Regulatory Environment
Regulatory Environment
Explain how healthcare exchanges change the concept of outpatient treatment. Many clinical information systems now embed practice guidelines and clinical pathways into their electronic medical record systems. Discuss some of the advantages and disadvantages of this. Describe demand management and how it can increase consumer involvement in care. Compare and contrast disease management and case management.
Reading and Resources
- Ferrier, G. D., & Trivitt, J. S. (2013). Incorporating quality into the measurement of hospital efficiency: A double DEA approach. Journal of Productivity Analysis, 40(3), 337-355. https://search.proquest.com/docview/1448800469?accountid=169658
- Search the site for US Department of Health and Human Services “Hospital Compare” and use the interactive database to compare and contrast health plans, hospitals, etc. How might you use this site with patients as a case manager?
- Chapter 16 pages 297-316, Chapter 23 pages 395-404, Chapter 20 pages 367-375, Chapter 26 pages 439-447 in Fundamentals of Case Management Practice.
- Review clinical guidelines of the AHRQ
- Pizzi, Michael A,PhD., O.T.R./L. (2014). Promoting health, wellness, and quality of life at the end of life: Hospice interdisciplinary perspectives on creating a good death. Journal of Allied Health, 43(4), 212-20.
- Annicka G M van der,Plas, Vissers, K. C., Francke, A. L., Donker, G. A., Jansen, W. J. J., Deliens, L., & Onwuteaka-Philipsen, B. (2015). Involvement of a case manager in palliative care reduces hospitalisations at the end of life in cancer patients; A mortality follow-back study in primary care. PLoS One, 10(7)
- Meyer, Star,R.N., B.S.N. (2012). Care management role in end-of-life discussions. Care Management Journals, 13(4), 180-3.
- Review the National Committee for Quality Assurance certification criteria.
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:
Instruction
Paper
- 4 to 6-page paper. Include title and reference pages.Collaboration for Improving Outcomes- Regulatory EnvironmentDescription: The baccalaureate graduate nurse will demonstrate basic knowledge of healthcare
policy, finance, and regulatory environments, including local, state, national, and global
healthcare trends.
Course Competency: 2) Develop a holistic case management plan for a specified disease or
population that incorporates the role of insurance, health care finance, and utilization of
community resources.
QSEN Competencies: 1) Patient-Centered Care 2) Teamwork and Collaboration 3) Evidence-
Based Practice
BSN Essential V
Area Gold
Mastery
Silver
Proficient
Bronze
Acceptable
Acceptable
Mastery not
Demonstrated
Evaluate Evaluates how
healthcare
exchanges can
change the concept
of outpatient
treatment
Discusses how
healthcare
exchanges can
change the concept
of outpatient
treatment
Lists how
healthcare
exchanges can
change the concept
of outpatient
treatment
Does not
address the
topic
Explain Explains the
advantages and
disadvantages of
embedding practice
guidelines and
clinical pathways
into electronic
medical record
systems
Discusses the
advantages and
disadvantages of
embedding
practice guidelines
and clinical
pathways into
electronic medical
record systems
Lists the advantages
and disadvantages
of embedding
practice guidelines
and clinical
pathways into
electronic medical
record systems
Does not
address the
topic
Describe Describe demand
management and
how it increases
consumer
involvement in care
Discusses demand
management and
how it increases
consumer
involvement in
care
Lists demand
management but
doesn’t discuss how
it increases
consumer
involvement in care
Does not
address the
topic
Compare
and Contrast
Compares and
contrasts disease
management and
case management
Discusses disease
management and
case management
Lists disease
management and
case management
Does not
address the
topic
APA,
Grammar,
Spelling,
and
Punctuation
No errors in APA,
Spelling, and
Punctuation.
One to three errors
in APA, Spelling,
and Punctuation.
Four to six errors in
APA, Spelling, and
Punctuation.
Seven or more
errors in APA,
Spelling, and
Punctuation.
References Provides two or
more references.
Provides two
references.
Provides one
references.
Provides no
references.
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