a part of the policy-making process is their participation in a professional nursing organization such as the American Academy of Nurse Practitioners (AANP). AANP members are involved in political advocacy committees that advocate policies like H.R 8812 ICAN Act which promotes improving patient access to health care by eliminating Medicaid and Medicare barriers to ARNP practice (AANP, 2022). Another way nurses can affect the policy-making process is through community advocacy in local groups or within their own organizations. By being involved at a local level in healthcare issues nurses draw public attention and can positively influence public perception (Milstead & Short, 2019).

While nurses are great advocates for patients, they face challenges in inserting themselves at the table of policy-making. The biggest challenge to overcome is the historically subservient nature of the nurse-physician relationship. Nurses report feelings of powerlessness within political spheres related to a perceived preference for male voices over nurses’ opinions (Rasheed, Younas & Mehdi, 2020). Another challenge for nurses is our perception as good implementers of policy which is a passive role and not as a policymaker which is an active role. Nurses have historically had low participation as policymakers and as members of committees that affect policy, however through education and empowerment that could be changed.

To improve nurses’ ability to be effective policymakers, nurse leaders should promote participation in professional organizations and organizational committees to their fellow nurses. Nurses should be educated on the importance of their voices and views and how they can be used for the betterment of others. When I first started with the VA, I didn’t participate in committees, and I wasn’t a part of a professional organization. However, as I moved to other positions within the organization, I came into contact with nurse leaders who both empowered and educated their nurses to be active in the policy-making process within our organization and would conduct training events to spread the word.

References

Milstead, J. A. & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6^th ed.). Jones & Bartlett Learning

Rasheed, S. P., Younas, A., & Mehdi, F. (2020). Challenges, extent of involvement, and the impact of nurses’ involvement in politics and policy making in in last two decades: An integrative review. Journal of Nursing Scholarship, 52(4), 446–455.

RE: Main Discussion Post – Week 9

Telemedicine is the use of electronic communication and information technologies to provide health care when distance separates the medical professional from the patient. It also includes educational and administrative uses of these technologies in support of health care, such as distance learning and administrative videoconferencing. During the COVID-19 pandemic, telehealth has proven its value as a vital healthcare alternative to traditional in-office visits. As telehealth continues to transform the healthcare landscape post-public health emergency, providers should begin shifting their thinking from short-term crisis health delivery to ensuring the long-term effectiveness and sustainability of such programs. To do this, health systems need to develop and implement robust performance monitoring systems, ensuring that high-quality telehealth services are delivered efficiently, affordably and effectively to patients and other stakeholders.

All successful telehealth programs leverage data to evaluate program performance and outcomes. Before an organization deploys a program, it should consider which data points are most essential in relation to the organization’s goals. Typically, such data will fall within one of four pillars: performance, affordability, quality of outcomes and quality of service delivery. Defining key performance indicators (KPIs) that effectively address these crucial areas is the first step toward establishing a sustainable telehealth program.

Pillar 1: Performance

The category of performance encompasses those factors relating to provider productivity and effectiveness. One such critical KPI is the measure of relative value units (RVU), which is a measure of provider productivity and weighted level of effort. Anecdotally, the telehealth format has demonstrated superior performance versus traditional in-office visits across several metrics. Physicians should be able to see more patients via telehealth versus in-person visits due to the elimination of time it takes for exam room turnover and because of streamlined patient-intake procedures.

In addition, since patients are able to attend telehealth appointments from the comfort of their homes or offices, they are more apt to arrive on time as compared with in-office visits, as they don’t have to arrange for childcare, take time off work or deal with traffic on the way to the appointment. Other key measures of performance include the connectivity of the underlying technology, the levels of examination that can be performed effectively over video (or audio), and the length of call queues and patient wait times. Dropped calls and video feeds present a real challenge in this medium, especially for providers and patients in rural and lower-income regions with limited access to broadband. Even when a call is not dropped completely, poor video connectivity can force telehealth visits to transition from full audiovisual to audio-only mid-appointment, disrupting the flow of the visit and sharply reducing outcome effectiveness.

Pillar 2: Affordability

Another key measure of success is the relative cost or affordability of telehealth versus in-person visits. In the current environment, many patients pay a flat out-of-pocket rate per telehealth appointment. In a world of high deductible health plans, the affordability of telehealth is no incidental matter, particularly for behavioral health visits, which tend to be regular, frequent and continuous over months or years. During the public health emergency, the Centers for Medicare & Medicaid Services has expanded the numbers and types of services healthcare providers can offer through telehealth and has increased the reimbursement rates for such services. Commercial payers have rapidly followed suit. While it is uncertain how these rates may change post-crisis, affordability and coverage will continue to be important factors in evaluating the sustainability of any telehealth program.

Pillar 3: Quality of Outcomes

As patient outcomes are one of the most important metrics to track in any health program, whether telehealth or in-person. KPIs that fall under this category include rates of readmission whether a patient’s problem is solved on the first visit; the need for follow-up telehealth or in-person appointments, whether the physician is able to assess, diagnose and resolve the patient’s medical concern during the visit; and whether the provider spent sufficient time with the patient to provide quality carefully and accurately. Increased frequency and availability of telehealth visits may result in more effective monitoring of recurring conditions and better disease management. This seems to be true for behavioral and mental health engagements as well as those addressing chronic physical health conditions.

Pillar 4: Quality of Experience

Lastly, the quality of the patient and provider experience are critical but often discounted measures of telehealth effectiveness. KPIs that measure patient satisfaction and quality of experience, including the provider’s ability to listen carefully to the patient’s needs, explain things clearly, and treat the patient with courtesy and respect are the aspects that the patients are concerned of.

Defining and tracking the right data is critically important for creating a successful telehealth program. Tracking and trending results and providing feedback to providers is key to ensuring that programs are moving in the right direction and positively influencing changes in clinical practices. Use of daily huddles where staff and providers review program performance through the utilization of dashboards is an effective mechanism to achieve continuous improvements and to realize program goals.

Telehealth is an important health services delivery model. Developing a successful and effective program is not a “one-and-done” exercise. It takes effort across the organization and requires constant oversight, monitoring and adjustments over time. As organizations set off on or continue their telehealth journey, a robust data plan is foundational to realizing telehealth’s benefits.

In response to the unprecedented pressure to expand services and control the transmission of COVID-19, the federal government, many states’ government and commercial insurers are expanding coverage of telemedicine and relaxing existing regulations. The federal government has focused on broadening telemedicine access for Medicare beneficiaries and waiving enforcement of HIPAA to enable use of video platforms like Facetime and Skype. Many states have relaxed telemedicine written consent, licensing and online prescribing laws, while expanding coverage in Medicaid and fully insured private plans. Meanwhile, many health centers have rapidly redesigned their existing models of care to implement telemedicine.

While these unprecedented and swift measures have been taken to broaden telemedicine access during this pandemic, gaps in coverage and access to telemedicine remain. Social determinants impact the issue by ensuring service parity and payment parity for telemedicine care as compared to in-person care, ensuring patients can access telemedicine services from their homes (home as “originating site”) to further enable social distancing practices, allowing use of audio-only phone for telemedicine visits to help ensure access for patients who do not have live-video technology and investing in telecommunications infrastructure for less-resourced sites of care and ensuring internet access to patients in rural areas and this may involve providing direct funding for health systems and smaller practices to implement telemedicine.

There are potential trade-offs in loosening regulations on telemedicine, including privacy issues and quality of care. Depending on the insurer, some patients may be able to engage in telemedicine visits with their usual providers while some may have to see providers from specific telemedicine vendors outside of their usual source of care. This could create discrepancies in access and continuity of care. Additionally, expanding coverage of telemedicine may result in increasing health spending, if patients use telehealth in addition to in-person care, rather than as a substitute. With all these factors in mind, it will be up to policymakers, payors, and providers to determine if the changes made to telehealth policy in light of COVID-19 outweigh the potential concerns, if they should remain permanently and if telemedicine helps enable accessible and quality health care. In sum, telemedicine is part of the expanding use of communications technology in health care, or “telehealth,” being used in prevention, disease management, home health care, long-term care, emergency medicine, and other applications. The diversification of such applications and continued advances in communications technologies, including the Internet, are raising expectations for telemedicine. However, the considerable attention focused on the technological aspects of telemedicine during the last decade has been accompanied by a lack of validated or well-demonstrated approaches for evaluating telemedicine. For program funding and policy making, there is increasing need to develop and adapt evaluative frameworks for telemedicine.

References

Collins, J.M., and Charboneau, W. Long Distance Procedures: Legal, Licensing, and Reimbursement Issues. In Proceedings of the Mayo Telemedicine Symposium. Broadcast simultaneously from Rochester, Minn., Jacksonville, Fla., and Scottsdale, Ariz. October 1-3, 1993. Rochester: Mayo Clinic, pp. 56-60.

National Academies of Sciences, Engineering, and Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. https://doi.org/10.17226/5296.

CHPS (Center for Health Policy Studies). Understanding and Choosing Clinical Performance Measures for Quality Improvement: Development of a Typology. Final report to the Agency for Health Care Policy and Research (Contract No. 282-92-0038), Rockville, Md., January 1995.

Dayhoff, R.E. Telemedicine Activities of Veterans Administration. Presentation at the National Forum II: Global Telemedicine and Its International Applications, McLean, Va., April 4, 1996.

Grigsby, J., Barton, P.L., Kaehny, M.M., et al. Analysis of Expansion of Access to Care Through Use of Telemedicine and Mobile Health Services . Report 1, Literature Review and Analytic Framework. Denver: Center for Health Policy Research, 1993.

Discussion: Role of the RN APRN in Policy Evaluation Essay

By Day 3 of Week 9

By Day 6 of Week 9

The Role of the RN/APRN in Policy Evaluation.

Name: NURS_6050_Module05_Week09_Discussion_Rubric

Name: NURS_6050_Module05_Week09_Discussion_Rubric

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