SIM410 Healthcare Policy and Regulation
Activity 1
National Health Coverage Plans, Reimbursements, and Quality
Baccalaureate education includes learning opportunities of healthcare policy, finance, and regulatory environments (AACN, 2008).
Complete the Nursing Quality Indicators (NQI) virtual simulation activity to explore the impact of nursing designs on quality measures, including cost, systems, processes, and outcomes of various points of care. The goal of this activity is to think about basic quality and safety investigations that are used to create and measures outcomes of quality improvement processes.
Please Note: You can navigate to the NQI activity by clicking on 'Sentinel Hospital', entering the lobby, and clicking the brown icon: 'Surgical Services.
Introduction & Healthcare Coverage and Vulnerable Populations
Describe the importance of healthcare coverage (insurance). End with a clearly worded purpose statement for this project. Discuss two ways healthcare coverage is beneficial (helpful) for the vulnerable/ uninsured populations.
Diagnosis Related Groups
Describe the purpose of Diagnosis Related Groups (DRGs). Explain the impact of DRGs on length of stay and payment of services. Discuss how payments for DRGs are now impacted by quality indicators and measures.
Select a Major Healthcare Plan
(Label heading with the name of the plan Ex: Preferred Provider Option Plan)
Select one of the patients from the cases you reviewed in NQI. Summarize two care options provided by the plan that facilitates access for your selected patient. Summarize two care options that limit access to care for your selected patient.
Select a Second Major Healthcare Plan
(Label heading with the name of the plan Ex: Medicaid)
Repeat this activity with the same patient. Summarize two care options provided by the second plan that facilitates access for your selected patient. Summarize two care options that limit access to care for your selected patient.
Impact of Nursing Interventions
Summarize at least four priority nursing interventions or considerations to promote self-care for your selected patient to provide high quality, safe healthcare considering nursing-sensitive indicators. Provide a rationale for each of your selected nursing decisions.
Conclusion
Summarize the key points of your project.
**You will not discuss the deductibles or costs of the insurance plans as this is not the focus of this this assignment.
Following the simulated activity, you will examine the relationship between healthcare coverage (insurance), quality care, and reimbursements (payments) to health care organizations. Select two different major national (U.S.) insurance health plans. You may choose Medicaid, Medicare, HMO, PPO, or private insurance plans. You can choose your own personal insurance plan if you prefer. Review healthcare coverage options offered by both plans that benefit (facilitate) and hinder (limit) access to care. Examples of healthcare coverage (insurance) options that facilitate, or limit access include medication coverage, primary care physician office visits, specialists physician office visits, emergency care, lab or blood work and diagnostics, wellness care, prevention services or surgery (these are just a few examples). You will also explore the role of Diagnosis Related Groups (DRGs) and charity care within healthcare facilities (hospitals) and how charity care impacts the vulnerable or uninsured population. Finally, summarize nursing interventions or considerations for your selected patient to provide high quality, safe healthcare considering nursing-sensitive indicators in his/her unique scenario.
Textbook and other resources
Centers for Medicare and Medicaid
Additional Instructions:
All submissions should have a title page and reference page.
Utilize a minimum of two scholarly resources.
Adhere to grammar, spelling and punctuation criteria.
Adhere to APA compliance guidelines.
Adhere to the chosen Submission Option for Delivery of Activity guidelines.
Submission Options
Choose One:
Instructions:
Paper
4 to 6-page paper. Include title and reference pages.
Microsoft PowerPoint Presentation
8 to 10 slides. Add title and reference slides.
Follow Rules of 7.
Other media (Prezi, etc.) presentation
8 to 10 slides with speaker notes. Add title and reference slides.
Follow Rules of 7.
Video Presentation
5 to 8-minute video presentation.
Attach reference page or include in video.
Professional appearance and background.
Video submissions must include a script in Word format, submitted through Turnitin for an Originality Report.
Table
Table with appropriate columns and headers.
Include title and reference pages.
Graphs or other illustrations
Graphs or illustrations with appropriate labels. Include title and reference pages.
Poster
Poster utilizing any applicable poster template. Include visual graphics/images/other formats for visual appeal. Include appropriate title and references on poster.
Note: Title and reference pages/slides do not count towards the count requirements.
SIM410 Healthcare Policy and Regulation
Activity 2
Global Health Goals and Health Disparities
Baccalaureate education provides learning of globalization, diversity, and sensitivity to vulnerable populations’ healthcare (AACN, 2008).
This activity is designed for you to examine global health goals and health disparities among vulnerable groups. Start by selecting one of the eight Millennium Developmental Goals (MDGs) from the World Health Organization (WHO). After choosing one of the MDGs, explore a specific outcome measurement (indicator) for a country of your choosing, from the list below, to determine the progress towards achieving the MDG. In addition, you will explore nursing roles that would be helpful in achieving the MDG.
Countries
France Italy Singapore Spain Japan Greece Iceland United Kingdom Ireland Sweden
Germany Israel Switzerland UAE China Rwanda USA Cuba Iran Iraq
Venezuela Syria Ethiopia Brazil Sudan Kenya North Korea India South Africa Saudi Arabia
Nicaragua Ecuador Australia Chad Haiti Canada South Korea Russia Central African Republic Republic of the Congo
Also, you will explore health disparities among vulnerable population groups. The term “health disparities” describes the phenomenon of different health outcomes of varied vulnerable groups of citizens. Access the Virtual Library and search in the CINAHL full text database the term “health disparity.” Choose at least two articles that describe health disparities of a particular vulnerable population or group of people (gender or sexuality identity-based groups, children, elderly, disabled, ethnic, or cultural minority).
Resources:
•From MDGs to SDGs, WHO launches new report
•Millennium Development Goals (MDG)
•World Life Expectancy
•Kaiser Family Foundation
•World Health Organization
Additional Instructions:
1.All submissions should have a title page and reference page.
2.Utilize a minimum of two scholarly resources.
3.Adhere to grammar, spelling and punctuation criteria.
4.Adhere to APA compliance guidelines.
5.Adhere to the chosen Submission Option for Delivery of Activity guidelines.
Submission Options
Choose One: Instructions:
Paper
•4 to 6-page paper. Include title and reference pages.
Microsoft PowerPoint Presentation
•8 to 10 slides. Add title and reference slides.
•Follow Rules of 7.
Other media (Prezi, etc.) presentation
•8 to 10 slides with speaker notes. Add title and reference slides.
•Follow Rules of 7.
Video Presentation
•5 to 8-minute video presentation.
•Attach reference page or include in video.
•Professional appearance and background.
•Video submissions must include a script in Word format, submitted through Turnitin for an Originality Report.
Table
•Table with appropriate columns and headers.
•Include title and reference pages.
Graphs or other illustrations
•Graphs or illustrations with appropriate labels. Include title and reference pages.
Poster
•Poster utilizing any applicable poster template. Include visual graphics/images/other formats for visual appeal. Include appropriate title and references on poster.
Note: Title and reference pages/slides do not count towards the count requirements.
SIM410 Healthcare Policy and Regulation
Activity 3
The Interrelationships of Socio-Cultural Influences in Healthcare
Within this activity, you will explore how determinants of health such as poverty, behavior, education, and income are related. One common element underlies poor health: poverty. Money is required to purchase the essentials of health such as food, clothing, shelter, clean water, education, and access to preventative health services. Each day in nursing, you are faced with persons from varying economic, social, and cultural backgrounds. In addition to varying backgrounds, you will also experience differing patient values and preferences related to their individual health and behavior. Caring for the vulnerable, at-risk, and aging populations is an essential competency for nursing. Therefore, we need to explore the interrelationships of socio-cultural influences, behavioral influences, as well as economic and non-economic barriers to healthcare to improve our knowledge. In doing so, we will be able to plan specific interventions designed to help achieve healthier outcomes. You will have the opportunity to examine poverty, behavior, and other determinants of health in Sentinel City®. As providers of care, BSN nurses need to understand how these are related and impact the health of our patients.
Activity Instructions:
Review course textbook and other resources.
Review World Health Organization (2017). The determinants of health. Retrieved from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Review Healthy People 2020 (Jan 25, 2017). Health Determinants. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health
Review Sentinel City® demographics and neighborhood demographics. Meet with Mayor Hill who can provide some information about Sentinel City® economics. Enter Sentinel City® and begin the bus tour. After touring Sentinel City, select a specific vulnerable or minority population group and identify one of the most common diseases, chronic condition, injury, or health concern that impacts your population group. Then list a total of 3 determinants of health from the Healthy People website. During your tour of the city, describe 1 observation related to the 3 selected determinants of health. (a total of 3 observations must be described). Note indicators of high or low employment. Consider education levels, number of female head of households, and median household incomes for example. Finally, describe a total of 3 strategies or evidence-based recommendations to help reduce or eliminate the selected observations noted during your Sentinel City® tour.
Additional Instructions:
All submissions should have a title page and reference page.
Utilize a minimum of two scholarly resources.
Adhere to grammar, spelling and punctuation criteria.
Adhere to APA compliance guidelines.
Adhere to the chosen Submission Option for Delivery of Activity guidelines.
Submission Options
Choose One:
Instructions:
Paper
2 to 3-page paper. Include title and reference pages.
Microsoft PowerPoint Presentation
4 to 8 slides. Add title and reference slides.
Follow Rules of 7.
Other media (Prezi, etc.) presentation
4 to 8 slides with speaker notes. Add title and reference slides.
Follow Rules of 7.
Video Presentation
5 to 6-minute video presentation.
Attach reference page or include in video.
Professional appearance and background.
Video submissions must include a script in Word format, submitted through Turnitin for an Originality Report.
Table
Table with appropriate columns and headers.
Include title and reference pages.
Graphs or other illustrations
Graphs or illustrations with appropriate labels. Include title and reference pages.
Poster
Poster utilizing any applicable poster template. Include visual graphics/images/other formats for visual appeal. Include appropriate title and references on poster.
Note: Title and reference pages/slides do not count towards the count requirements.
SIM410 Healthcare Policy and Regulation
Activity 4
Healthcare Delivery and Quality Case Study
Landmark studies To Err is Human (1999) and Crossing the Quality Chasm (2001) from the Institute of Medicine (IOM) identified medical errors are causing harm and death to almost 45,000 Americans and costing over $29 billion every year. Other studies have indicated preventable healthcare associated conditions (HACs) such as infections, sepsis, CHF, and pneumonia are main contributors for increasing the length of patient stays, the cost of care, and the likelihood of mortality (death).
Consider the below case study:
Margret Spinner-Ramirez is a 66 y/o female Hispanic-American who speaks both Spanish and English fluently. She is retired, lives alone, and has Medicaid as her primary insurance. Ms. Spinner-Ramirez was scratched by a stray cat that she feeds on her back porch daily. She has been cleaning the wound daily; however, after 2 days she went to her local ER for increased pain, redness, and swelling in her left lower leg wound where she was scratched by the stray cat. Ms. Spinner-Ramirez explained she recently had her left knee replaced about 6 months ago and verbalized new difficulty with baring weight on that extremity to the point that she was having to use her cane again. Her vital signs at the ER visit were stable. Her left leg wound was cleaned and redressed. After 5 hours in the ER, Ms. Spinner-Ramirez was discharged to home on oral Keflex for her left lower leg infection and was instructed to call her primary care physician for a follow-up appointment. Five days later Ms. Spinner-Ramirez was taken back to the same ER via ambulance. Her neighbor found her lethargic, short of breath, and was experiencing difficulty being able to move. A CT scan and blood work revealed that Ms. Spinner-Ramirez’s knee replacement in her left leg was infected secondary to the cat scratch. She was admitted as an inpatient for sepsis. She needed to have a second left knee replacement surgery with wound irrigation and debridement, which extended her inpatient stay to 3 weeks. Once she was discharged to home, she required six weeks of IV antibiotics, extensive rehab, and home health.
If you were in charge of a healthcare insurance company:
Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs, readmissions, or death (mortality) from a hospital-acquired infection or medical error. Support your why or why not?
Describe two ways (initiatives) healthcare quality can be improved to help reduce errors and improve patient safety.
Discuss how creating incentives for providers (healthcare organizations) can improve quality and reimbursements (payments) for services/care.
Resources:
Understanding Health Insurance
What's Behind the Health Insurance Rankings
Hospitals will have to Pay for their Mistakes
Medical Errors: Focusing More on What and Why, Less on Who
National Business Coalition on Health: Health Care Purchaser Toolkit
Agency for Healthcare Research and Quality
Additional Instructions:
All submissions should have a title page and reference page.
Utilize a minimum of two scholarly resources.
Adhere to grammar, spelling and punctuation criteria.
Adhere to APA compliance guidelines.
Adhere to the chosen Submission Option for Delivery of Activity guidelines.
Submission Options
Choose One:
Instructions:
Paper
2 to 3-page paper. Include title and reference pages.
Microsoft PowerPoint Presentation
4 to 8 slides. Add title and reference slides.
Follow Rules of 7.
Other media (Prezi, etc.) presentation
4 to 8 slides with speaker notes. Add title and reference slides.
Follow Rules of 7.
Video Presentation
5 to 6-minute video presentation.
Attach reference page or include in video.
Professional appearance and background.Video submissions must include a script in Word format, submitted through Turnitin for an Originality Report.
Table
Table with appropriate columns and headers.
Include title and reference pages.
Graphs or other illustrations
Graphs or illustrations with appropriate labels. Include title and reference pages.
Poster
Poster utilizing any applicable poster template. Include visual graphics/images/other formats for visual appeal. Include appropriate title and references on poster.
Note: Title and reference pages/slides do not count towards the count requirements.
SIM410 Healthcare Policy and Regulation
Activity 5
Healthcare Priority Issue
Baccalaureate education will provide learning opportunities to use safety principles, quality improvement concepts, basic quality and safety investigations, and monitoring the results and outcomes (AACN, 2008).
Transforming healthcare and improving quality are priorities for the profession of nursing. The following activity will help you explore key national priority health care areas for quality improvement as identified by the Institute of Medicine. Begin by selecting a key healthcare priority area and a population. Next, review and locate 2 article that describes a nursing intervention designed to improve a patient outcome for the chosen population selected healthcare priority issue. Finally, discuss why it is important for nursing to be involved in Quality Improvement and describe how nursing values can be used to help improve safe patient care.
Access the Priority Areas for National Action: Transforming Health Quality and read Chapter 3: Priority Areas for Quality Improvement, pages 41-45. Select ONE priority area (priority healthcare issue) and identify a patient population you would like to explore.
Additional Instructions:
All submissions should have a title page and reference page.
Utilize a minimum of two scholarly resources.
Adhere to grammar, spelling and punctuation criteria.
Adhere to APA compliance guidelines.
Adhere to the chosen Submission Option for Delivery of Activity guidelines.
Submission Options
Choose One:
Instructions:
Paper
4 to 6-page paper. Include title and reference pages.
Microsoft PowerPoint Presentation
8 to 10 slides. Add title and reference slides.
Follow Rules of 7.
Other media (Prezi, etc.) presentation
8 to 10 slides with speaker notes. Add title and reference slides.
Follow Rules of 7.
Video Presentation
5 to 6-minute video presentation.
Attach reference page or include in video.
Professional appearance and background.
Video submissions must include a script in Word format, submitted through Turnitin for an Originality Report.
Table
Table with appropriate columns and headers.
Include title and reference pages.
Graphs or other illustrations
Graphs or illustrations with appropriate labels. Include title and reference pages.
Poster
Poster utilizing any applicable poster template. Include visual graphics/images/other formats for visual appeal. Include appropriate title and references on poster.
Note: Title and reference pages/slides do not count towards the count requirements.
