Question

nursing management

Q1: Discuss how pay for performance can affect the quality of care?

Q2: Identify barriers to evidence-based practice and strategies to overcome those barriers?

Answer 1

Discuss how pay for performance can affect the quality of care?

· Pay-for - performance schemes are now standard features of public and private insurance payment systems alike. Although pay-for - performance backers are most often individual health plans, a range of consumers and multistakeholder coalitions are introducing the services in a number of markets.

• The implementation problems faced by responsible payers who seek to use pay-for-performance to increase the efficiency or value of health care are not restricted to achieving the desired response from health practitioners. Unintended effects are likely, too. From the point of view of patient care, the 2 most critical pay-for - performance issues are: (1) coping effectively with diverse patient groups to reduce pressure to avoid those patients, and (2) ensuring that "teaching to the test" does not necessarily lead to worse treatment.

• Many physicians who object to pay-for-performance are concerned that variations in seriousness of disease and patient conduct are confused with the quality metrics on which payment is based. It is well known that, despite working hard to deliver high-quality treatment, doctors who treat sicker or less compliant groups are likely to have lower scores on process and outcome indicators. Therefore, a crucial pay-for - performance challenge is to use risk management or other tailor-made methods to reasonably account for these disparities and thereby reduce incentives for physicians to avoid certain types of diseases and patients

• The rewarding of a few (or even many) clear, easy-to-document quality processes would almost certainly deter unrewarded behaviours, some of which may be important for patient health but hard to quantify. In education, this response to being graded on test results is called "teaching to the test," and critics worry about the loss of important dimensions of educational experience when school districts pay too much attention to test scores. Similarly, since pay-for - performance systems generally concentrate on the few clinical fields where there is strong consensus about what constitutes high-quality treatment, there is a risk of deprivation from other facets of treatment. To some extent, payors may resolve this by creating comprehensive sets of metrics that cover both patient experience and individual care processes.

• In many ways, the pay-for-performance is the unavoidable product of many decades of quality assessment and monitoring refinements. Now that ample data are available to persuade most people (including Congress and major health benefits buyers) that there is a quality issue, it will be difficult to avoid the popular temptation to use the same information to change a clearly imperfect payment. Effectively used, pay-for-performance may eliminate some of the well-known inconsistencies created by the underlying framework of current payment systems and help refocus delivery on essential aspects of the public health. In order to succeed in improving patient wellbeing and the value for the dollar in healthcare, pay-for-performance would require careful planning and proactive protections against possible unintended outcomes, including those associated with patient selection rewards (and related fairness concerns) and 'teaching to the test' to ensure that these optimistic results are not accomplished at too great a cost.

Identify barriers to evidence-based practice and strategies to overcome those barriers

· The most frequently reported organisational barriers to EBP implementation were lack of human resources (nurse shortages), lack of internet access at work , high workload and lack of access to a rich library of nursing journals

· Curricular modifications which effectively incorporate EBP concepts may begin with current educational design assessments. To strengthen themselves as educators, their students, and the future practise of athletic training, educators should review curriculum content and competency delivery, identify potential barriers, and devise strategies to address those barriers.

· Today's students are the clinicians of tomorrow; therefore, to encourage critical thinking, stimulate research interest and further expand the available body of information in our growing clinical practise we need to include EBP concepts in entrance-level education.