$ 2 ½ trillion 17 100,000/25,000/10,000



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  • The Future of Nursing: IOM’s Call to Action
  • Catherine Dower
  • San Diego, CA January 12, 2011
  • $ 2 ½ trillion
  • 17%
  • 100,000/25,000/10,000
  • 4th-8th
  • #1 37/190 19/19
  • 2700
  • 30+ million
  • 11+ million

Explore with me how APRN Consensus Model may fit in context of . . .

  • IOM Report
  • Inbox
  • PPACA
  • IOM Report
  • Key Messages
  • Nurses should practice to the full extent of their education and training.
  • Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
  • Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.
  • Effective workforce planning and policy making require better data collection and an improved information infrastructure.

Key Message #1. Nurses should practice to the full extent of their education and training.

    • The variability of scope-of-practice regulations across states may hinder advanced practice nurses from giving care they were trained to provide and contributing to innovative health care delivery solutions.
    • Although some states have regulations that allow nurse practitioners to see patients and prescribe medications without a physician’s supervision, a majority of states do not.
    • The federal government is well suited to promote reform of states’ scope-of-practice laws by sharing and providing incentives for the adoption of best practices.
  • Scope of practice laws are state-based and politically driven…
  • … resulting in state variability and unnecessary limitations on practice.
  • NOTE: Collaboration refers to a mutually agreed upon relationship between nurse and physician.
  • SOURCE: AARP, 2010b. Courtesy of AARP. All rights reserved.
  • Requirements for physiciannurse collaboration, 2010
  • Exclusive scopes of practice exacerbate interprofessional tensions.
  • Several states have new ways to help decide scope issues.
  • California uses a waiver process to test new scopes of practice
  • Expert opinion, opinion pieces, anecdotes
  • Meta-analyses
  • Controlled trials
  • Educational curricula, accreditation standards
  • State laws & regulations
  • Demonstrations
  • Research studies
  • Survey articles, state studies
  • Degree of filtering
  • © 2008 UCSF Center for the Health Professions
  • Evidence pyramid gives guidance.
  • Advanced practice registered nurses should be able to practice to the full extent of their education and training. To achieve this goal, the committee recommends actions for the following entities:
    • State Legislatures
    • Congress
    • Centers for Medicare and Medicaid Services
    • Office of Personnel Management
    • Federal Trade Commission and Antitrust Division of the Department of Justice
  • www.cacenter.org
  • Patient Protection and Affordable Care Act
  • Five ACA categories relate to our work
  • Coverage
  • Workforce
  • Innovations in Care Delivery
  • Financing
  • Expand Coverage
  • Financing: Provider payment policies
  • A September 2010 Google search for “Accountable Care Organizations” brings up 346,000 results
  • Tying payment to quality
  • Innovative Practice Models
  • New models will push providers and consumers to rethink how and where care is delivered.
  • New models will encourage shift from acute and specialty care to…

New models will push for expanded scopes of practice

  • Inbox
  • Costs
  • US % Bankruptcies due to Medical Bills
  • Demographic shifts
  • Technology
  • Consumers
  • Market
  • Baicker & Chandra, Health Affairs 2004
  • Three Take-Away Themes
  • INTEGRATION
  • ACCOUNTABILITY
  • CREATIVITY

Understanding how the APRN Consensus Model fits into current health care context provides tremendous opportunity.

  • IOM Report
  • PPACA
  • Inbox
  • Catherine Dower
  • UCSF Center for the Health Professions
  • http://futurehealth.ucsf.edu
  • (415) 476-1894
  • cdower@thecenter.ucsf.edu


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