SIM440-19A Activity 8 Regulatory Environment

Activity 8

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.

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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
Choose One:	Instructions:
Paper	4 page paper. Include title and reference pages.

Collaboration for Improving Outcomes- Regulatory Environment
Description: 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. SIM440-19A Activity 8 Regulatory Environment	Provides two references.	Provides one references.	Provides no references.