Leaving Washington's February chill behind, I pushed through the Grand Hyatt's doors and into an inaugural National Child Health Conference session entitled "Driving Health System Transformation." It immediately said something about the perceived importance of the topic that the break-out room was packed shoulder-to-shoulder for a panel presentation that characterized the Affordable Care Act as a 3.0 upgrade of our country's child health system.
This improved operating system focused on achieving optimal health by integrating complex systems and life-course pathways, and investing in
Sunny Hallowell, PhD, CRNP, IBCLC, is a Research Fellow at the Center for Health Outcomes and Policy Research in the University of Pennsylvania's School of Nursing, and a Fellow at Penn's Leonard Davis Intitute of Health Economics (LDI).
population-based prevention.
As a clinician, I understand the ACA requires a fundamental shift in focus on the wellness of a patient rather than the episodic treatment of illness. The patient is placed at the center of a network of community relationships that influence health outcomes.
Not a breakthrough However, these are not really breakthrough "3.0" ideas, but rather traditional concepts central to the clinical practice of nursing. So, if this were the upgrade, it was not new to me. I was a little disappointed; I thought we were already practicing within this model.
It seems to me as a health policy researcher that it will take more than a shift in desire to create policy that supports changes in clinical practice within a new sort of reimbursement structure. Bullish pediatric research opportunities were major conference themes: innovation, collaboration and collection of high quality data. But to me, these were opportunities for pediatric research as much as they were a call for nurse researchers to participate in the work.
Innovations of health care models developed for the ACA provide an opportunity to understand patient outcomes directly linked to health care provided by the nurse workforce. In 2010, the Institute of Medicine (IOM) Future of Nursing recommended the expansion of "opportunities for nurses to lead and diffuse collaborative improvement efforts." Nursing innovation has influenced health policy, as evidenced by the widespread use of the Transitional Care Model most recently developed as the basis for a Medicare benefit impacting hospital discharge planning.
Nurses' vital role Nurses also play a vital role in implementation of health care models. The five-year, $1.5 billion investment of the ACA in the Maternal, Infant and Early Childhood Home Visitation Program relies heavily on nurses and other professionals to provide counseling and intervention services to improve health outcomes. Since 2010, $200 million in funding has been invested to improve delivery and support of services provided to about 20 million patients at community and school based health centers where health care is delivered by nurses and advance practice nurses (APNs).
These innovative programs are examples of successful models that have been rapidly "scaled-up and spread" to achieve sustainability based on demonstrated patient and population outcomes.
The ACA relies on new service delivery and payment models to demonstrate patient outcomes. Nurses have an opportunity to collaborate in the innovation of these models to integrate core values and practical knowledge that are consistent with the 3.0 upgrade vision of health care.
Breaking down traditional silos Interdisciplinary collaboration will require researchers to break out of the isolation of their professional silos. Nurses are well prepared to collaborate in children's health policy issues. According to the IOM by 2020, the number of nurses with a doctoral level degree will double, and this includes PhD prepared nurses who are trained in research. Collaboration with nurse researchers would provide projects with a distinct hands-on point of view.
In pediatrics, nurses may employ a socio-ecological model to develop an individualized patient-care plan for a patient since children's issues resonate through the experiences of their families and communities. As in clinical practice, nurses are natural agents to lead design and collaboration with groups outside of academia and include the participation of patients, families and communities from the inception to the dissemination of research. Policy developed with this level of collaboration might help us understand with greater clarity the networks of care, provision of services and the effects on children's outcomes at the individual and population levels.
The collection of high quality data for analysis is imperative to pediatric outcomes research and the development of policy. Policymakers need to demonstrate that ACA-driven changes had a measurable impact on pediatric outcomes.
More APN data needed APNs will be an important part of this story. APNs provide a large proportion of primary care but very little is known about the staffing, utilization and reimbursement structures associated with the care they provide. Even less is known about the impact on pediatric outcomes. Better data collection, development and systems will allow researchers to broaden our understanding of these relationships, and to translate outcomes more clearly to health policymakers. The benefit to patient outcomes may not be realized until data is used to describe reimbursement packages of the ACA that transform pediatric outcome measures into units that describe cost savings.
The afternoon closing plenary discussion refocused my thoughts about my clinical practice and research life. The work of great American women such as nurse and human rights activist Lillian Wald was used to remind the diverse audience about the unique and temporary state of childhood. The distinct needs of children should be recognized in the development of health policy, rather than the use of adult health policy adapted for children.
As one of the few nurses in attendance, the National Child Health Policy Conference left me hopeful that a year from now, when I come in from the capital cold, we will know much more about the impact of the ACA in achieving successful pediatric outcomes. Hopefully, we will also know more about the impact nurses have had on these outcomes and their collaboration in research and design of health policy.
Implementation of the ACA may not be an upgrade of pediatric health policy more than it is a redesign that harnesses collaborative innovation to move us closer to transforming American health care.
