The accountable care organization (ACO) will need to measure progress toward optimized population health. The measures for the ACO would include:
A benchmarks that provide frames of reference against which an organization can compare itself relative to others.
B population health measures on clinical process and outcome indicators, patient satisfaction, functional status, quality of life, economic and utilization indicators, and changes in health disparities.
C structured care methodologies, such as critical pathways or streamlined interdisciplinary tools, identification of best practices, facilitated standardization of care, quality enhancement, and outcomes measurement.
D variances identifying positive and negative differences between what was expected from a standard and what actually occurred with client- and family-related, systems-related, or provider-related factors.
The correct answer is ACOs will need population health measures on clinical process and outcome indicators, patient satisfaction, functional status, quality of life, economic and utilization indicators, and changes in health disparities. The first answer is incorrect because benchmarking—which is established by professional societies, health systems, national databases, or texts and manuals—is a useful strategy to understand internal processes and performance levels and can be used for evaluating evidence-based practices to construct better critical pathways and to have a frame of reference to compare itself relative to others. The third answer is incorrect, because the standardized care methods focus on patients within settings and not across settings that work together. The fourth answer is incorrect, because standards and processes would need to exist to document, collect, analyze, and determine differences for all of the client, family, systems, and provider factors.
A model of population care management would include:
A population needs assessment, identification of health services, targeted health planning, wellness and prevention, care management, and case management.
B population needs assessment, prioritization of needs, community wellness resources, provider prevention services, and health education services.
C population needs surveys, community funding, emergency medical services, medical home clinic services, school health programs, and occupational health for workers.
D population needs surveys, community engagement, community planning, emergency medical services, medical home clinic services, school health programs, and occupational health education services.
Public health guides the health care organization to coordinate and integrate services across the continuum from hospital to community to reduce costs and eliminate redundancy of services. The continuum includes health promotion/illness prevention, public health, primary care, diagnostics/drugs, ambulatory care, acute inpatient, rehabilitative/chronic, long-term care, home services, and palliative care segments. The first answer was an older model used to manage clients that needed services in order to even leave the institution and relied on social services, rehabilitation, and public health to address coordination of care for the ill and the poor to manage catastrophic injury or illness. The second answer was traditional public health nursing after hospitalization. It addressed the coordination of client-centered care within the community setting and was also part of the visiting nurses association model for care outside of the hospital setting. The third answer was a tertiary care model that addressed the treatment of acute, episodic health care conditions to eliminate the costs of hospitalizations and was less concerned with the situation for care at home.
The correct answer is open systems theory, where the leaders emphasize the dynamic interaction and interdependence of the organization, and key individuals, nursing staff, and support staff provide input based on their role, expertise, and experience. The best information is then used to select and implement the EHR system in the organization. The scientific management school is incorrect because the nurse's role is to learn the EHR system and adapt and implement it to work in settings or units where it was not intended, thus creating gaps in functions for different services, such as obstetrics, oncology, or home care services. The classic management theory is incorrect because nurses are expected to learn the system and implement it without providing input into selection, build of content, or implementation process. The bureaucratic theory is incorrect because the mass production and technical efficiency in implementing the EHR would have decisions made by top-level executives and pushed down based on both technical and staffing issues. The nurse's role is to implement the system and design workarounds for any missing technical functions, information, or knowledge context in the design, thus using paper documents to fulfill missing functions.