Proposing Evidence-Based Change in Regional Health Care System

Proposing Evidence-Based Change in Regional Health Care System

Executive Summary

The U.S. healthcare delivery system is a massive and complex array of institutions, including thousands of hospitals, nursing homes, mental health facilities, and home health agencies and hospices. The U.S. healthcare delivery system aims to deliver high-quality healthcare services to all Americans and ensure optimal national health.     

Proposed Change

Although the United States employs much more resources and funding on health care than any other developed country, the higher spending on health care does not translate to any health advantage. Many people do not have easy and affordable access to medical care as they are medically underinsured. Even insured Americans report problems getting quality medical care. Only 70 percent of U.S. adults feel confident about getting the most effective treatments if seriously ill (NCBI Bookshelf, 2013). Deficiencies in public health systems can impact healthcare quality, especially in rural and disadvantaged urban communities. There are notable differences in healthcare access in rural and urban areas in the United States due to lower physician density and financial constraints.

The State Office of Rural Health (SORH) Programs serve as a focal point within each state and support workforce recruitment, collect data and resources, and keep the locals aware of healthcare initiatives (HRSA, 2020). SORH aims to network with providers and partners to improve healthcare access in rural areas. About 95 rural hospitals closed in the U.S. between 2010 and 2019, 32 of which were critical care hospitals (HRSA, 2020). These events have received increased attention from the media and policymakers.

 Proposed Change for Rural Health in the United States

The analysis of rural health policies and services under the broader health system reveals the pressures for cost control and higher efficiency under the availability of fewer resources. The rural public health infrastructure has not been given the desired attention, and pastoral medical care does not offer the full range of therapies (Ricketts, 2000). The healthcare conditions of rural areas can be supported with telemedicine, which can help curb the shortages of physicians, improve the range of therapies, and lower the financial stress experienced in rural areas.

Desired Outcomes

Telemedicine is the most important way to balance the health disparities between rural and urban areas. Telecommunications with interactive videos and real-time data transmission via the Internet or by telephone can link rural hospitals and patients with modern medical science. Telemedicine can encourage remote patient monitoring, mob, ill health communication, and transmission of medical information. The aim is to offer efficient and cost-effective quality care to rural areas.

Desirable outcomes are the long and short-term objectives associated with a patient and the medical health care system. For a patient, desirable outcomes include reduced frequency of in-person hospital visits, reduced time of stay, timely treatment for fatal diseases such as heart attack, and early intervention through symptoms (Totten et al., 2019). Hospitals’ desired outcomes include preventing congestion in hospitals, reducing mortality of patients, and flexibility in working (Totten et al., 2019). Regarding payment, studies described a one-time investment is required for the hospital and patients in terms of infrastructure, which is necessary to set up the meeting between the physicians and the patients (Snoswell et al., 2020). The government must bear the initial cost of including telehealth in the public health infrastructure (Snoswell et al., 2020). Further, patients must pay “pay per service” for consultation (Snoswell et al., 2020). The limitation in achieving desirable telehealth outcomes lies in factors such as the level of awareness among patients, availability of nurses that can assess patients by following physicians’ instructions, remote location of patients, low availability of technology in low-income areas, and treatment level can be administered through telehealth.

However, telemedicine’s expansions and the use of telecommunications to treat patients in rural areas would mean planning adequate strategies and having sufficient funding to address the current barriers to providing pastoral health care. Advanced broadband networks, licensure issues, budget, and adoption of telemedicine are some of the critical obstacles to improving healthcare access in rural communities (Lustig, 2012). Wastage of funds and resources, gaps in broadband coverage, and lack of sustainability only add to those barriers.

Denmark and the Canadian healthcare system have produced positive outcomes in improving rural healthcare with the help of telemedicine. Denmark’s health system has successfully implemented large-scale telehealth solutions in recent years. It uses digital technologies such as mobile apps, videoconferencing, and interactive software to ensure faster, easier, and cost-effective health care in rural areas and underserved communities (Denmark & Henriksen, 2018). Healthcare Denmark is a fine example of healthcare expertise and innovation with best practices. Canadian Medicare system is fast adopting telehealth solutions, and the Canadian Medical Association, the Royal College of Physicians, the College of Family Physicians of Canada, and the Surgeons of Canada have developed a Virtual Health Care Task Force to increase the adoption of virtual care across Canada and reach the rural communities (CMA, 2019).

The Rationale for the Proposed Change

The inclusion of telehealth services is likely to bolster desirable health outcomes, as described earlier, for several reasons. Telehealth can potentially alleviate congestion in hospitals as patients with mild diseases or routine follow-ups can consult through online videoconferencing (Totten et al., 2019). Telehealth can prove cost-effective as it requires a patient to only pay for the service (Snoswell et al., 2020). Moreover, it saves transportation costs (Snoswell et al., 2020). Telehealth can provide the benefit of reduced hospital stay as the patient must check in only when it is necessary. The expected improvements are reasonable. However, with the current status of the health care system, telehealth may not live up to expectations because of the shortage of trained nursing staff required to perform specific medical procedures for patient help. Moreover, facilities for telehealth, such as technology, equipment, etc., are not readily available and accessible to all income groups and geographical locations.

Expanding telemedicine and telehealth care in the U.S. will ensure more accessible and more convenient physician consultation and primary care access. The rural population can get timely health care and will need fewer physician visits.

Financial and Health Implications

The persistent issues in rural health care in the U.S. and the impact of COVID-19 have pushed the nation into a new phase of advancements based on telemedicine. The health care providers must provide timely care to rural communities and urban populations in social isolation. However, rapid technological advances are required to make telemedicine more sustainable and overcome barriers to accessing care (Jin et al., 2020).

With a growing demand for telemedicine, the telehealth policy needs changes for broader coverage and implementation to make telemedicine more widely accessible. The federal government is loosening telehealth restrictions to encourage penetrations in distant geographic locations and relaxing limitations on licensing written consent and online prescribing. Commercial insurers can focus on cost-sharing under the expanding network of telemedicine providers (Weigel et al., 2020). However, these efforts require significant financial and workforce investment, as telehealth services will increase spending. Gaps in technology access among patients may also be a concern, especially among low-income patients from rural areas. Most patients from rural areas do not have access to live video technology.

Conclusion

There is no denying that telemedicine can improve rural healthcare services. However, if the U.S. desires to use telemedicine effectively over the longer term, it needs to consider changing telehealth policies and taking permanent measures to expand telemedicine access to rural patients who can easily access telemedicine services from their homes. Priority should be providing direct funding for investing in telecommunications infrastructure in rural areas.

Appendix

Table 1: Health Care System Comparative Analysis

Outcomes	Danish Health Care System	Canadian Health Care System	The local U.S. Health Care System
Reduced frequency of in-person visits to the hospital.	The TeleCare North project in Denmark ensures that patients are monitored from their homes, reducing in-person visits (Denmark & Henriksen, 2018). This is achieved through remote patient monitoring (RPM) and videoconferencing.	The Ontario Telemedicine Network has established programs such as Telehomecare that ensure patient’s vitals, such as blood pressure, are monitored from home (CMA, 2019). This reduces in-person visits to the hospital.	The local healthcare system experiences long patient queues because they must visit the hospital in person.
Reduced time of stay in hospital.	Denmark uses telehealth to reduce the time of stay in hospital. An example is the Aarhus University Hospital, which uses telehealth solutions such as RPM to monitor pregnancy complications from home, reducing hospital stays (Denmark & Henriksen, 2018).	Although not well-established countrywide, the Ontario Telemedicine Network works in concert with many Canadian hospitals to reduce patients’ time of stay (CMA, 2019). This is achieved through telehomecare and RPM techniques that enable health workers to monitor recuperating patients from their homes and reduce their hospital stays.	Patients in the local health facility have long stayed in the hospital. The patients have to wait until they have fully recuperated.
Timely treatment of fatal diseases such as heart attack.	TeleCare North Heart Failure telehealth services help to address this. The process starts with patient education, and then therapy is initiated. Patients are equipped with equipment to help them monitor vitals such as blood pressure (Denmark & Henriksen, 2018). They are given devices with telehealth apps that facilitate close monitoring when they are at home.	The Ontario Telemedicine Network advocates for providing health education to patients with heart failure and Chronic Obstructive Pulmonary Disease. Patients are taught how to recognize a poor prognosis of their disease and necessary lifestyle modifications (CMA, 2019). Patients have tablets, mobile phones, and telehealth apps to monitor their progress.	The local hospital relies on emergency services by ambulances to respond to a patient with fatal diseases such as heart attack.
They are preventing congestion in hospitals.	The TeleCare North project in Denmark ensures that patients are monitored from their homes, reducing in-person visits (Denmark & Henriksen, 2018). This can be achieved through RPM, hence preventing congestion in hospitals.	The Ontario Telemedicine Network has established programs such as Telehomecare that ensure patient’s vitals, such as blood pressure, are monitored from home (CMA, 2019). This reduces in-person visits to the hospital and prevents congestion in hospitals.	The local healthcare system experiences long patient queues because they must visit the hospital in person. This has led to congestion in the hospitals.
Reduced mortality of patients.	TeleCare North ensures that patients are monitored remotely, and there is the timely treatment of diseases such as heart failure through the North Heart Failure program (Denmark & Henriksen, 2018). This reduces the patient’s mortality rates.	The Ontario Telemedicine Network ensures patients are monitored remotely through RPM and telehomecare (CMA, 2019). Furthermore, it has led to hospital decongestions. This reduces mortality rates because the patient’s needs are addressed promptly.	The local hospital relies on the healthcare providers giving the best care to patients visiting the hospital to reduce mortality rates. This has been a challenge, especially for patients with emergencies such as myocardial infarctions.
The flexibility of working.	TeleCare North has created flexible working among healthcare providers (Denmark & Henriksen, 2018). They can work away from the workplace because patients can be monitored remotely from their homes.	The Ontario Telemedicine Network enables healthcare providers to operate away from their workplaces, allowing work flexibility (CMA, 2019).	The healthcare providers in the local hospital have to report to work to provide healthcare services to patients.

References

CMA. (2019). Virtual Care in Canada. Canada Medical Association. https://www.cma.ca/sites/default/files/pdf/News/Virtual_Care_Discussionpaper_v2EN.pdf

Denmark, H., & Henriksen, H. E. (2018). Denmark –A Telehealth Nation. 32. http://healthcaredenmark.dk/media/1625194/HCD-Telehealth-White-Paper-v1-Single-0318.pdf

Jin, M. X., Kim, S. Y., Miller, L. J., Behari, G., & Correa, R. (2020). Telemedicine: Current Impact on the Future. Cureus, 12(8), e9891–e9891. https://doi.org/10.7759/cureus.9891

Lustig, T. A. (2012). The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. National Academies Press. https://books.google.co.in/books?id=lVCfAwAAQBAJ

Ricketts, T. C. (2000). The Changing Nature of Rural Health Care. Annual Review of Public Health, 21, 639–657. https://doi.org/10.1146/annurev.publhealth.21.1.639

Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if Telehealth Can Reduce Health System Costs: Scoping Review. Journal of Medical Internet Research, 22(10), e17298–e17298. https://doi.org/10.2196/17298

Totten, A., Hansen, R., Wagner, J., Stillman, L., Ivlev, I., Davis-O’Reill, Y., Towle, C., Erickson, J., Erten-Lyons, D., Fu, R., Fann, J., Babigumira, J., Palm-Cruz, K., Avery, M., & McDonagh, M. (2019). Telehealth for Acute and Chronic Care Consultations. In Comparative Effectiveness Review (Issue 216). https://doi.org//10.23970/AHRQEPCCER216

Weigel, G., Ramaswamy, A., Sobel, L., Freed, A., Cubanski, S., & Meredith, J. (2020). Opportunities and Barriers for Telemedicine in the U.S. During the COVID-19 Emergency and Beyond. KFF. https://www.kff.org/womens-health-policy/issue-brief/opportunities-and-barriers-for-telemedicine-in-the-u-s-during-the-covid-19-emergency-and-beyond

Woolf, S. H., & Aron, L. (2013). The U.S. Health in International Perspective: Shorter Lives, Poorer Health. In U.S. Health in International Perspective: Shorter Lives, Poorer Health. https://doi.org/10.17226/13497Proposing Evidence-Based Change in Regional Health Care System

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Propose a change to one aspect of your local or regional healthcare system or program that would improve outcomes. Then, conduct a comparative analysis of other non-U. S. health care systems, focusing on the proposed change. Summarize the proposed change and your comparative study in a 4–5-page report.

Note: Complete the assessments in the order in which they are presented.

Healthcare systems around the world provide valuable models for analysis. Familiarity with different models and approaches to health care enables leaders to identify what works and what does not as the basis for proposing a change. As we continue to evaluate the complex and fragmented system in the United States, nurse leaders need to become familiar with the programs and systems that provide evidence-based quality care that is affordable and focused on continual improvement.

This assessment provides an opportunity to examine a local or regional healthcare issue from a global perspective. By completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Identify the challenges and opportunities facing health care.

• • Identify an aspect of a local or regional healthcare system or program that should be a focus for change.

Competency 2: Compare the effects of different healthcare finance models and policy frameworks on resources and patient outcomes.

• • Define desirable outcomes, including who will pay for care and factors limiting achieving those outcomes.
  • Analyze two non-U.S. healthcare systems or programs that offer insight into a proposed change for a healthcare system or program in the United States.

Competency 3: Evaluate leaders’ positive and negative influences on healthcare processes and outcomes.

• • Determine the financial and health implications of making—and not making—proposed changes to a healthcare system or program.

Competency 4: Develop proactive strategies to change the organization’s culture by incorporating evidence-based practices.

• • Explain why specific changes will lead to improved outcomes.

Competency 5: Communicate effectively with diverse audiences in an appropriate form and style consistent with applicable organizational, professional, and scholarly standards.

• • Write clearly and concisely in a logically coherent and appropriate form and style.
  • Support assertions, arguments, propositions, and conclusions with relevant and credible evidence.