Assignment 1: Issues in Health Care Reform (Interview)

According to the AACN (2006), “Political activism and commitment to policy development are central elements of professional nursing practice” (p. 13). Throughout this course, you will hone the skills and competencies required for this type of involvement in policy.

Research is an essential step in the process of acquiring the skills and competencies, and interviews are one form of research that can serve as a valuable source of information. As such, this Assignment (which you will start this week, and submit by the end of Week 9) provides an opportunity for you to identify a health reform issue of interest and discuss the issue with a state or national politician (or their aide).

To prepare:

• Identify      a state or national politician (state representative or legislator,      senator, congressman, governor, etc.), or aide, whom you would like to      interview regarding current issues in health care reform. (I live in the state of Maryland.      The 2 states senators are Chris Van Hollen since 2017 and Ben Cardin since      2007; the Governor name is Larry Hogan. You can also google any of the      information about the state of Maryland in the US)
• As      soon as possible, contact the individual’s office to request a meeting.      Keep in mind that it may be difficult to get on their calendar, so plan      accordingly. You may conduct the interview in person or by phone.
• In      advance of the interview, ask yourself:
  • What       health care policy issue is important to me personally?
  • What       issue do I want to bring to this person’s attention?
• With      this in mind, develop your list of questions for the interview around your      selected health policy issue. In addition, you may wish to include      questions related to health care reform:
  • What       are your constituents most concerned about regarding health care reform?
  • What       are the trade-offs associated with recent health care reform policy?

To complete:

• Write  a 3- to 4-page paper with at least 5 scholarly references providing a summary and analysis of the interview and the health care reform issues you discussed. Include an introduction and a conclusion.

Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from appropriate Learning Resources and additional scholarly sources as appropriate (at least 5 references). Refer to the Publication Manual of the American Psychological Association to ensure that your in-text citations and reference list are correct.

This assignment is due by Thursday 04/26/18 by 10 pm.

Required Readings

Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical.

Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary Care”

Chapter 6, “How Health Care is Organized – II: Health Delivery Systems”

McClellan, M. (2010). Accountable care organizations in the era of health care reform. American Health & Drug Benefits, 3(4), 242–244.

The PPACA of 2010 encourages the formation of accountable care organizations (ACOs) to improve the quality and efficiency of health care delivery. An ACO is a group of health care providers who coordinate care for their Medicare patients and share the financial incentives of health care improvement gains.

Moore, K. D., & Coddington, D. C. (2010). Accountable care: The journey begins. Health Care Financial Management, 64(8), 57–63.

This article provides information on the importance of health care provider organizations taking steps to become accountable care organizations (ACOs) and provides examples of systems that have historically functioned in this capacity. The authors also provide steps for developing and transitioning to an ACO structure.

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

This report discusses how nurses can and should play a fundamental role in meeting the challenges of increased demand for health care brought about by the implementation of the 2010 Affordable Care Act. In addition, it stresses the need for nurses to be partners with other health professionals and assume leadership roles in redesigning health care in the United States.

Institute of Medicine. (2010). Report brief: The future of nursing: Leading change, advancing health. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf

This report brief highlights the four key recommendations from the Robert Wood Johnson and Institute of Medicine the Future of Nursing: Leading Change, Advancing Health report. The recommendations focus on nursing practice, education and training, partnerships with other healthcare professionals, and workforce planning and policymaking.

HealthCare.gov. (n.d.). Understanding the Affordable Care Act. Retrieved from http://www.hhs.gov/healthcare/rights/index.html

This website introduces the Affordable Care Act and presents the timeline for implementation of the various provisions of the Act.

HealthCare.gov. (n.d.). Understanding the Affordable Care Act: About the law. Retrieved from http://www.hhs.gov/healthcare/rights/law/index.html

Read the full Affordable Care Act law at this website. An overview of the law is also provided along with an outline of how the Affordable Care Act helps reduce health insurance costs.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy: Reforming health care delivery: Accountable care organizations. Baltimore: Author.

Note: The approximate length of this media piece is 7 minutes.

In this media presentation, Dr. Kathleen White explains the structure of accountable care organizations (ACO) and discusses the benefits and challenges of becoming an ACO.

Optional Resources

APRN Joint Dialogue Group Report. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Retrieved from http://www.aacn.nche.edu/education-resources/APRNReport.pdf

Fisher, E. S., & Shortell, S. M. (2010). Accountable care organizations: Accountable for what, to whom, and how. JAMA: Journal of the American Medical Association, 304(15), 1715–1716.

Fisher, E. S., Staiger, D. O., Bynum, J. W., & Gottlieb, D. J. (2007). Creating accountable care organizations: The extended hospital medical staff. JHealth Affairs, 26, w44-w57. doi:10.1377/hlthaff.26.1.w44–57

McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A national strategy to put accountable care into practice. Health Affairs, 29(5), 982–990.

Kaiser Health News. (2011). Accountable care organization proposed regulations: Resources. Kaiser Family Foundation. Retrieved from http://www.kaiserhealthnews.org/Stories/2011/March/31/ACO-Documents-In-The-News.aspx

Details:
While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections:

1. Title page
2. Introduction section
3. A comparison of research questions
4. A comparison of sample populations
5. A comparison of the limitations of the study
6. A conclusion section, incorporating recommendations for further research

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

 

 

Literature Evaluation Table

Student Name:

Change Topic: Obese children under the age of 12 can be described as those children with a BMI index of 30 or more. My capstone project proposes an intervention that involves increasing knowledge on nutrition education involving proper diet and engaging in physical activities.

Criteria	Article 1	Article 2	Article 3	Article 4
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Bleich, S. N., Segal, J., Wu, Y., Wilson, R., & Wang, Y. doi: 10.1542/peds.2013-0886. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691541/	Tester, J. M., Phan, T. T., Jared M. Tucker, J. M., Leung, C.W., Gillette, M. L., Sweeney, B. R., Kirk, S., Tindall, A., Olivo-Marston, S. E., & Eneli, I. U. DOI: 10.1542/peds.2017-3228 http://pediatrics.aappublications.org/content/141/3/e20173228	Cunningham, S. A., Kramer, M. R., & Narayan, K. V. DOI: 10.1056/NEJMoa1309753 http://www.nejm.org/doi/10.1056/NEJMoa1309753	Arthur M. L., Scharf, J. R., DeBoer, M. D. DOI: 10.1016/j.nut.2017.12.008 http://www.nutritionjrnl.com/article/S0899-9007(18)30025-X/fulltext
Article Title and Year Published	Title: Systematic review of community-based childhood obesity prevention studies. Year: 2013	Characteristics of Children 2 to 5 Years of Age with Severe Obesity. Year: 2018	Incidence of Childhood Obesity in the United States Year: 2014	Association between kindergarten and first-grade food insecurity and weight status in U.S. children. Year: 2018
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study	The purpose of the study was to conduct a systematic review of community based childhood obesity prevention.	The purpose of the study was to investigate the characteristics of obese children between the age of 2 and 5 years.	The paper aimed at identifying the prevalence of obesity in the United States at the national level.	The aim of the paper was to determine if food insecurity is an independent risk factor for obesity in U.S. children
Design (Type of Quantitative, or Type of Qualitative)	Systematic Review	Qualitative	Qualitative	Qualitative
Setting/Sample	Intervention was exclusively in a community setting eg, home, school, primary care, child care	Sample included children between 2 and 5 years. N=7028, from NHANES (1999–2014) Classification: normal weight, overweight, obesity	7738 participants who were in kindergarten in 1998 in the United States.	Early Childhood Longitudinal Study—Kindergarten Cohort 2011
Methods: Intervention/Instruments	Comparative Review as recommended by the Agency for Healthcare Research and Quality Methods Guide	Survey weights were used to account for probability sampling design. This analysis was done in accordance with recommendations from the National Center for Health Statistics.	Height and weight were measured seven times between 1998 and 2007. An obese baseline was set and the population analyzed	Statistical analyses were performed to evaluate longitudinal associations between food security and body mass index (BMI) z-score.
Analysis	Relevant articles were searched from Medline, Embase, Psych-Info, CINAHL, and the Cochrane Library. It was also based on medical subject headings terms and text words of key articles that we identified a priori.	Multinomial logistic and linear regressions were conducted, with normal weight as the referent.	The study used Growth Charts to calculate each child’s BMI CDC’s standard thresholds of the 85th percentile for overweight and 95th percentile for obesity. estimates of prevalence and incidence were stratified according to sex and quantile	Regression models were formulated on race/ethnicity, household income, and parental education.
Key Findings	The study’s search revealed 9 relevant articles, four of which use combined diet and physical activity approaches to childhood obesity. It is also important to note that at least one of the articles revealed significant improvements in intermediate weight-related outcome, which can be related to the physical activity that results from the intervention.	Findings from the results revealed that factors such as race, ethnicity, household income and level of education of parents as well as other factors such as breastfeeding will affect the weight of a child. The study also revealed that energy intake and Healthy Eating Index 2010 scores were not significantly different in children with Severe Obesity.	Significant statistics obtained from the study revealed that there were no significant increases in prevalence between the ages of 11 and 14 years. It was also revealed that prevalence of obesity was higher among Hispanic children than among non-Hispanic white children of all ages while those from the wealthiest families had a lower prevalence of obesity. The incidence of obesity between the ages of 5 and 14 years was 4 times as high among children who had been overweight at the age of 5 years as among children who had a normal weight at that age.	Findings of the study indicated that children with household food insecurity had increased obesity prevalence from kindergarten through grade 3.
Recommendations	Based on the review conducted, the study identifies a research gap, noting that not much has been done to determine the impact of community-based childhood obesity prevention programs on primary or secondary weight outcomes. From the literature available, however, the article recommends the use of this intervention as a combination of events would lead to more effective ways to prevent weight gain.	The study recommends a better understanding of behavioral and physiologic mechanisms and relationships behind the risk factors behind weight problems among children	Based on the findings, the study recommends a better understanding of the ding risk over a lifetime and identifying potential ages for intervention.	The study identified food-insecure children as most prone to obesity calling for interventions to focus on this area.
Explanation of How the Article Supports EBP/Capstone Project	This article provides the research gap that would be exploited by working on the capstone. It asserts that more needs to be done to provide better interventions on weight management. It also pointed out that multiple settings may be more effective at preventing weight gain in children than single-component interventions located in the community only. This information is critical for purposes of coming up with better EPB through the capstone.	This article provides a better understanding of the characteristics of obese children and classifies them into different categories. It also provides an overview of other characteristics based on social and economic aspects.	The study has provided the much needed information on the prevalence of obesity in the country. This provides a rationale for the importance of having the necessary EBP that can be used as interventions to the problem, one of which will be provided by the capstone.	This article also emphasized on some of the most prone characteristics of childhood obesity. It identified food-prone children as having the highest chances. The capstone project will therefore consider this when coming up with an intervention

 

 

 

 

 

Criteria	Article 5	Article 6	Article 7	Article 8
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Fetter, S. D., Scherr, R. E., Linless, D. J., Dharmar, M., Sara, E. Schaefer, E. S., & Zidenberg-Cherr, S. DOI: 10.1080/07315724.2018.1436477 https://www.tandfonline.com/doi/full/10.1080/07315724.2018.1436477	Lydecke, J. A., Riley, K. E., & Grilo, C. M. DOI: 10.1002/eat.22858 https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.22858	Marcum, C. S., Goldring M. R., McBride, C. M., & Persky, S. DOI: 10.1093/abm/kax041 https://academic.oup.com/abm/article-abstract/52/3/252/4822907?redirectedFrom=fulltext	Vollmer, R. L. DOI: https://doi.org/10.1016/j.jneb.2017.12.009
Article Title and Year Published	Effect of the Shaping Healthy Choices Program, a Multicomponent, School-Based Nutrition Intervention, on Physical Activity Intensity. Year published: 2018	Associations of parents’ self, child, and other “fat talk” with child eating behaviors and weight. Year published: 2018	Modeling Dynamic Food Choice Processes to Understand Dietary Intervention Effects. Year published: 2018	An Exploration of How Fathers Attempt to Prevent Childhood Obesity in Their Families. Year published: 2018
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study	The main aim of the study was to determine whether physical activity patterns improved School-Based Nutrition intervention.	The study aimed at identifying the relationship between parenting and eating behaviour and how they all relate wo weight gain.	The article aimed at identifying limitations in dietary behaviour and how micro-level choices undertaken by people on a daily basis affect it as an intervention to obesity.	The objective of the article was to understand how fathers, a parent, understand overweight preschoolers
Design (Type of Quantitative, or Type of Qualitative)	Qualitative	Qualitative	Qualitative	Qualitative
Setting/Sample	Youth enrolled in a Shaping Healthy Choices Program	581 Parents of preadolescents or adolescents	221 mothers	117 US fathers with an average of 35 years, 85% white
Methods: Intervention/Instruments	Pre and post-intervention assessments were conducted alongside a control experiment Youth at the control and intervention schools wore a Polar Active monitor on their non-dominant wrist 24 h/d for at least 2 consecutive days.	Parents were interviewed and asked if they talk about weight gain (fat talk) with their children (pre-adolescents and adolescents.	The study modelled the choices of the 221 mothers who had adopted an information-based intervention for their children.	Online survey with nine questions.
Analysis	Multiple linear regression was used to evaluate change in physical activity   Statistical significance was set at p < 0.05.	Fat-Talk was categorized into self‐fat talk, obesity‐fat talk and child-fat-talk. All these were analyzed based on the responses given by each parent	Relational event modeling, where participants were grouped into control information, childhood obesity risk information and childhood obesity risk information plus a personalized family history	Content analysis was used to analyze their responses using constant comparative method
Key Findings	There were no significant differences in the change in MVPA between the schools.	A bigger percentage of parents admit to talking to their children about obesity i.e. child-fat talk. Generally, sons are easier to talk to than daughters	The results indicated that choice inertia decreased and the overall rate of food selection increased among participants receiving the strongest intervention condition	From the results of the survey, it was revealed that there are distinct causes of childhood obesity that can be prevented or treated using parents, specifically, fathers. They can be used to identify child excess weight at an early stage and work towards correcting the situation. This also includes identifying barriers to changing behaviour and overcoming them.
Recommendations	According to the authors, the overall small physical activity intensity pattern shift supports that physical activity is an important area to target within a multicomponent nutrition intervention aimed at preventing childhood obesity.	The study recommended the use of different types of talks about obesity.	The study therefore recommended that better food choices can help make any dietary behaviour intervention better	The article therefore recommends fathers as the best parents to base the intervention on. It also recommends engaging mothers as well.
Explanation of How the Article Supports EBP/Capstone	The study provides an in-depth analysis into how physical activity can be used as an intervention to prevent childhood obesity. The results will be used to compare with those found after the capstone project is complete.	This article introduces childhood obesity from the parent’s perspective. It assumes that parents are directly responsible for their children and that they would be able to talk them into better eating habits, thereby stopping obesity. This is an intervention that can be exploited further by the capstone project	The article provides a new intervention that scrutinizes the effectiveness of having a dietary behaviour intervention. Indeed, there are several other factors that contribute to this. It is important to have counter measures for every intervention adopted.	This study gave me a different approach to the intervention involving parents. It proves that the best intervention would involve both parents and practitioners. This is the idea that I would replicate in my capstone project.

 

 

 

 

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