​Employees in the nursing profession are required to provide direct patient care while adhering to ever-evolving healthcare regulations. Nurses are designed to adjust to any situation that comes their way. Every hospital system has its own set of healthcare regulations that complement state and federal laws. Daily, registered nurses (RNs) work with patients while adhering to these established healthcare rules. They are the ideal candidates for the review of both new and old regulations since they use each policy practically. The function of APRNs and RNs in policy evaluation is discussed (Rasheedet al., 2020).

​By actively participating in healthcare entities, registered nurses and advanced practice registered nurses (APRNs) can also take part in policy evaluation. Participants of these associations are frequently exclusively committed to healthcare advocacy and laws and regulations. The three parts of advocacy include “creating regulations in cases where they are required when none are available, reforming harmful or ineffective policies, [and] ensuring good policies are implemented and enforced,” according to the APHNs as evidenced by Anders et al. (2021). When taking part in policy reviews, registered nurses and advanced practice registered nurses face difficulties, such as a lack of knowledge about the intricacies of policy formulation. When nurses or APRNs don’t believe they fully understand the policy-making process, reviewing or contesting an approved regulation can become a daunting endeavor.

​Feeling powerless to affect policy change is a second issue that nurses and APRNs have when taking part in healthcare policy reviews. An increase in the number of nurses in the spotlight of change is one of the easiest and best strategies for advocating for nurses. When it comes to media coverage, nurses are less visible as compared to physicians in both public policy and political communities. To encourage other nurses to become active participants in the change policy, it is important to create awareness that nurses play a vital role in the making of the policy. Holding seminars in each hospital is another strategy to communicate the opportunity for RNs and APRNs. The seminars provide information to nurses in line with their participation. The availability of Members from local, regional, and national nursing organizations helps nurses to be active in participation (Anders et al., 2021).

References

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. https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/jnu.12567

Anders, R. L. (2021, January). Engaging nurses in health policy in the era of COVID‐19. In Nursing forum (Vol. 56, No. 1, pp. 89-94). https://onlinelibrary.wiley.com/doi/abs/10.1111/nuf.12514

Regina Candice Shaw

Discussion 9

The program My Plate was initiated by former First Lady Michelle Obama and the U.S. Department of Agriculture to promote healthy eating habits (USDA MyPlate What Is MyPlate?, n.d.). This health policy addresses well-being and provides a customizable approach to healthy eating. “MyPlate captures the latest Dietary Guidelines for Americans in a simple way that allows you to make the most of every bite” (MyPlate.gov). The purpose of this policy is to have a visual guide of what your plate should incorporate and to help the effort to reduce the obesity rate in the USA. Unlike the food pyramid, My Plate is easy and focuses on incorporating vegetables, grains, protein, dairy, and fruit into daily diet. MyPlate is for the benefit of the American people and is based on research, not on what is financially beneficial to an influential lobbying group.

To evaluate the effectiveness of this policy, different facets can be monitored. Due to its versatility and open-mindedness, MyPlate is easily adaptable to an increasingly pluralistic society. A change in food relationships: Americans who follow the policy will be more conscious of what should be on their plate and follow the plate composition model offered by the MyPlate template. Moreover, my plate can be adjusted for cultural traditions as well as individual preferences and unique dietary needs (MyPlate.gov). Additionally, we can measure nutritional knowledge improvement before and after the implementation of the policy.

The vulgarization of knowledge will empower people to plan out the meals encompassing the nutritional value that they need to eat well and still enjoy traditional feasts with their family and friends that they have become accustomed to, given their cultural heritage and belief systems. Next, we can take a look at how accessible the policy is and the participation rate. MyPlate.gov provides everyone with numerous tools to guide food preparation, in addition to suggestions on how to maintain a healthy diet while not breaking the bank. For healthcare professionals’ food photography is made readily available for mass dissemination to promote healthy eating and inform patients on how to consume a more balanced meal. Finally, the most crucial date is to monitor the health benefits and see if there is a change in the obesity rate if more people are maintaining a healthy weight, losing weight, etcetera.

Social determinants of health that could affect consuming healthy food are income and education. Low-income families might find it hard to afford fresh produce; this is why programs like the WIC offer checks for vegetables and fruits. Next, food pantries across the states now carry fresh produce and allow people who can’t afford fresh produce to have access to it. Food pantries in Illinois have various sources and are partnered with local farms.  Next, there are also nutrition classes given at local pantries for example, in the Rockford area for example before you can shop in the food pantry, you have to attend the nutrition class (Winnebago County Food Pantries in Rockford & Machesney Park, IL, n.d.). Also, recipients of the SNAP can change the way they shop and gravitate toward more healthy choices. This why offices like the WIC, state health department, and doctor offices have brochures of MyPlate, to make sure everyone gets the knowledge, learns about the benefits, and makes smart choices. Finally, there were surveys conducted in some Midwest states to measure how teachers were familiar with My Plate, were aware of the program, and incorporated it into the curriculum the barriers encountered were cultural issues (Hastert et al., 2022). MyPlate has a sense of food portion. For example, half of a person’s plate should be fruits and vegetables.

In conclusion, MyPlate policy cares about American health and is committed to its fight to reduce the rate of obesity that leads to chronic disease. To ensure the long-term effect, we nurses have to make sure we continue to educate our patients and provide them with the knowledge that can make a positive impact on their lives.

References

Hastert, M., Chrisman, M., Endsley, P., Skarbek, A., & Marchello, N. (2022). Familiarity and Use of MyPlate: An Online Focus Group Exploration Among Midwestern K–12 Teachers. Journal of Nutrition Education & Behavior, 54(12), 1125–1131. https://doi.org/10.1016/j.jneb.2022.08.017

USDA MyPlate What Is MyPlate? (n.d.). Retrieved October 23, 2024, from https://www.myplate.gov/eat-healthy/what-is-myplate

Winnebago County Food Pantries in Rockford & Machesney Park, IL. (n.d.). My Pantry Express. Retrieved October 23, 2024, from https://www.mypantryexpress.org/locations/food-pantry-in-winnebago-county-il/

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Discussion Post: Evaluation of Federal Policy in Home Health Care

The evaluation of the Home Health Quality Reporting Program (HHQRP), a federal policy under the Centers for Medicare & Medicaid Services (CMS), provides a robust mechanism for assessing the quality of care provided by home health agencies. The HHQRP mandates that home health agencies report quality measures, and the effectiveness of the program is evaluated through metrics such as patient outcomes, hospital readmission rates, and the improvement of patients’ functional status. The overarching goal of this policy is to enhance the quality of home health care services, ensuring that patients receive appropriate and effective care in their homes (CMS, 2023).

The criteria used to measure the effectiveness of the HHQRP include clinical outcomes (such as improvement in mobility), patient safety (such as fewer instances of falls), and the reduction in avoidable hospital readmissions. Additionally, patient satisfaction surveys are utilized to assess the overall experience and care quality from the patient’s perspective. The evaluation data is publicly reported, enabling consumers to make informed choices and holding home health agencies accountable (CMS, 2023).

Social determinants of health (SDOH), including economic stability, access to quality healthcare, education, and social support, profoundly impact home health care. For instance, patients living in low-income areas may struggle to access necessary home health services due to insufficient insurance coverage or transportation challenges (Artiga & Hinton, 2018). Additionally, individuals with limited health literacy or who face language barriers may have difficulty understanding care instructions, which can hinder the effectiveness of home health interventions. Addressing these social determinants is crucial in ensuring that all individuals benefit equally from policies like HHQRP (Gundersen et al., 2018).

References

Artiga, S., & Hinton, E. (2018). Beyond health care: The role of social determinants in promoting health and health equity. Kaiser Family Foundation. https://www.kff.orgLinks to an external site.

Centers for Medicare & Medicaid Services (CMS). (2023). Home health quality reporting requirements. Centers for Medicare & Medicaid Services. https://www.cms.govLinks to an external site.

Gundersen, C., Dewey, A., Engelhard, E., & Crumbaugh, A. (2018). The impact of social determinants of health on home health care quality and outcomes. Health Affairs, 37(4), 597-606. https://doi.org/10.1377/hlthaff

Program or Policy of Interest

I chose the Improving Mental health and Wellness in schools Act of 2023 for this discussion. This bill incorporates guidelines for school wellness policies, and integrates them with the school lunch program. The United States department of agriculture (USDA) is required to work with local agencies for the promotion of mental health education and reduction of eating disorders thus leading to nutritional guidelines for schools and healthy life habits per this bill.

This new policy will require schools to work together with multi-disciplinary teams for periodic review and updating of their local wellness policies based on the recommendations of dietitians and school-based mental health providers. These evaluations will be reviewed by outside agencies to determine if these policies are effective and if any changes need to be made. The USDA will also provide assistance to ensure that these policies are followed, and improvements are beneficial to their local populations (Klobuchar, 2023).

In addition, the USDA will be responsible for promoting mental health making regular assessments establishing resilient school environments. A resilient school environment is one that is safe and supportive, promotes student well-being, and is equipped to handle crises.

Policy Evaluation & Criteria Used to Measure Effectiveness

Programs efficiency versus effectiveness is important to decide if the program worked or not (Walden, 2018). It is important to decide if a program is useful, but it can sometimes be important to determine if it is efficiently scalable. If a program works, but the costs are unfeasible, then it should be reformulated to a different population, or streamlined to make it more cost effective. This new policy will require schools to work together with multi-disciplinary teams for periodic review and updating of their local wellness policies based on the recommendations of dietitians and school-based mental health providers. These evaluations will be reviewed by outside agencies to determine if these policies are effective and if any changes need to be made. The USDA will also provide assistance to ensure that these policies are followed, and improvements are beneficial to their local populations.

In addition, the USDA will be responsible for promoting mental health making regular assessments establishing resilient school environments. A resilient school environment is one that is safe and supportive, promotes student well-being, and is equipped to handle crises.

According to the CDC, to measure the effectiveness of a school wellness policy, you assess factors like student health data (height, weight, BMI), participation rates in physical activity programs, changes in food choices made in the cafeteria, student knowledge about healthy habits gained through nutrition education, staff compliance with policy guidelines, and regular reviews of policy alignment with school practices using tools like the CDC’s “Wellness Policy in Action Tool (WPAT)” to identify areas for improvement and track progress over time (CDC.gov, 2022). These objective evaluation methods allow clear data to help make decisions rather than subjective and anecdotal evidence.

Social Determinants of Health Impact

Poverty, illiteracy, uneducated, drug and alcohol addictions, food insecurity, and many other similar factors can increase the risk of mental health issues in a community, and they disproportionately affect children. There is evidence to correlate an association between mental health problems and psychiatric disorders during youth with further development of these problems into adulthood. Identifying issues in primary settings can have lasting positive effects on the health of an individual through adulthood, and their interactions with others throughout their lives. Those in less affluent areas often have less access to mental health screening, and as a result have poor outcomes through their adulthood with relation to mental health and support services.

Resolving issues with poverty, education, illicit drugs, and alcohol abuse can result in better outcomes and improved quality of life for children (Sakellari et al, 2021). School meal programs have been proven to help children focus and thrive during their childhood years resulting in higher graduation rates, and better employment opportunities for them in the future. These better opportunities lift up not only them but their families and their neighborhoods.

References:

Adams, J., & Neville, S. (2020). Program Evaluation for Health Professionals: What It Is, What It Isn’t and How to Do It. International Journal of Qualitative Methods, 19. https://doi.org/10.1177/1609406920964345Links to an external site.

Local School Wellness Policy. (2022, 8 4). Retrieved 10 2024, from CDC Healthy Schools: https://www.cdc.gov/healthyschools/nutrition/wellness.htm

Klobuchar, A. (2023, 3 9). S.754 – Improving Mental Health and Wellness in Schools Act. Retrieved 10 2024, from Congress.gov: https://www.congress.gov/bill/118th-congress/senate-bill/754/text

Sakellari, E., Notara, V., Lagiou, A., Fatkulina, N., Ivanova, S., Korhonen, J., Kregar Velikonja, N., Lalova, V., Laaksonen, C., Petrova, G., & Lahti, M. (2021). Mental Health and Wellbeing at Schools: Health Promotion in Primary Schools with the Use of Digital Methods. Children (Basel, Switzerland), 8(5), 345. https://doi.org/10.3390/children8050345Links to an external site.

Walden University, LLC. (Producer). (2018). The Importance of Program Evaluation [Video file]. Baltimore, MD: Author.

U.S Centers for Disease Control and Prevention. (2024, 1 17). Social Determinants of Health (SDOH). Retrieved 10 2024, from About CDC: https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html

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Health care is ever changing so our job as providers to constantly evaluate and re-evaluate policies and programming is never finished. As a RN or APRN you are in a unique position to be on the front lines of policy and implementation but also have the ability to convey effectiveness of program or policy to those who are behind the dollar signs and allocation of funding. A health care program that I would like to evaluate/ reevaluate is the programming surrounding our public health and addressing the needs for food stamps. Working with very low-income individuals it is very frustrating as a health care provider to encourage a healthy diet when a single individual who make $1400 per month does not qualify for food assistance especially with inflation at the rate it is currently. Health- in- all policies (HiAP) is a systemic approach acknowledging that every policy that is passed/ considered has a health effect on the population, and these effects need to be considered prior to policy implementation and consistently re-evaluated for continued effectiveness, (Short, 2022). Consistently obtaining data, evaluating effectiveness and how to improve the process is integral in policy evaluation, (Short, 2022); and food assistance is no different.  Over 14% of the US population participate in the SNAP program, so much so that this program takes up roughly half the FDA’s budget, (Oliveira, Prell, Tiehen & Smallwood, 2018). There is concern that SNAP assistance may be too low, as the programming does not take into consideration cost of living in different geographical areas, different nutritional needs according to age, or time spent in making food, as not everyone has the same amount of time to prepare foods from scratch, (Oliveira, Prell, Tiehen & Smallwood, 2018).  Lack of adequacy in this programming directly effects our lower income families, and in turn increase health costs for the nation due to lack of preventive health in relation to basic nutrition. There needs to be an active re-evaluation timeframe allowing considerations for these inadequacies to be addressed and problem solved by policy makers.  In relation to this policy our public health nurses who work in DHHS, and the health department would be our key leaders in evaluating this information and it’s effects. There could also be data pulled from Medicaid, as many of the individuals who qualify for SNAP also qualify for Medicaid, hence making evaluation a necessity in a public program such as this.

Resources:

Oliveira, V., Prell, M., Tiehen, L. and Smallwood, D. (2018). Design Issues in USDA’s Supplemental Nutritional Assistance Program: Looking ahead by looking back. Retrieved on October 22, 2024. https://www.ers.usda.gov/webdocs/publications/86924/err-243_summary.pdf?v=0Links to an external site..

Short, N., (2022). Milstead’s Health Policy and Politics A Nurse’s Guide. Jones and Bartlett Learning. Burlington, MA.

The Comprehensive Addiction and Recovery Act (CARA) of 2016 allocates over $181 million annually to tackle the opioid crisis, aiming to improve prevention and treatment programs. CARA introduced an evidence-based program for treating opioid and heroin addiction, reinforced prescription drug monitoring systems to assist states in tracking drug misuse and aiding at-risk individuals in accessing services. It expanded prevention and educational initiatives targeted at teens, parents, caregivers, and older adults to control opioid and heroin abuse and promote recovery. CARA increased support for high school students and those in higher education and improved resources for identifying and treating incarcerated individuals with addiction issues by collaborating with the criminal justice system and providing evidence-based care. It also increased the availability of naloxone for law enforcement and first responders to reverse overdoses and save lives. Furthermore, CARA reauthorized a grant program for residential opioid treatment for pregnant and postpartum women and their children, they also established a pilot program for state substance abuse agencies to address gaps in care, including non-residential treatment services (SAMHSA, 2019).

The Comprehensive Addiction and Recovery Act (S.524) of 2016 represents a significant effort to address the opioid epidemic in the US. CARA takes a holistic approach by joining prevention, treatment, recovery support and law enforcement efforts. This strategy recognizes that addressing addiction requires more than just treatment. The act authorizes funding for prevention and treatment programs, enabling states and local communities to implement effective strategies to combat opioid abuse. One drawback to the program is that there may not be enough funding while the need for services increases. This program emphasizes evidence-based education, recognition and treatment with a targeted population such as, teens, their parents and other at-risk demographics. According to CADCA 2023, CARA authorizes a $5 million enhancement grant program in ONDCP for current and former Drug-Free Communities (DFC) grantees to apply for supplemental funds of up to $50,000 for 3 years to deal with their community’s prescription drug and/or methamphetamine epidemic in a comprehensive, community-wide fashion.

Social determinants impact the issue of opioid abuse and addiction in several ways. People facing financial hardship may experience higher stress levels, leading to substance use as a coping mechanism. Unemployment or low income can limit access to treatment and recovery resources. Education levels influence awareness and understanding of the risks associated with opioid use. Lower education can correlate with higher rates of substance misuse. Access to healthcare services, including mental health and substance use treatment, is crucial. Individuals in areas with limited healthcare access may struggle to receive the necessary care for addiction or underlying mental health issues. Living in areas with high drug availability or crime can increase exposure to opioids and contribute to higher rates of addiction. Safe, stable neighborhoods are associated with better health outcomes. Family history of substance use or dysfunctional families can influence an individual’s likelihood of developing addiction. Supportive relationships can facilitate recovery and resilience. “Despite a growing literature documenting prevention and health promotion interventions that have proven successful in well-controlled research, few of these interventions are consistently implemented in applied settings. This is true across preventive counseling services for numerous target behaviors, including tobacco use, dietary change, physical activity, and behavioral health issues such as alcohol use, depression” (Glasgow et al., 2003). As time evolves, research continues and policy changes, things are looking hopeful to decrease the risks associated with substance abuse for a better America.

References

CADCA. (2023, March 8). CARA – CADCA. Www.cadca.org. https://www.cadca.org/cara/

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

SAMHSA. (2019, May 7). Laws and regulations. Samhsa.gov. https://www.samhsa.gov/about-us/who-we-are/laws-regulations

Initial Response

As a result of The National Suicide Hotline Designation Act of 2020, 988 Suicide and Crisis Lifeline was launched in July 2022 (Baker & Sorenson, 2024). This program is free service to anyone needing emotional support (SAMHSA, n.d.).  Any individual in crisis whether due to suicidal thoughts, anxiety, depression, substance abuse or other causes can call, text, or chat anonymously to receive support.

Ensuring that the program is reducing suicide rates, providing resources, and improving crisis outcomes is essential to providing better care for the population at risk. Performance data such as answered calls, abandoned calls, speed of answer, and contact time are published monthly by the Substance Abuse and Mental Health Service Administration [SAMHSA] (2023). These sets of data help program designers and implementers to identify opportunities for improvement. Other information such as additional mental health policies, state funding efforts, follow up support, source of referral, reason for call, and user satisfaction may also be pertinent to overall program success (Saunders, 2024). Two years following the program launch, answer rates have increased and wait times decreased, displaying the fact that although there may still be room for improvement, this program is helping the national mental health crisis.

Similarly to any other healthcare issue, there are social determinants that may affect care. Economic disparities remain a major factor along with location, cultural differences, and health literacy. For example, the LGBTQ services have lower answering rates and increased wait times in relation to the main 988 line (Saunders, 2024). Additionally, efforts are being made to provide services in Spanish, but no other languages. A more diverse provision of services is being worked on, but at this time still remains a disparity for individuals with differing ethnicities and cultures. A study of Geogia’s 988 implementation showed that despite the call centers being present, insurance issues and provider availability held back the state’s progress as far as mental health and crisis support (Baker & Sorenson, 2024).

There is much more that can be done to guarantee the program’s success such as increasing sustainable funding, addressing disparities, and troubleshooting technological issues. However, the 988 Suicide & Crisis Lifeline is a step in the right direction to creating open and nonjudgemental mental health support for our nation.

References

Baker, M. & Sorenson, J. (2024). The 988 suicide hotline-Lifeline or letdown? A pre-post policy analysis. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1337362Links to an external site.

Saunders, H. (July 29, 2024). 988 Suicide & crisis lifeline: Two years after launch. KFF. Retrieved October 23, 2024 from https://www.kff.org/mental-health/issue-brief/988-suicide-crisis-lifeline-two-years-after-launch/#:~:text=Since%20launch%2C%20national%20answer%20rates,1%20minute%20and%2031%20secondsLinks to an external site..

Substance Abuse and Mental Health Service Administration [SAMHSA]. (n.d.). 988 Suicide & crisis lifeline fact sheet. Retrieved October 22, 2024 from https://www.samhsa.gov/sites/default/files/988-factsheet.pdfLinks to an external site.

Substance Abuse and Mental Health Service Administration. (2023). 988 Lifeline performance metrics. Retrieved October 23, 2024 from https://www.samhsa.gov/find-help/988/performance-metricsLinks to an external site.

Existing Healthcare Program

Chronic diseases pose a significant challenge to healthcare systems worldwide, particularly among the elderly population. The Chronic Care Management (CCM) Program, therefore, seeks to address this problem by offering organizing framework and tools for relief to the sufferers of chronic disease. The CCM program targets on the follow up of the patients, proper compliance to the doctors’ prescription and the development of individualized patient plans as a way to improve the health of the members of the program and their quality of life. However, the success of such program is dependent with the social indicators on economic power, literacy level, healthcare facility and social support. In light of this the Chronic Care Management Program is analyzed and assessed on measurable factors that indicate its efficacy as well as the influence which social determinants have on the program’s outcomes. Appreciating these factors is apparent to improving the policies in the health sector and improving the health disparities of each older adult with chronic diseases.

Evaluation Overview

The evaluation of the CCM program focuses on several key criteria:

i. Outcomes

The evaluation of the Chronic Care Management (CCM) Program primarily focuses on its outcomes, which are crucial for determining its effectiveness. Some shared objectives include decreased rates of new cases of chronic diseases and better treatment of those cases diagnosed in older patients. More specifically, it seeks to reduce cases of hospitalization and improve patient’s quality of life as well (Hamar et al., 2010). By comparing qualitative and quantitative health measures before and after implementation, evaluators are also able to observe patterns across outcomes like blood pressure, diabetes, and factors that patients regard as indicative of their quality of life. Such outcomes are not only good measures of success for the program, but also standards for innovating the process. This focus leads to the increased ability to target interventions based on the measurable health outcomes which are required for the care of elderly patients. In turn, such outcomes play a role in improving knowledge about chronic care management and its capability to result in improved health outcomes and lower costs in the future.

ii. Success Measurement

Success measurement in the CCM Program is a critical component of its evaluation process. A comparison of health statistics gathered before and after the program is a major method used to determine effectiveness. Therefore, Hospitalization rates, ER visits, medication adherence and patient reported outcomes are carefully measured to assess of the program on the health of the patients. For example, a drastic decrease in the number of admitted patients may be attributed to the stable control of chronic diseases through appropriate check-ups and follow-up treatment. Also, patients’ involvement, regarding the reaction rate and questionnaires, show the level of compliances of patients to prescribed treatment. Using these metrics will not only allow the healthcare providers to prove the value of the program but also to understand where the issue is. The use of this approach makes sure that the CCM Program serves the patient’s need appropriately and proceeds more based on the accomplishment data.

iii. Reach

The reach of the Chronic Care Management (CCM) Program is an essential criterion for evaluating its effectiveness. The program mainly focuses on elders, but for patients 65 years and above who are worst affected around the globe by chronic diseases. Outreach strategies aim at enrolling a large population of targeted participants to guarantee that persons most likely to benefit from better co-ordination of care services are enrolled. The enrollment rates are good predictors of reach; effective programs are supposed to enroll more than 70% of patients. This high level of participation is important in order to ensure the program makes the optimal impact on public health. Also, by including targeted education sessions within the community and engaging with other organizations strengthen the possibility of enrolment in the CCM by potential participants being seen as a positive endeavor. For this reason, by expanding its reach the program not only enhances specific individual’s health, but also promotes the overall health within a given community.

iv. Impact

The impact of the Chronic Care Management (CCM) Program is evaluated through various metrics that reflect changes in health outcomes among participants. This encompasses evaluation of reduced incidence of transmitted diseases and general health status of all elderly people under the program. Survey and medical records are also used by evaluators to compare pre and post program implementation for trends related to chronic disease management (Pimple, 2019). As a result of a successful CCM initiative, incidences of hospitalization and visits to emergency rooms are reduced in part owing to stronger control of chronic diseases by effective care tactics. Furthermore, patients’ QoL indicators show positive trends that prove that the developed program can enhance the quality of life and functioning in elderly patients. In this way, stakeholders are able to capture the extent of these impacts, show the contribution of CCM towards increased positive health outcomes, and equally justify further support of such programs within a system of healthcare delivery institutions.

v. Unintended Consequences

Evaluating the CCM Program also involves identifying any unintended consequences that may arise during its implementation. These may be; for example; attrition costs such as an increase in the overall expense incurred in provision of health care or different demographic distributions of access to health care services. For instance, although the program will enhance the overall health of consumers, it may result in increased charges since consumers need many treatments than estimated. Further, some people will also not be able to participate because of the current level of economic development they are at thus creating disparity. Studying these unintended effects more systematically will also help stakeholders learn how to fine-tune equity and effectiveness within the CCM framework.

Stakeholders

Stakeholders in the CCM Program are the healthcare givers, patients, and policy makers and organizations in the community. All the groups under consideration are likely to gain from the information generated from the evaluation. Evaluation findings are important to the healthcare taskers in that they can enhance the health services delivery strategies concerning the patients in questions. Promoting improved care coordination and effectiveness of the interventions that are delivered of the patients that require them. To this end, policymakers are well-placed to rely on the outcomes of the evaluation in making decisions on funding for chronic care management and policy changes. Community organizations are also important in sharing information and educating patients about services they may be eligible for. Inviting these stakeholders into the program implies the formation of a teamwork effort hence improving the degrees of impact on the health of the community.

Social Determinants Impact

i. Economic Status

Economic status is a significant social determinant impacting the effectiveness of the Chronic Care Management (CCM) Program. Patients with financial problems usually have problems getting the right healthcare services that are important for them to be active in chronic care management. They may not be able to afford certain medications for a disease, get to doctor’s appointments, or afford healthy meals; all factors that could lead to poorer health status (Pimple, 2019). Also, economic crisis leads to anxiety and worsens mental disorders, which worsen chronic diseases, anyway. Specifically for the economic challenges above, the support services under the CCM model increases their participation rates and improves their health status.

ii. Education Level

Education level plays a crucial role in shaping health literacy, which directly affects patients’ understanding of their chronic conditions and adherence to treatment plans. Differences in education give rise to differences in how different people understand and respond to medical information. As would expected, patients with higher education have better access to information, which makes them more knowledgeable about their care. On the other hand, patients with low literacy levels …may not be able to grasp complicated medical instructions given to them hence putting them in a wrong compliance to prescribed treatments. Hence the need to incorporate educational support into the CCM Program in order to enhance the health literacy and self-management among all the participants.

iii. Access to Care

Access to care is a critical factor influencing the effectiveness of the CCM Program. Accessibility to healthcare centres and efficient resource provision for control of chronic illnesses varies with geographical location of an individual (Pimple, 2019). This particularly true given that many rural areas struggle with staff shortages and qualified medical practitioners are scarce. In other cases, people in urban food desert may not have sufficient opportunity to procure foods that are healthy for the chronic diseases. Using these access concerns—like transport or telemedicine— the CCM Program should expand its impact and guarantee that patients receive proper care measurements for overall health improvement.

iv. Social Support Networks

Social support networks are vital social determinants that significantly impact health outcomes for individuals enrolled in the CCM Program. Those Patient with well-established social systems bring better health as they get more encouragement and help in managing their chronic illnesses. Family and friend support as well as organizational support can improve patient compliance with standard treatment regimens and the adoption of better health habits. On the other hand, those who is not supported often live isolated and have mental disorders which negatively impact their control over chronic illnesses. Due to an understanding of network relationships within the context of communities, the CCM Program has the potential to build and enhance such networks to support overall patient outcomes in supportive communities.

Conclusion

In conclusion, the effectiveness of the Chronic Care Management (CCM) Program is significantly influenced by various social determinants, including economic status, education level, access to care, and social support networks. These factors have to be tackled in order to increase the rate of participation on such programs and promote the health of elderly chronic illness patients. Through the use of methods that address these SDoH, clinicians can design a fair and optimal CCM approach. In the long run, it revels those causes to control, enhance the participants’ quality of life, and make the whole healthcare system stronger and more sustainable.

References

CMS. (2023). CHRONIC CARE MANAGEMENT TOOLKIT Chronic Care Management Resources for Health Care Professionals and Communities. https://www.cms.gov/files/document/chronic-care-management-toolkit.pdf

Hamar, B., Wells, A., Gandy, W., Haaf, A., Coberley, C., Pope, J. E., & Rula, E. Y. (2010). The Impact of a Proactive Chronic Care Management Program on Hospital Admission Rates in a German Health Insurance Society. Population Health Management, 13(6), 339–345. https://doi.org/10.1089/pop.2010.0032

Pimple, C. (2019). Evaluation of a Chronic Care Management Program in a Rural Primary Care Clinic. https://kuscholarworks.ku.edu/server/api/core/bitstreams/29d63bcc-3c3d-4501-8a21-cfc48290a4a8/content

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Selected Topic of Interest

In this case, the selected topic of interest is the Federal Affordable Care Act. It mainly impacts the expansion of healthcare coverage to deserving populations. The Affordable Care Act was implemented in 2010, and the purpose was to reduce the number of uninsured Americans, improve healthcare access, and control costs (Glied et al., 2020). It evaluates the effectiveness and typically involves measuring the health outcomes in preventive care, disease management, and the general population health. There is also an increase in the number of Americans with health insurance among the low-income and minority groups (Glied et al., 2020). There is also a reduction in healthcare access gaps between socioeconomic, racial, and ethnic groups.

Social Determinants of Health Impacting the ACA

The success of the ACA is mainly impacted by social determinants like income, where lower-income individuals benefit from the Medicaid expansion. However, the populations are still vulnerable in the states that did not expand Medicaid. Health literacy mainly affects the individual’s ability to effectively understand and utilize healthcare coverage (Gómez et al., 2021). Employment is another factor where employer-based insurance coverage is considered a vital source of health insurance, and those in low-paying or part-time jobs are not able to access the benefits. Disparities in health access and outcomes may persist more so for racial minorities, even though the ACA has helped to reduce the gaps (Nutbeam & Lloyd, 2021). Finally, geography is essential regarding access to healthcare providers, especially in rural areas, and how this impacts the reach and effectiveness of ACA coverage. The evaluation of the ACA needs consideration of the social determinants to be able to fully understand the reach and the limitations.

References

Glied, S. A., Collins, S. R., & Lin, S. (2020). Did The ACA Lower Americans’ Financial Barriers To Health Care? A review of evidence to determine whether the Affordable Care Act was effective in lowering cost barriers to health insurance coverage and health care. Health Affairs, 39(3), 379-386. https://doi.org/10.1377/hlthaff.2019.01448Links to an external site.

Gómez, C. A., Kleinman, D. V., Pronk, N., Gordon, G. L. W., Ochiai, E., Blakey, C., … & Brewer, K. H. (2021). Addressing health equity and social determinants of health through healthy people 2030. Journal of public health management and practice, 27(Supplement 6), S249-S257. https://journals.lww.com/jphmp/fulltext/2021/11001/addressing_health_equity_and_social_determinants.9.aspxLinks to an external site.

Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health, 42(1), 159-73. https://nursing.jhu.edu/wp-content/uploads/excellence/community/global-center/documents/research-articles/Understanding%20and%20Responding%20to%20Health%20Literacy%20as%20a%20Social%20Determinant%20of%20Health.pdfLinks to an external site.

S. 113 “Nurse Staffing Standards for Patient Safety and Quality Care Act of 2023” was introduced by Senator Brown in March of 2023. This bill, according to Congress.gov (2023), requires hospitals to submit a staffing plan to the Department of Health and Human Services (HHS) that will comply with a minimum nurse-to-patient ratio specific to each unit. This bill would also require hospitals to post the required ratios in each unit, and document whether the ratio was met and maintained during each shift. S. 1113 would also give the nurses in each unit the opportunity to object or refuse an assignment due to exceeding the required ratio or if the nurse does not feel adequately experienced to care for this patient and prohibits hospitals from taking disciplinary action on the nurse refusing the assignment assuming the refusal is done on legitimate grounds. It is proposed that HHS must work directly with Medicaid to cover any additional costs to comply with these ratios.

Evaluation is a learning process that allows someone to show documentation on progress, success, and challenges (Short, 2022). Policy evaluations can either be informal or formal, and each policy and program should be evaluated according to their setting. To properly evaluate this policy, a formal evaluation process should be conducted to standardize the evaluation process. Short (2022) mentions that formal evaluations are the appropriate next step after implementing a policy to assess the effectiveness of outcomes and goals associated with it. A national standardized model or framework is the preferred method for evaluating policies to ensure that everyone is evaluating on the same level, making it more objective than subjective.

Short (2022) describes the criteria used to measure the effectiveness of policies as the “Benefits of Policy and Program Evaluation”, and it can be broken down in five steps:

1) Assess effectiveness (short and long-term performance measures).

2) Assess achievement of goals/aims (accountability measures).

3) Assess efficiency (cost-benefit relationship).

4) Determine impact (unintended consequences).

5) Establish future improvements and goals.

This criterion gives us a framework that nurses, health care teams, economists, politicians, scientists, and administrators can use to evaluate data throughout the entirety of a program or policy development. This ensures that the policies are feasible, useful, accurate, and effective (Short, 2022). A social determinant that this policy could affect is the economic status of the nurses working in these understaffed units and the economic status of the hospitals that would need to improve their staffing ratios. Wood et al. (2024) reports that nurses experience barriers when attempting to integrate social determinants into daily work, such as time constraints and discomfort when discussing social needs. A way to overcome this barrier would be to educate nurses on social determinants and how they can affect a policy’s effectiveness. By increasing the knowledge that nurses have on the subject, this would strengthen them and give them the confidence that they need to organically address the issue while evaluating policies.

References

Congress.gov. (2023, May 16). S. 1627 – PRECEPT Nurses Act. Congress.gov. https://www.congress.gov/bill/118th-congress/senate-bill/1113/text

Short, N. M. (2019). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

Wood, E. B., Brown, A., Douglas, C. S., Lawrence, J., Wotherspoon, Z., & Gollenberg, A. (2024). Engaging Emergency Nurses in Strategies to Address the Social Determinants of

Main Post

Evaluation Topic: School-Based Mental Health Programs for Children

This evaluation centers on a state-funded initiative designed to implement school-based mental health programs aimed at enhancing the mental well-being of children in elementary and middle schools. According to Short evaluations can include assessing effectiveness, if goals were met, and assessing efficiency. This program provides access to counselors, mental health education, parent workshops, and peer support groups. Over a three-year period, the evaluation will assess the program’s effectiveness by measuring changes in student’s mental health, school attendance, and academic performance (Richter, A., et. al, March 15).

Criteria for Measuring Effectiveness:

1. Mental Health Outcomes: Employing standardized assessments like questioners evaluate changes in participant’s symptoms of anxiety, depression, and overall emotional well-being.
2. Academic Performance: Analyzing shifts in grades and standardized test scores to explore the relationship between improved mental health and academic achievement.
3. School Attendance: Monitoring attendance rates to determine whether mental health support contributes to decreased absenteeism. This is an ongoing issue in schools with mental health and ensuring the family is onboard to assist.
4. Engagement and Participation: Assessing the involvement of students and parents in mental health programs and workshops to measure community engagement.
5. Feedback and Satisfaction: Gathering qualitative data through surveys and interviews to understand satisfaction levels among students, parents, and teachers regarding the program’s effectiveness (Lyon, A. et al, 2016, January).

Impact of Social Determinants:

Social determinants of health play a crucial role in shaping children’s mental health and the effectiveness of school-based programs.

• Socioeconomic Status: Children from low-income families often experience higher stress levels due to financial challenges, which can contribute to increased mental health issues. Programs offering resources like free counseling and support services can be especially helpful for these families. These resources are also limited in rural areas who most often need them.
• Education Level of Parents: Parents with lower educational levels may lack knowledge about mental health, which can hinder their ability to support their children effectively. Initiatives designed to educate parents can improve their involvement in mental health care.
• Access to Healthcare: In areas with limited mental health services, school-based programs become vital resources. However, their effectiveness can be diminished if they are underfunded or lack qualified personnel. In my school we are in a rural area and have issues finding clinicians who are willing to drive this far to work. We have implemented telehealth a little more but it isn’t a great first option especially for kids K-3^rd

Cultural Factors: Cultural attitudes toward mental health can affect how families engage with these programs. In communities where mental health issues are stigmatized, outreach efforts need to be sensitive and tailored to encourage participation (Atashbahar, O. et al, 2022, June 8).

• Community: A safe and supportive neighborhood can enhance mental well-being, while exposure to violence, crime, or instability can worsen mental health challenges for children.

This evaluation focuses on a state-funded initiative aimed at establishing school-based mental health programs to improve the mental well-being of children in elementary and middle schools. The program offers access to counselors, mental health education, workshops for parents, and peer support groups. Over a three-year timeframe, the evaluation will measure the program’s effectiveness by tracking changes in students’ mental health outcomes, school attendance, and academic performance.

References

Atashbahar, O., Sari, A. A., Takian, A., Olyaeemanesh, A., Mohamadi, E., & Barakati, S. H. (2022, June 8). The impact of Social Determinants of health on early childhood development: A qualitative context analysis in Iran. BMC public health. https://pmc.ncbi.nlm.nih.gov/articles/PMC9178833/

Lyon, A. R., Ludwig, K., Wasse, J. K., Bergstrom, A., Hendrix, E., & McCauley, E. (2016, January). Determinants and functions of standardized assessment use among school mental health clinicians: A mixed methods evaluation. Administration and policy in mental health. https://pmc.ncbi.nlm.nih.gov/articles/PMC4500742/

Richter, A., Sjunnestrand, M., Romare Strandh, M., & Hasson, H. (2022, March 15). Implementing School-Based Mental Health Services: A scoping review of the literature summarizing the factors that affect implementation. International journal of environmental research and public health. https://pmc.ncbi.nlm.nih.gov/articles/PMC8948726/

Short, N. M. (2019). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

Discussion 6

NURS 6050

Brianna Cole

October 23, 2024

Introduction

As a nurse, advocacy is one of the best and most useful skills learned. Many policies in hospitals derive from health care personnel speaking out regarding the safety of their patients. Policies are created to guide decisions towards the favorable outcomes of specific organizations. Evaluation is the last step in the policymaking process. According to Short (2022), “evaluation provides an informed means of feedback, improvement, and justification of expending resources for all health and social programming.” Through evaluation, policies and programs can determine effectiveness and can also pinpoint whether there needs to be any changes.

H.R 7704 – Food and Nutrition Education in Schools Act of 2020

Childhood obesity is a serious problem that is increasing worldwide. H.R. 7704 was introduced to the House of Representatives with the intent to help lower childhood obesity rates by starting a food and nutrition education program in schools that most likely will fall under title one funding. This means they’re students of lower income families. According to Congress (2019), the purpose of this program is to “provide local educational agencies with human resources dedicated to implementing integrated, hands-on food and nutrition education in schools with the goal of increasing acceptance and consumption of healthy, high-quality meals and snacks by students.” Teaching students the benefits of consuming health food can help to change the trajectory of their lives.

Projected Outcomes

The goals of the Food and Nutrition Education in Schools Act of 2020 is to decrease childhood obesity rates by providing education of healthy eating, involving the students in the building and care of a community garden, taking part in preparing the meals at school, setting portion controls, and help improve and increase student performance and behavior.

Healthcare Disparities/Social Determinants of Health

This program put and emphasis on the fact that it wants to serve schools with at least 40 percent of the students on free or reduced lunch and neighborhoods with high childhood obesity rates. From research is proven that a higher rate of childhood obesity can stem from the lack of education, financial instability, neighborhood environment and access to healthcare. (National Heart, Lung, and Blood Institute, 2022) For example, living in a neighborhood without close access to grocery store, and lack of transportation leads families to turn to turn the nearest fast-food chains to feed their families.

Conclusion

            Properly educating children on healthy eating habits and involving them in process of preparing meals will help to decrease the rates of childhood obesity. Developing programs like Food and Nutrition Education in Schools Act of 2020 are useful to help reach these goals, but effectivity of the program is determined from the evaluation process.

References

Congress (2019) H.R.7704 – 116th Congress (2019-2020): Food and Nutrition Education in Schools Act of 2020. Congress.gov. https://www.congress.gov/bill/116th-congress/house-bill/7704/text?s=5&r=1&q=%7B%22search%22%3A%22childhood+obesity%22%7DLinks to an external site.

National Heart, Lung, and Blood Institute. (2022, March 24). Overweight and Obesity – Childhood Obesity | NHLBI, NIH. Www.nhlbi.nih.gov. https://www.nhlbi.nih.gov/health/overweight-and-obesity/childhood-obesityLinks to an external site.

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning

Main Discussion Post

The Fatal Overdose Reduction Act of 2024 is a bipartisan bill that would certify organizations to become a Health Engagement Hub. These hubs would provide rapid treatment for patients with substance abuse disorders without an appointment to increase treatment availability (Congress.gov, n.d.). Treatments would include prescribing buprenorphine, primary care, and other social services. This bill was introduced by Senator Maria Cantwell (D-WA) and Senator Bill Cassidy (R-LA).

This bill was evaluated at the community level in 2023 in Washington, where the pilot program was developed. The University of Washington demonstrated a 68% decrease in fatal opioid overdoses among 825 participants (Maria Cantwell, n.d.). This formal evaluation demonstrated how successful the program could be nationwide.  To evaluate this policy at the federal level would include establishing Health Engagement Hubs and determining if they are effective in decreasing fatal opioid overdoses compared to treatment received elsewhere or no treatment at all. Following the CDC Framework for program evaluation can help determine if this policy is effective. Evaluations can include assessing effectiveness, if goals were met, and assessing efficiency (Short, 2022).

Social determinants of health that lead to a higher likelihood of opioid overdose include poverty, lower levels of education, and unemployment (Grinspoon, 2021). The risk of fatal opioid overdose has been linked to homelessness (Banta-Green et al., 2024). While the Health Engagement Hubs focus on rapid medication management for opioid addiction, they also must offer social services that could help relieve some of the social determinants such as homelessness and unemployment.

Resources

Banta-Green CJ, Owens MD, Williams JR, Floyd AS, Williams-Gilbert W, & Kingston S. (2024). Community-Based Medications First for Opioid Use Disorder – Care Utilization and Mortality Outcomes. Substance Abuse and Rehabilitation, ume 15, 173–183.

Congress.gov. (n.d.-b). S.4430 – Fatal Overdose Reduction Act of 2024. https://www.congress.gov/bill/118th-congress/senate-bill/4430Links to an external site.

Grinspoon, P. (2021, September 28). Poverty, homelessness, and social stigma make addiction more deadly. Harvard Health. https://www.health.harvard.edu/blog/poverty-homelessness-and-social-stigma-make-addiction-more-deadly-202109282602

Maria Cantwell United States Senator for Washington (n.d.). Cantwell Introduces Bill to Take WA-Developed, Low-Barrier Fentanyl Treatment Pilot Program Nationwide. https://www.cantwell.senate.gov/news/press-releases/cantwell-introduces-bill-to-take-wa-developed-low-barrier-fentanyl-treatment-pilot-program-nationwideLinks to an external site.

Short, N. M. (2019). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

Part 1: The Role of the RN/APRN in Policy Evaluation

Becoming involved in policy evaluation as a registered nurse (RN) or advanced practice registered nurse (APRN) can feel overwhelming. Many nurses would feel uncomfortable initially, probably because of unfamiliarity with the policy-making process and its complexities. Many nurses’ practice focus has been direct patient care, and they may view their role as advocates for their patients in clinical settings rather than the broader political arena. However, nurses are uniquely positioned as frontline healthcare providers with valuable insights into patient needs and system inefficiencies. According to Gorsuch et al. (2020), nursing perspectives are highly necessary for shaping health policies that can genuinely reflect the needs of patient care, and, as such, nurses have to be involved in these discussions.

By nature, nurses are patient advocates in one-on-one interactions with patients or a team with physicians and healthcare leadership. This kind of advocacy needs to be extended to policy and regulatory agencies. Due to their unique position, nurses are much better able to identify gaps in healthcare delivery and recommend evidence-based solutions. For instance, during the COVID-19 pandemic, nurses were on the frontline in advocating for policy provisions that guaranteed adequate PPE and protection of the mental health of health workers (Guilamo-Ramos et al., 2021). .This, in turn, means that nurses, as they go further in active participation in policy analysis, will have more voices of patients remain central, hence a better health outcome and superior healthcare system.

It has been a natural evolution to expand this advocacy into the government and regulatory agencies. Their broad knowledge of the dynamics in patient care places them in an influential position within health policy. In working with policymakers, the nurse provides personal descriptions of specific clinical challenges and successes to be used to form more educated and useful policies. According to Rasheed et al. (2020), such nurses who participate in policy-making have done much more than represent their patients; they have contributed a great deal to the development of those policies, which may lead to system change, thereby benefiting the larger community. In that respect, acceptance of their role in policy evaluation furthers their professional practice and bolsters the voices of the patients they serve.

Part 2: Policy Evaluation

The Affordable Care Act was enacted in 2010 with the idea of greater health insurance coverage and adequate access to care for all persons in the United States. Reviews of the ACA are designed on various standings of relative success, including encouraging expansion of coverage, ensuring access to preventive services, and attainment of reductions in healthcare disparities. For instance, numerous studies have reported that the ACA has reduced the uninsured rate, especially among the population with low incomes and members of racial and ethnic minorities (Finegold et al., 2021). In this assessment, it is underlain by the social determinants of health like socioeconomic status, education, and access to healthcare resources. According to such instances, it has been one of the most typical barriers to health care use among people with lower social and economic positions, which, through the coverage expansion by Medicaid and provision of subsidies for buying insurance under the ACA, is supposed to disappear. While gains have occurred, complete disparities persist. This indicates that ongoing monitoring and focused interventions will be required to address an array of social determinants at the root of such differences.

References

Finegold, K., Conmy, A., Chu, R. C., Bosworth, A., & Sommers, B. D. (2021). Trends in the US uninsured population. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation.

Gorsuch, C. R. P. F., Gallagher Ford, L., Koshy Thomas, B., Melnyk, B. M., & Connor, L. (2020). Impact of a formal educational skill‐building program based on the ARCC model to enhance evidence‐based practice competency in nurse teams. Worldviews on Evidence‐Based Nursing, 17(4), 258-268..

Guilamo-Ramos, V., Thimm-Kaiser, M., Benzekri, A., Hidalgo, A., Lanier, Y., Tlou, S., … & Hagan, H. (2021). Nurses at the frontline of public health emergency preparedness and response: lessons learned from the HIV/AIDS pandemic and emerging infectious disease outbreaks. The Lancet Infectious Diseases, 21(10), e326-e333.

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.

S.324 – STOP Neglected Diseases of Poverty Act

The STOP Neglected Diseases of Poverty Act was initially introduced to Congress in 2019 with an aim to study, treat, observe, and prevent diseases that disproportionately affect people living in poverty.  These diseases are less known and are spread through soil, water, and food in areas with substandard living conditions.  Many of the diseases are considered NTDs, or neglected tropical diseases, diseases understudied and typically found in “third world” countries.  However, the Gulf Coast states of the US – that is, Louisiana, Mississippi, Florida, Texas, and Alabama – have been impacted by several of the diseases on the neglected diseases list, including Chagas, trichomoniasis, Dengue fever, and typhus, to name a few.  They are considered diseases of poverty because they are more rapidly transmitted in impoverished areas due to substandard conditions and become precursors for chronic illnesses due to a lack of accessible treatment modalities and financial barriers to receiving treatment (Hotez & Booker, 2020).

The goal of this act is to allot more funds to create a taskforce including members from various agencies including EPA, NIH, USDA, FDA, and HHS to research into these diseases, create preventative vaccines, tools and parameters for diagnosing NTDs, establish accessible care centers to treat these diseases, and to provide education to healthcare workers and the public (Congress.gov, 2023).

Variations of this act have been introduced in Congress since 2017.  This bill, however, has not been enacted into law as of 2024, despite endorsements from various national and global organizations (U.S. Senator Cory Booker, 2019).  It was reintroduced in 118^th congress on February 9, 2023 and was referred to the committee of Health, Education, Labor, and Pensions (Congress.gov, 2023).

An evaluation of the effectiveness of this act, once implemented, would include the following:

• Findings of the research conducted with respect to:
  • Occurrence, Mortality, Morbidity of NTDs
  • Risk factors of NTDs
  • Established centers of excellence for treatment and research of NTDs
  • Economic burden of NTDs
  • Comorbidities associated with NTDs
• Barriers to research, establishment of preventative care and treatment (Congress.gov, 2023)

This is a public health issue impacting people of low socioeconomic status in rural areas or areas with lack of access to quality healthcare.  Additionally, limited research has been done on these diseases that were thought to be eradicated within the United States.  Thus, more research must be conducted to decipher the actual occurrence of these diseases within the U.S.  This will require mandatory reporting for the extensive list of neglected tropical diseases.  Our unhoused community is most impacted by this, followed by people living in substandard conditions without regular access to clean water and shelter.  In the southern US particularly, people are at a higher risk due to climate.  The inequities related to the prevalence and transmission of these diseases underline a problem descending from colonialism – black and brown people are most impacted, yet research and assistance are minute, if present at all (Hotez & Booker, 2020).  We must rectify this to move toward a healthier and more equitable nation.

References

Congress.gov. (2023, February 9). S.324 – 118th Congress (2023-2024): STOP Neglected Diseases of Poverty Act. https://www.congress.gov/bill/118th-congress/senate-bill/324Links to an external site.

Hotez, P. J., & Booker, C. (2020). STOP: Study, Treat, Observe, and Prevent Neglected Diseases of Poverty Act. PLoS neglected tropical diseases, 14(2), e0008064. https://doi.org/10.1371/journal.pntd.0008064Links to an external site.

Short, N. M. (2019). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

U.S. Senator Cory Booker. (2019, October 23). Booker Introduces Legislation to Help Eliminate Neglected Diseases of Poverty in United States. Retrieved October 22, 2024, from https://www.booker.senate.gov/news/press/booker-introduces-legislation-to-help-eliminate-neglected-diseases-of-poverty-in-united-states.

Hi Colleagues,

My evaluation topic is H.R. 590 – Ensuring Kids Have Access to Medically Necessary Dental Care Act. This bill adjusts dental coverage under the Children’s Health Insurance Program (CHIP). CHIP provides low-cost health benefits to children in families that earn too much money to qualify for Medicaid (HealthCare, n.d.). The Ensuring Kids Access to Medically Necessary Dental Care Act eliminates lifetime or annual limits for dental care for children under CHIP.  It also requires states to offer dental-only extra coverage under CHIP to children who have other health insurance but are eligible for wraparound coverage. There are 9.7 million eligible children enrolled in this insurance program through both Medicaid and separate coverage (Medicaid, 2024).  Good oral health is necessary for overall health, especially in children. Access to dental care is important because it can help prevent and treat oral disease which can have serious results for a child’s overall health and well-being. Poor oral health can lead to painful and costly health conditions.

The criteria to measure the effectiveness of community, state, and federal policies for this act is through the National Quality Forum (NQF) that endorses two performance measures involving percentage of children enrolled in Medicare with an annual dental visit and the percentage of children with a preventive care visit within the past 12 months, Child Core Set which includes a range of children’s quality measures of inclusive oral health initiatives that will increase the proportion of low-income children who receive any protection dental services within a year, access to pediatric dental care by estimating demand using an access model and evidenced-based strategies by engaging community stakeholders in intervention activists, and collecting and reporting economics and cost-effectiveness data (Griffin, et al., 2014).

About 1 in 10 people in the United States lack health insurance. Without coverage, children are more likely not to go to essential care appointments and receive dental attention (Nemours Health Care, 2024).  Social determinants conditions can influence children’s access to dental treatment in various ways like children from lower socioeconomic environment that have higher rates of tooth decay, deficiency of access to care due to dental insurance, absence of transportation or available providers, monetary restrictions which leads to poor nutritions and unhealthy dietary habits which causes oral health issues, lack of dental professionals with extensive training to treat complex circumstances, and accessibility of dental providers willing to accept Medicaid insurance.

Reference

HealthCare. (n.d.). Healthcare.gov. The Children’s Health Insurance Program (CHIP). Retrieved from https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/Links to an external site. 

Medicaid, 2024. Medicaid.gov. Children’s Health Insurance Program (CHIP). Retrieved from https://www.medicaid.gov/chip/index.html#:~:text=9.6%20Million%20Children%20Enrolled%20*&text=The%20Children’s%20Health%20Insurance%20Program,states%20and%20the%20federal%20governmentLinks to an external site. 

Griffin, et al. September 12, 2014. CDC. Use of Dental Care and Effective Preventive Services in Preventing Tooth Decay Among U.S. Children and Adolescents — Medical Expenditure Panel Survey, United States, 2003–2009 and National Health and Nutrition Examination Survey, United States, 2005–2010. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/su6302a9.htm#:~:text=The%20National%20Quality%20Forum%20(NQF,%231334)%20(20)Links to an external site..

Nemours Children’s Health, 2024. Nemours Children’s Health. Understanding Social Determinants of Health. Retrieved from https://www.nemours.org/well-beyond-medicine/understanding-social-determinants-of-health.html#:~:text=Many%20SDOH%20factors%20affect%20how,care%20or%20get%20needed%20medicationsLinks to an external site..

    The evaluation of Medicaid expansion under the ACA focuses on how extending Medicaid eligibility to more low-income individuals has affected access to healthcare, health outcomes, and financial stability in various states. The evaluation utilizes criteria such as enrollment numbers, healthcare utilization rates, hospitalization rates for preventable conditions, and changes in uninsured rates. This program was designed to reduce the number of uninsured individuals and improve access to necessary healthcare services.

Criteria for Effectiveness:

1. Enrollment and Coverage Rates: A primary metric is the number of individuals enrolled in Medicaid post-expansion compared to pre-expansion figures.
2. Healthcare Utilization: Evaluating changes in the frequency of preventive services, routine check-ups, and emergency room visits.
3. Health Outcomes: Measuring shifts in rates of chronic disease management, hospitalization for avoidable conditions, and overall mortality rates.
4. Economic Impact: Assessing changes in financial strain for low-income families, including reductions in medical debt and bankruptcies related to healthcare costs.

Social determinants of health significantly influence the effectiveness of Medicaid expansion. Factors such as socioeconomic status, education, employment, and access to transportation play critical roles in determining how individuals utilize healthcare services. For instance, individuals living in areas with high unemployment may face barriers to accessing care, despite having Medicaid coverage. Additionally, educational disparities can affect health literacy, impacting individuals’ understanding of their benefits and available services.

A study by Kenney et al. (2017) found that states expanding Medicaid saw substantial reductions in uninsured rates, particularly among vulnerable populations. However, barriers such as transportation and knowledge about available services continued to impede access for some groups. This highlights the need for integrated approaches that address not just healthcare access but also the underlying social determinants affecting health outcomes.

References

Kenney, G. M., et al. (2017). “The Effect of Medicaid Expansion on Insurance Coverage and Access to Care.” Health Affairs, 36(1), 30-38.

Artiga, S., & Hinton, E. (2018). “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity.” Kaiser Family Foundation.

Main Post

                                                         The Role of the RN/APRN in Policy Evaluation

Introduction

The field of health care is always changing, and regulations significantly influence the provision and effectiveness of medical services. Professional nurses, encompassing Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs), are particularly distinctly qualified to apply their experience in the policy assessment procedure. Nurses, as proponents of patient-focused care and primary caregivers, hold important perspectives into the practical ramifications of health care regulations. This paper or discussion will examine the roles of RNs and APRNs in policy appraisal and underscore the importance of their participation in the formulation of effective healthcare policies.

Policy Evaluation

Policy evaluation entails the systematic assessment of current healthcare initiatives or regulations in order to ascertain their influence, success, and affordability. Nurses typically concentrate on patient care, although their participation in policy review is essential due to their profound understanding of the provision of healthcare and patient requirements (Milstead & Short, 2019). Nurses, as the predominant segment of the healthcare workforce, can offer practical insights on the implementation of policies.

Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) engage in many functions related to policy assessment while also participating in direct treatment of patients, which enables them to gather vital information concerning health results, the experiences of patients, and utilization of resources. This data is crucial for evaluating the efficacy of healthcare initiatives. Nurses, as patient representatives, can offer significant insights into the effects of particular regulations on patient care, service accessibility, and health benefits. Their contributions are essential for recognizing policy deficiencies and possible enhancements. Nurses are progressively involved in research, aiding in the evidence that shapes policy selections (Chilton, 2015). Their research can yield crucial knowledge on the effects of particular policies on the patient experience and healthcare systems. They engage with healthcare professionals, politicians, and other important participants to guarantee that policy appraisals successfully meet the requirements of the community residents and patients. Additionally, RNs and APRNs champion health equity and highlight inequities in healthcare access and outcomes, aiding legislators in contemplating the wider societal ramifications of policies.

We can assess a state-level initiative aimed at enhancing mother and child health performance by choosing any current health care system or legislation for review. An example is the “Mother’s and Child Health (MCH) Plan” in California, United States (Naylor & Kurtzman, 2010). The assessment evaluates the efficacy of many treatments, including prenatal treatment services, postnatal aid programs, and childhood vaccination projects, in enhancing mother and child health metrics.

In this assessment, societal determinants of health profoundly influence the health of mothers and their children. Earnings and economic standing might influence one’s ability to obtain healthcare during pregnancy and other vital necessities. Insufficient schooling and medical literacy may also impede one’s decision-making over their children’s health. Moreover, unreliable housing and hazardous conditions might result in detrimental health effects for women and children (Oden et al., 2010). The policy examination must encompass a thorough review of the program’s effects on marginalized communities to tackle these socioeconomic factors. Assessors must assess the project’s efficacy in reaching underserved populations and its approach to addressing the distinct issues encountered by underrepresented groups. Furthermore, input from nurses actively engaged with these demographics can provide vital perspectives into the program’s efficacy and possible areas for enhancement.

Conclusion

In summary, the involvement of RNs and APRNs in policy review is essential for formulating effective, focused patient health care policies. Their experience, data gathering proficiency, advocacy, and dedication to evidence-based practice render them essential participants in the assessment process. Incorporating nurses in assessment processes enables healthcare systems to tackle socioeconomic factors and formulate more inclusive and effective policies that enhance health outcomes for all persons and communities.

References

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones & Bartlett Learning. Chapter 7, “Health Policy and Social Program Evaluation” (pp. 116–124).

Chilton, L. (2015). Nurse practitioners have an essential role in health policy. The Journal for Nurse Practitioners, 11(2), A19.

Oden, L. S., Price, J. H., Alteneder, R., Boardley, D., & Ubokudom, S. E. (2010). Public policy involvement by nurse practitioners. Journal of Community Health, pp. 25, 139–155.

Naylor, M. D., & Kurtzman, E. T. (2010). The role of nurse practitioners in reinventing primary care. Health Affairs, 29(5), 893-899.

Main Post

The Importance of Nurses in Evaluating Policies and the Medicaid Expansion under the Affordable Care Act (ACA)

One important healthcare policy that the Affordable Care Act (ACA) implemented was the expansion of Medicaid to include more low-income people. To guarantee that expanding Medicaid really improves healthcare access and outcomes, it is crucial to assess its effects. Because of their extensive knowledge of healthcare delivery and hands-on experience caring for patients, nurses, especially RNs and APRNs, are invaluable assets when it comes to evaluating policies.

Assessment of the Medicaid Expansion
Individuals with incomes below 138% of the federal poverty threshold were expanded to be eligible for Medicaid as part of the ACA’s Medicaid expansion, which aimed to reduce the uninsured rate. Patient health outcomes, healthcare utilization, and financial consequences on healthcare systems are some of the factors that will be used to evaluate this strategy. As a result of their training and experience, nurses are in a prime position to see firsthand how expanding access to healthcare improves patients’ health and well-being.

Policy Evaluation Standards for Health Outcomes for Patients: Improvements in patient outcomes, including the management of chronic diseases and the reduction of avoidable hospitalizations and mortality rates, are key indicators of the success of Medicaid expansion. By coordinating treatment and managing chronic diseases, nurses can help determine if Medicaid expansion has improved health outcomes, particularly for at-risk groups (Foutz et al., 2020).

Evaluation Criteria Number Two: Healthcare Utilization This evaluation metric includes primary care visits, preventative services, and visits to the emergency department. It is essential for nurses to monitor changes in healthcare utilization since they frequently serve as gatekeepers to these services. Additionally, nurses play an active role in patient education, which can potentially affect patients’ care utilization patterns and frequency of visits (Baicker et al., 2021).

Health Inequalities: Expanding Medicaid has lessened racial and ethnic inequities in access to healthcare. Griffith et al. (2020) note that nurses caring for diverse groups might monitor changes in marginalized populations’ access to care and outcomes as a means of evaluating the efficacy of Medicaid expansion in treating these disparities.

Economic Implications: It is critical to assess the long-term fiscal viability of expanding Medicaid. In order to evaluate the policy’s cost-effectiveness, nurses in management positions or employed by managed care companies might look at the decrease in uncompensated care and the savings from better preventative care (Buchmueller et al., 2021).

When it comes to the effectiveness of Medicaid expansion, social determinants of health (SDOH), such as income, education, housing, and healthcare access, are crucial. By gauging patients’ access to essential services and resources, nurses, especially those in community health, can ascertain how effectively Medicaid expansion tackles these factors (Artiga & Hinton, 2020).

Evaluating Policies: The Role of Nurses
A nurse’s unique perspective on patient care and health outcomes makes them an ideal candidate to assess healthcare legislation such as Medicaid expansion. To the extent policies are enhancing access to care and decreasing health inequities, for example, they might offer insightful criticism. Nurses ‘ participation in the policy evaluation process is highly valued due to their ability to advocate for patients and estimate their requirements. Nurses may help make sure healthcare policies are fair and work for the people they serve by taking part in policy evaluations.

Expanding Medicaid has meant better healthcare access and fewer health disparities for low-income people. The efficacy of this approach, however, can only be determined with the help of several healthcare experts, especially nurses. Healthcare administrators and patients alike can benefit greatly from the knowledge and experience that nurses bring to bear on the effects of Medicaid expansion on healthcare delivery and reform.

References

Artiga, S., & Hinton, E. (2020). Beyond health care: The role of social determinants in promoting health and health equity. Kaiser Family Foundation. https://www.kff.org/report-section/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity-issue-brief/

Baicker, K., Taubman, S. L., & Finkelstein, A. (2021). The effect of Medicaid on labor market activity and program participation: Evidence from the Oregon Health Insurance Experiment. American Economic Journal: Economic Policy, 13(3), 1-26. https://doi.org/10.1257/pol.20160400

Buchmueller, T., Levy, H. G., & Valletta, R. G. (2021). Medicaid expansion and the labor market: Evidence from the Affordable Care Act. Journal of Policy Analysis and Management, 40(4), 1027-1051. https://doi.org/10.1002/pam.22245

Foutz, J., Artiga, S., & Garfield, R. (2020). The role of Medicaid in rural America. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america/

Griffith, K., Evans, L., & Bor, J. (2020). The Affordable Care Act reduced socioeconomic disparities in health care access. Health Affairs, 36(8), 1503-1510. https://doi.org/10.1377/hlthaff.2017.0323

Assessing the success of the Medicare Opioid Misuse Strategy (MOMS) demonstrates a simple manner in which healthcare polices can affect the most fragile populations. At the federal level, the program known as MOMS is designed to increase access to treatment and to improve education and safer prescribing for Medicare beneficiaries with regards to opioids. The three main parameters that are followed for the evaluation of this policy relate to the decrease in the rate of opioid prescription, the number of beneficiaries receiving treatment for OUD, and the overall number of opioid related hospitalization.

Certainly, one of the most important indicators to investigate when reviewing the efficacy of the MOMS program is the extent to which social determinants of health apply. High rate of economic fluctuations, poor and restricted health care access, and poor education are conditions that have been associated with higher opiate use among the Medicare patients. For this reason, many of the target population in this category resides in rural settings that may not have adequate access to healthcare services and related services such as therapy, which may highly influence their interaction with the program interventions. Also, economic challenges including; expensive treatment and lack of insurance cover for other related treatment further complicate the problem for those with opioid dependency (Tofighi et al., 2019).

In addition, it was evident that the effectiveness of the program in decreasing opioid prescriptions is greatly influenced by provider-perceived beliefs and behaviour. Based on the program guidelines, some of the providers may be reluctant to embrace the program with their full potential including patient satisfaction and perceived inadequate pain management. However, one of the essential pieces of the policy and whose implementation aims at overcoming the challenges include the ongoing provider education that constantly remind the practitioners of the need to balance pain with risk of addiction. The program also focuses on incorporating mental health into the treatment process because many individuals with opioid use disorder also have a mental disorder.

The success of the MOMS program depends on the extent to which it is successful in identifying and engaging hard-to-reach populations prone to opioid use and on the consideration of the multifaceted nature of opioid use (Kim et al., 2020). In other words, the program directed at increasing access to treatment, increasing awareness of education, and reducing opioid prescribing practices should eliminate the epidemic among the Medicare population. However, the consistent social factors that affect the health of people including poverty and geographical isolation cannot be eliminated and therefore always form part of barriers to the program with subsequent evaluation.

References

Haegerich, T. M., Jones, C. M., Cote, P.-O., Robinson, A., & Ross, L. (2019). Evidence for state, community and systems-level prevention strategies to address the opioid crisis. Drug and Alcohol Dependence, 204, 107563. https://doi.org/10.1016/j.drugalcdep.2019.107563Links to an external site.

Kim, J., Clary, E., Ribar, C., Palmer, S., & Weigensberg, E. (2020). Strategies for Rural Communities for Addressing Substance Misuse among Families Involved with the Child Welfare System. https://aspe.hhs.gov/sites/default/files/migrated_legacy_files/195326/SAFE-CORE_Strategies_Brief.pdfLinks to an external site.

Tofighi, B., Williams, A. R., Chemi, C., Suhail-Sindhu, S., Dickson, V., & Lee, J. D. (2019). Patient Barriers and Facilitators to Medications for Opioid Use Disorder in Primary Care. Substance Use & Misuse, 54(14), 2409–2419. https://doi.org/10.1080/10826084.2019.1653324Links to an external site.