FPA legislation

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What are the advantages and disadvantages of collaborating with physician organizations when pursuing FPA legislation?

EVIDENCE BASE IN DESIGN

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Maria Hernandez

Main Post:

H.R. 977- Patient Access to Higher Quality Health Care Act of 2023.

 

Description: When a patient has health insurance, depending on which premium, they are made to use providers or hospitals that are “in-network” to avoid higher costs of services. This can often be an issue for patients because some providers are not in network with their health insurance, specifically Medicare recipients. The Patient Access to Higher Quality Health Care Act would “repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals” (Congress.gov, 2023).

Background: According to the American Hospital Association, “For decades, the Ethics in Patient Referrals Act (“Stark Law”) has protected the Medicare program from the inherent conflict of interest created when physicians self-refer their patients to facilities and services in which they have a financial stake” (AHA, n.d.). At one point, physicians were allowed to make referrals to hospitals with ownership within the entire facility; this gap was closed in 2010 when the Affordable Care Act was passed.  

Social Determinant: One social determinant is access to health care and quality care. Patients, regardless of their socioeconomic status, should receive high-quality care. The American Hospital Association states, “The Government Accountability Office (GAO), the Centers for Medicare & Medicaid Services and MedPAC all found that physician-owned hospitals’ patients tend to be healthier than patients with the same diagnoses at general hospitals” (AHA, n.d.). This would lead those with serious illnesses to rely on general hospitals for healthcare services.

Evidence: The growth of Physician-owned hospitals was prohibited in 2010 after the passing of the Affordable Care Act. According to Ehrenfeld, “a systematic review of 30 years of research demonstrating that physician-owned specialty hospitals or so-called “focused factories” offer higher-quality care at comparable or lower cost, while physician-owned community hospitals are no worse than their counterparts” (Ehrenfeld, 2023). If H.R. 977 is passed into law, it would allow physicians of physician-owned hospitals to extend their services to the community by opening new hospitals that would provide high-quality, efficient care and be affordable to patients. This would place competition against general hospitals at risk of losing market share, leading them to reform their services to stay in competition. This would benefit patients in being able to seek assistance in a variety of hospital or hospital-owned facilities. 

 

References:

American Hospital Association. (n.d.). Fact sheet: Physician self-referral to physician-owned hospitals. https://www.aha.org/fact-sheets/2023-02-27-fact-sheet-physician-self-referral-physician-owned-hospitals

Congress.gov. (n.d.). H.R.977 – 118th Congress (2023-2024): Patient Access to Higher Quality Health Care Act of 2023. https://www.congress.gov/bill/118th-congress/house-bill/977?q=%7B%22search%22%3A%5B%22HR+977%22%5D%7D&s=1&r=1

Ehrenfeld, J. M. (2023, August 10). End restrictions on physician-owned hospitals to expand Quality Care. American Medical Association. https://www.ama-assn.org/about/leadership/end-restrictions-physician-owned-hospitals-expand-quality-care

D. Saa Critical Care Wk 4 Discussion

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MY NUMBER ASSIGNED WAS 2 WHICH IS: Renal Failure

Each student will be assigned a number randomly.  Whatever your number is, select the corresponding topic below, then post a minimum of 5 bullet points about the topic.

Your bullet points should address key components of the topic, such as what, how, who, & why.  This information should not be basic things you learned in Med/Surg, but rather advanced critical care based. 

Think about this as a group effort to create a study guide. Use ONLY your textbook, but do not cut & paste from the book.

Then create, find, or borrow a test style question about your topic & post at the bottom of your bullet points. The format needs to be multiple choice or select all that apply. Think NCLEX style.

Part 2:

Interview:You will take a few minutes and ask 2 people about their personal coping mechanisms for dealing with the stress of working in healthcare during this unique time of Covid. Stress can be physical, emotional, spiritual, or any combination of triggers. Ask a diverse variety of people, don’t forget those in other departments at different points of hierarchy. For example, ask your unit manager, environmental services, volunteers, patients, fellow nurses, etc. Write 2-3 paragraphs on your findings and impressions while respecting the person’s identity.

250 Nurse Evidence Based Discussion

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Due 9/25   12pm EST

250 WORDS not including title and reference APA

 

As you complete the gathering and evaluation of the evidence, it’s important to review the significance and next steps related to EBP.

Consider the following questions in your discussion post:

  • How does a nurse know what (if any) knowledge in a research study is usable for clinical practice?
  • What would a critical thinker look for in the evidence before deciding to change?
  • What influence do credibility and clinical significance have on your decisions to integrate research-based evidence into your practice?

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

  All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format. 

life-span development

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Research Paper Assignment Guide

Prompt:

The Research Paper assignment is designed to integrate your developing skills in self-reflection, scientific knowledge, awareness of research methods, and critical thinking, as they relate to the field of developmental psychology. You may find that your topic for the Research Paper is related to your focus in the Autobiographical Developmental Essay (e.g., you may choose to focus on the same or similar developmental stage) and/or the Theory Essay (e.g., you may choose to explore more of the theories you discussed). You may also wish to tackle a completely new developmental stage and/or topic, and that is just fine! The important part of selecting your focus for this assignment is that you follow your own natural curiosity about the human condition.

Your Research Paper should be at least 1000 words double-spaced (the last page will be your references page which does not count towards your word count)using 12-point font and 1-inch margins. You must incorporate at least 3 peer-reviewed journal articles as sources, in addition to your textbook.

Preparation:

Ensure that you are up to date on your reading assignments for the course (through Chapters 15 and 16, Middle Adulthood).

Review key characteristics of each major developmental stage to help with your focus for the paper.

Reflect on the major area of development in which you are most interested (e.g., physical, cognitive, social, emotional).

To complete this assignment, you will:

Step 1: Select one of the major developmental periods you have studied thus far in the course: infancy, early childhood, middle childhood, adolescence, early adulthood, or middle adulthood.

Step 2: Select a phenomenon or construct that features prominently in your chosen developmental stage. The construct should reflect one or more of the major areas of human development (physical, cognitive, social, emotional). For instance, if you are focusing on adolescence, perhaps you select the construct of egocentrism, which includes both cognitive and social components.

Step 3: Review the section(s) of the Santrock text that are relevant to your developmental stage and construct.

Step 4: Prepare a research paper that addresses the following:

Step 4.1: Describe, in detail, the developmental stage you are focusing on for this research paper. You should briefly review the major developmental tasks of this stage as they pertain to physical, cognitive, social, and emotional development.

Step 4.2: Describe, in detail, your selected construct of interest. Be sure to define the construct and discuss its relevance during your selected stage of development. If the construct first appears earlier in development, or somehow changes with development across various stages, you will need to discuss how the construct changes over time.

Step 4.3: Pick at least one theory that helps to explain the relevance of your construct to your chosen developmental stage. Explain the theory and its application to your construct and stage.

Step 4.4: From the available 12 peer-reviewed journal articles, select and read at least 3 peer-reviewed journal articles that have some relevance to your topic and/or proposed study. Some articles may contribute information about your topic of study, or they may contribute information about research methods that could be applied to your specific topic of study. You are not required to understand or discuss the statistics involved in these articles, but you should be able to glean some information from the articles with relevance to your topic or proposed methods.

Step 4.5: Now, consider yourself a scientist. Imagine you can conduct any study you like about this construct in your chosen developmental stage. Put forth at least 1 research question, and describe the method(s) you would use to collect the data (e.g., observational, survey/interview, standardized test, case study, physiological measures). Explain what type of study design you would use (e.g., descriptive, correlational, experimental). What is your hypothesis about what the results of the study will be? Why would this study be important to conduct, and how might it contribute to new knowledge in this area of developmental science?

Step 4.6: Prepare a references page that lists each of your sources in APA style. Note that you will need to list your textbook as well as each of your 3 peer-reviewed journal articles. The References page will be the last page of your research paper.

References

(should include 3 articles and Santrock text)

Conrod, P. J., & Nikolaou, K. (2016). Annual Research Review: On the developmental neuropsychology of substance use disorders. Journal of Child Psychology and Psychiatry, 57, 371-394. https://acamh.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jcpp.12516

Dirks, M. A., De Los Reyes, A., Briggs-Gowan, M., Cella, D., & Wakschlag, L. S. (2012). Annual Research Review: Embracing not erasing contextual variability in children’s behavior – theory and utility in the selection and use of methods and informants in developmental psychopathology. Journal of Child Psychology and Psychiatry, 53, 558-574. https://psyc.umd.edu/sites/psyc.umd.edu/files/pubs/Dirks,%20De%20Los%20Reyes,%20Briggs-Gowan,%20Cella,%20&%20Wakschlag%20(2012).pdf

Glenn, C. R., Kleiman, E. M., Kellerman, J., Pollak, O., Cha, C. B., Esposito, E. C., Porter, A. C., Wyman, P. A., & Boatman, A. E. (2020). Annual Research Review: A meta-analytic review of worldwide suicide rates in adolescents. Journal of Child Psychology and Psychiatry, 61, 294-308. https://kleimanlab.org/wp-content/uploads/2019/09/Glenn_et_al-2019-Journal_of_Child_Psychology_and_Psychiatry.pdf

Koss, J. J., & Gunnar, M. R. (2018). Annual Research Review: Early adversity, the hypothalamic-pituitary-adrenocortical axis, and child psychopathology. Journal of Child Psychology and Psychiatry, 59, 327-346. https://acamh.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jcpp.12784

Lau, J. Y. F., & Waters, A. M. (2017). Annual Research Review: An expanded account of information-processing mechanisms in risk for child and adolescent anxiety and depression. Journal of Child Psychology and Psychiatry, 58, 387-407. https://acamh.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jcpp.12653

Mandy, W., & Lai, M-C. (2016). Annual Research Review: The role of the environment in the developmental psychopathology of autism spectrum condition.Journal of Child Psychology and Psychiatry, 57, 271-292. https://efisiopediatric.com/wp-content/uploads/2016/10/mandy2016.pdf

McAdams, T. A., Cheesman, R., & Ahmadzadeh, Y. I. (2023). Annual Research Review: Towards a deeper understanding of nature and nurture: combining family-based quasi-experimental methods with genomic data. Journal of Child Psychology and Psychiatry, 64, 693-707. https://acamh.onlinelibrary.wiley.com/doi/pdf/10.1111/jcpp.13720

Newlove-Delgado, T., Russell, A. E., Mathews, F., Cross, L., Bryant, E., Gudka, R., Ukoumunne, O. C., & Ford, T. J. (2023). Annual Research Review: The impact of Covid-19 on psychopathology in children and young people worldwide: Systematic review of studies with pre- and within-pandemic data. Journal of Child Psychology and Psychiatry, 64, 611-640. https://acamh.onlinelibrary.wiley.com/doi/pdf/10.1111/jcpp.13716

Odgers, C. L., & Jensen, M. R. (2020). Annual Research Review: Adolescent mental health in the digital age: facts, fears, and future directions. Journal of Child Psychology and Psychiatry, 61, 336-348. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221420/

Russell, M. A., & Gajos, J. M. (2020). Annual Research Review: Ecological momentary assessment studies in child psychology and psychiatry. Journal of Child Psychology and Psychiatry, 61, 376-394. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428969/

Santrock, J. W. (2023). Life-Span Development (19th ed.). McGraw-Hill Higher Education (US).

Thomas, M. S. C., Ansari, D., & Knowland, V. C. P. (2019). Annual Research Review: Educational neuroscience: progress and prospects.Journal of Child Psychology and Psychiatry, 57, 477-492. https://acamh.onlinelibrary.wiley.com/doi/pdf/10.1111/jcpp.12973

Williams, N. J., & Beidas, R. S. (2019). Annual Research Review: The state of implementation science in child psychology and psychiatry: a review and suggestions to advance the field. Journal of Child Psychology and Psychiatry, 60, 430-450. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389440/pdf/nihms-983463.pdf

W2 D see attachment

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Chamberlain



NR506NP-63763



Modules




Week 1

Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study

Preparing the Discussion

You are a family nurse practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back-office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice and has an excellent rapport with all of the providers. 

Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient's name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie nor do the other providers in the practice. 

Case Study Questions: 

1. What are the potential ethical and legal implications for each of the following practice members? 

· Medical assistant

· Nurse Practitioner

· Medical Director

· Practice

2. What strategies would you implement to prevent further episodes of potentially illegal behavior? 

3. What leadership qualities would you apply to effect a positive change in the practice?  Be thinking about the culture of the practice.

4. A scholarly resource must be used for EACH discussion question each week.

PN#1A

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I need a psychiatric progress note regarding a patient with PPH: of Depression, Anxiety and Insomnia . It cannot be similar, Thank you.

Here below I leave you a sample.

 Patient is a XXXX  y/o, female with Past Psychiatric History of Depression, Anxiety and Insomnia was seen today on telehealth platform for follow up and medication treatment who alleges getting better with the last treatment of trazodone 50mg at bedtime  and mirtazapine 7.5mg at bedtime, she reports decrease symptoms of sadness ,loneliness, depression , hopelessness, as well as she expresses feeling motivated, optimistic and with more energy in the morning, improve mood, self-esteem and affect because she feels useful ,decreased anxiety and stressing over her personal problems, restlessness, nervousness, as result decreased difficulty falling asleep because sleeping better and more hours at night with her previous treatment the melatonin 5mg at bedtime, also in the morning she waking up rested after a night’s sleep. Patient denies side effects of the medications, suicidal and homicidal ideation, no visual or auditory hallucinations, agitation, psychotic symptoms or paranoia .Follow up in 4 weeks.

disscusion 6psych

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 Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:

C.Z. is a 20-year-old Caucasian male who is in his second year of college. He is seeking treatment due to persistent fears that campus security and the local police are tracking and surveilling him. He cites occasional lags in his internet speed as evidence that surveillance devices are interfering with his electronics. His intense anxiety about this has begun getting in the way of his ability to complete schoolwork, and his friends are concerned – he says they have told him, “you’re not making sense.”

C.Z. occasionally laughs abruptly and inappropriately and sometimes stops speaking mid-sentence, looking off in the distance as though he sees or hears something. He expresses concern about electronics in the room (phone, computer) potentially being monitored and asks repeatedly about patient confidentiality, stating that he wants to be sure the police won’t be informed about his treatment. His beliefs are fixed, and if they are challenged, his tone becomes hostile.

Questions:

Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers. 

  1. Discuss the etiology, course, and the structural/functional abnormalities of schizophrenia. 
  2. Discuss the evidence-based pharmacological and nonpharmacological treatment for this patient using the US Clinical Guidelines.

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
  • All replies must be constructive and use literature where possible.
  • Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
  • Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
  • You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Care Setting Environmental Analysis

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Preparation

You have been asked to conduct an analysis of your care setting that will result in two potential pathways toward a strategic plan to improve health care quality and safety in your organization, department, team, community project, or other care setting. To accomplish this, you will take two approaches to the analysis:

  1. Complete the discovery and dream phases of an appreciative inquiry (AI) project.
  2. Conduct a strengths, weaknesses, opportunities and threats (SWOT) analysis.

To help ensure that your analysis is well-received, the requester has suggested that you:

  • Present your analysis results in four parts:
    • Part 1: Appreciative Inquiry Discovery and Dream.
    • Part 2: SWOT Analysis.
    • Part 3: Comparison of Approaches.
    • Part 4: Analysis of Relevant Leadership Characteristics and Skills.
  • Your analysis should be 5-8 pages in length.

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

One key aspect to being an effective leader, manager, or administrator is an awareness of your leadership strengths, weaknesses, and style.

  • How would you assess your general leadership, communication, and relationship-building skills?
  • How would describe your leadership style?

Imagine the future for a care setting that is your place of practice or one in which you would like to work.

  • What aspirational goals can you envision that would lead to improvements in health care quality and safety?
  • How well do these goals align with the mission, vision, and values of your care setting?
Part 1: Appreciative Inquiry Discovery and Dream
  • Synthesize stories and evidence about times when a care setting performed at its best with regard to quality and safety goals.
    • Collect stories from your care setting. You may collect stories through interviews or conversations with colleagues or provide your own.
    • Explain how your stories are related to quality and safety goals.
    • Describe the evidence you have that substantiates your stories.
    • Identify the positive themes reflected in your stories.
    • Describe other evidence (for example: data, awards, accreditations) that validates your care setting’s positive core.
  • Propose positive, yet attainable, quality and safety improvement goals for your care setting.
    • Explain how accomplishing these goals will lead to ethical and culturally-sensitive improvements in quality and safety.
    • Explain how your proposed goals align with your care setting’s mission, vision, and values.
Part 2: SWOT Analysis
  • Conduct a SWOT analysis of your care setting, with respect to quality and safety goals.
    • Provide a narrative description of your analysis.
    • Identify the assessment tool you used as the basis of your analysis.
    • Describe your key findings and their relationships to quality and safety goals.
  • Describe one area of concern that you identified in your SWOT analysis—relevant to your care setting’s mission, vision, and values—for which you would propose pursuing improvements.
    • Explain how this area of concern relates to your care setting’s mission, vision, and values.
    • Explain why you believe it will be necessary and valuable to pursue improvements related to this area of concern.
Part 3: Comparison of Approaches

Compare the AI and SWOT approaches to analysis and reflect on the results.

  • Describe your mindset when examining your care setting from an AI perspective and from a SWOT perspective.
  • Describe the types of data and evidence you searched for when taking an AI approach and a SWOT approach.
  • Describe the similarities and differences between the two approaches when communicating and interacting with colleagues.
Part 4: Analysis of Relevant Leadership Characteristics and Skills

Analyze the leadership characteristics and skills most desired in the person leading potential performance improvement projects, taking both an AI and SWOT approach.

  • Explain how these characteristics and skills would help a leader facilitate a successful AI-based project and a successful SWOT-based project.
  • Comment on any shared characteristics or skills you identified as helpful for both AI and SWOT approaches.