Thomas Jefferson University Jefferson Digital Commons College of Nursing Faculty Papers & Presentations Jefferson College of Nursing 4-2017 Leveraging National Reports to Transform Ambulatory Care Practice Anne T. Jessie Evolent Health, Roanoke, VA Beth Ann Swan Thomas Jefferson University Follow this and additional works at: https://jdc.jefferson.edu/nursfp Part of the Nursing Commons Let us know how access to this document benefits ouy Recommended Citation Jessie, Anne T. and Swan, Beth Ann, "Leveraging National Reports to Transform Ambulatory Care Practice" (2017). College of Nursing Faculty Papers & Presentations. Paper 89. https://jdc.jefferson.edu/nursfp/89 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in College of Nursing Faculty Papers & Presentations by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. Anne T. Jessie Perspectives in Ambulatory Care Beth Ann Swan Leveraging National Reports to Transform Ambulatory Care Practice EXECUTIVE SUMMARY Multiple national reports identify actionable recom - mendations to transform education and practice to meet the needs of health care and healthcare deliv - ery beyond the hospital walls. S HEALTHCARE REFORM con - The Josiah Macy Jr. Conference (2016) focused on tinues to be debated and transforming primary care and changing healthcare the future of the Patient culture to support expansion of roles for registered Protection and Afforda - nurses (RNs). Able Care Act (ACA, 2010) re mains Partnerships between academia and clinical practice uncertain, some truths en dure are critical to expanding learning opportunities as foundational to the fu ture beyond traditional acute care settings. of healthcare delivery re design. Development of primary care expertise in nursing fac - America’s current healthcare de - ulty and adjunct faculty, in collaboration with primary livery system is fragmented and care and ambulatory care nursing leaders, is essen - lacks coordination. Indivi duals tial. Academic-practice partnerships must advocate for Anne T. Jessie with chronic conditions often experience unnecessary service removing regulatory and practice barriers to allow use, receive conflicting advice RNs to practice to the full scope of education and from multiple providers, experi - training. ence difficulty in accessing serv - Recommendations from national reports extend ices, struggle with out-of-pocket beyond enhanced roles in primary care practice and expenses, and must rely on oth - have global implications for all RNs practicing in ers for financial support and per - ambulatory care. sonal assistance (Anderson, 2010). Individuals with complex United States are spent on people with chronic con - care needs require time-consum - ditions. The approximate 28% of Americans who ing processes such as compre - have two or more chronic conditions are responsible hensive history taking, counsel - for two-thirds of healthcare spending, and Medicare Beth Ann Swan ing, medication reconciliation, beneficiaries with five or more chronic conditions and psychosocial interventions that must be consid - account for two-thirds of all expenditures (Anderson, ered to ensure quality of care delivery (Bodenheimer 2010). The incidence and prevalence of chronic dis - & Berry-Millett, 2009). Primary care providers often ease has had a significant impact on current primary lack the time or direct access to resources necessary to care resources as 75% of all primary care visits are provide the high-touch, intensive, and comprehen - related to chronic illness management (Zamosky, sive management required by these individuals 2013). Additionally, an anticipated primary care (Anderson, 2010). physician shortage looms as the pace of current retire - Compounding the plight are the 117 million peo - ments will exceed those entering the specialty by ple in the United States with one or more chronic 2020 (Health Resources Services Administration, conditions, with two or more chronic conditions 2013; Petterson, Liaw, Tran, & Bazemore, 2015). These occurring in one out of four adults (American challenges are culminating in the need to develop Academy of Ambulatory Care Nursing [AAACN], new practice models that integrate the expertise of all 2017; Ward, Schiller, & Goodman, 2014). According interprofessional care team members to increase to Anderson (2010), 85% of healthcare dollars in the access, identify and reduce gaps in care, improve care NOTE : This column is written by members of the American Academy of Ambulatory Care Nursing (AAACN) and edited by Kitty ANNE T. JESSIE, DNP, RN, is Senior Director, Clinical Operations, Shulman, MSN, RN-BC. For more information about the organiza - Evolent Health, Roanoke, VA. tion, contact: AAACN, East Holly Avenue/Box 56, Pitman, NJ 08071-0056; (856) 256-2300; (800) AMB-NURS; FAX (856) 589- BETH ANN SWAN, PhD, CRNP, FAAN, is Professor, Jefferson 7463; Email: [email protected]; Website: http://AAACN.org College of Nursing, Thomas Jefferson University, Philadelphia, PA. 96 NURSING ECONOMIC$/March-April 2 017/Vol. 35/No. 2 coordination across the care continuum, promote clinical outcomes, and enhance quality of life for Table 1. individuals and their families. Strategies for Enhancing the Role of RNs The ACA (2010) emphasized the importance of in Primary Care primary care within the context of complex, chronic disease management. While primary care providers 1. Provide RNs with additional training in primary care skills, have been traditionally on the front line of care deliv - so they can make more clinical decisions. ery, innovative care delivery and payment reform 2. Empower RNs to make more clinical decisions using models place registered nurses (RNs) at the center, standardized procedures. working to their level of education and training, thus 3. Reduce the triage burden on RNs to free up time for other providing unique opportunities to expand primary responsibilities. care and ambulatory care nursing practice (AAACN, 4. Include RNs on care teams, allowing them to focus on their team’s patients. 2017; Bindman, Blum, & Kronick, 2013; Bodenheimer , 5. Implement RN-led new patient visits to increase patient Bauer, Olayiwola, & Syer, 2015; Edwards & Landon, access to care. 2014). Approximately 3.7 million RNs make up the 6. Offer patients co-visits in which RNs conduct most of the largest segment of healthcare professionals (Institute visit, with providers joining at the end. of Medicine [IOM], 2015). Working in a variety of set - 7. Deploy RNs as “tactical nurses.” tings that include hospitals, physician practices, 8. Provide patients with RN-led chronic care management schools, businesses, community health centers, tele - visits. health services, long-term care facilities, and homes, 9. Employ RNs’ skills to care-manage patients with complex RNs serve as direct care providers coordinating care healthcare needs. and managing transitions from one setting to another 10. Train some RNs to take responsibility for specialized functions. (AAACN, 2017). Registered nurses provide a continu - 11. Schedule RNs to perform different roles on different days. um of services including and not limited to direct 12. Preserve the traditional RN role and focus on training care, health promotion and disease prevention, edu - MAs and LVNs to take on new responsibilities. cation and counseling, support for self-care manage - ment, acute and chronic disease management, and Reprinted with permission from Bodenheimer et al., 2015. care coordination activities as part of the interprofes - LVN = licensed vocational nurse, MA = medical assistant, sional care team (AAACN, 2017; Bodenheimer et al., RN = registered nurse 2015; Haas & Swan, 2014). Recommendations from National Reports Preparing Registered Nurses for Enhanced Roles in The IOM’s Future of Nursing (2010) report, iden - Primary Care (Josiah Macy Jr. Foundation, 2016). tified actionable recommendations to prepare nurses In June 2016, the Josiah Macy Jr. Foundation con - for new and vital roles to enhance healthcare delivery vened a group of more than 40 healthcare leaders and for the future. In 2015, IOM evaluated movement primary care professionals representing professional toward its recommendations and released the report nursing organizations, nursing, medicine, social Assessing Progress on the Institute of Medicine work, educators, healthcare delivery organizations, Report: The Future of Nursing. Findings reinforced public and private funders, pre-licensure and gradu - the need to continue developing an RN workforce that ate nursing students, as well as other key stakehold - (a) practices to the full extent of their education and ers. To prepare for conference discussions, four training; (b) achieves higher levels of education and papers were commissioned and reviewed by all con - training through improved education systems that ferees: promote seamless academic progression and include 1. The Future of Primary Care: Enhancing