Overview and Summary: Organizational Outcomes for Providers and Patients

Abstract

Citation: Rosenkoetter, M., (May 31, 2016) "Overview and Summary: Organizational Outcomes for Providers and Patients" OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 2, Overview and Summary.DOI: 10.3912/OJIN.Vol21No02ManOSThe Commonwealth Fund (2014) reported that while the United States (US) has the most expensive healthcare system among 11 industrialized countries, it ranked last on "measures of health system quality, efficiency, access to care, equity, and healthy lives" (para.1). While we have a substantial investment in healthcare, there continues to be a deficient in attainable outcomes. The Patient Protection and Affordable Care Act (ACA) (Kaiser Family Foundation, 2013), was signed into law on March 23, 2010 by President Obama as a comprehensive health reform law. It was intended to "expand healthcare coverage, control healthcare costs, and improve healthcare delivery system[s]" (p. 1). Controversy continues regarding whether the outcomes of this law have actually achieved the goals and the original purpose. In this election year, the law has become fodder for considerable debate, with some Republicans pushing for its repeal. The outcome of the Presidential and Congressional elections may well determine the law's future.At the same time, total healthcare costs in the US are expected to be $4.8 trillion in 2021. Healthcare spending was nearly $2.6 trillion in 2010 and half of this was to pay the cost of medical services by hospitals and physicians (Aetna, 2016). Many Americans continue to lack health insurance, experience rising healthcare costs, and have difficulty paying for healthcare needs (Consumer Reports. 2014). With healthcare costs rising, accountability and measuring the actual outcomes of care provided has greater emphasis. The ACA includes a provision to "allow providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings...[and] ...must agree to be accountable for the overall care of their Medicare beneficiaries." (Kaiser Family Foundation, 2013, section 11). This implies that sufficient data must be compiled to document outcomes.Two other current concerns are the number of preventable adverse events that occur in hospitals and premature deaths associated with preventable harm. James (2013) estimated this number between 210,000 and 400,000 per year, depending on the completeness of medical records and the search technology. Given the ramifications and potential repercussions of these events, it is plausible to assume that some are not reported and hence, accurate outcomes are unknown. Greater involvement in their healthcare decisions by patients and families is indicated, with greater attention to outcomes that they perceive have caused "harm" as well as how nursing care at the individual and team level can impact those outcomes.Over the past decade, technology has increasingly changed both healthcare delivery and outcome measurement. Electronic medical records, medication distribution systems, online patient record systems, and sophisticated diagnostic technology have grown exponentially. Technology has not only facilitated accuracy but many patients now have full access to their healthcare records. Patients themselves are better able to judge the effectiveness of their care and determine which of many alternatives they wish to pursue. It is the responsibility of healthcare providers to make the information available so patients, and their families, can make informed decisions. Concepts such as telehealth and eHealth will continue to grow; with this growth is the concomitant need to measure the effectiveness of these new approaches and protect privacy while providing quality care. Telemedicine can impact cost effectiveness, reach remote patients, monitor patients in home settings, facilitate physician consultations, reduce travel, and provide rural healthcare providers with access to specialty care (American Telemedicine Association, 2015; California Telehealth Resource Center, n. …