Access, Cost, and Quality for Advanced Practice Nurse

Discuss the access, cost, and quality of quality environments, as well as recent quality initiatives (See Chapter 24 and Table 24.1). Student is to reflect on the relationship between quality measures and evaluation and role development. In addition, describe this relationship and note how the role of the APN might change without effective quality measures.


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Access, Cost, and Quality for Advanced Practice Nurse








Access, Cost, and Quality for Advanced Practice Nurse


The quality of the environment reflects the level of vigilance and compassion the healthcare provider has for the patient. The way to improve patient safety is to design systems of care that reduce the causes of error. Patients are not contented with the value of care they are getting and concerns about access to preferred care are a major concern. The growing consumer movement, cost concerns, and managed care have increased the appetite for information about the quality of healthcare in relation to cost and the performance of healthcare providers in all components of the system. Advocacy groups have been championing greater accountability from healthcare providers. State and federal government bodies want to know the best possible healthcare service outcomes at the best prices.

The Quality Environment

Throughout the world, monitoring patient experiences is being increasingly done to get material about the provision and quality of healthcare. People experiences in healthcare centers can be used as a replication of what took place during the care course. It will offer useful information on the performance of the healthcare providers. In the United States, access and cost issues have received considerably more attention than quality in the recent past. The increase in cost and development of new delivery systems leading to greater attention on quality and value (Girouard et al., 2017). Research has also shown that quality theories and practices can be applied in the nursing arena. Assessing patient experience provides data related to actual experience and reveals the quality aspects the consumer regards most important. General quality aspects include

  • Respect for patient preferences
  • Patient involvement in decision making
  • Adequate and clear information
  • Empathy, respect, and emotional support
  • Fast and reliable access to advise
  • Effective treatment
  • Family involvement and support
  • Attention to physical and environmental needs
  • Healthcare continuity and smooth transitions

Nurses prefer to work in environments where there are clinically competent nurses, there exists a good nurse-doctor relationship, nursing practice is autonomous, and there is adequate staffing. There should be adequate control over nursing practice, support for continuous training, and a culture that values concern for the patient.

Access, Cost, and Quality

Improved healthcare first depends on a patient’s ability to receive services. The objective of health coverage is to help people pay for their services whether preventable or diagnostic. Insurance protects the whole family money-wise in the event of unexpected injury or illness. Health insurance enables access to physicians, healthcare providers, and resources required for health and wellness. Access to wide-ranging and quality healthcare services is essential for supporting and sustaining health. It is also crucial in prevention and management of diseases as well as decreasing premature death and preventable disability and attaining equity in matters health (Girouard et al., 2017). Access means the timely use of services to realize the best healthcare results.

Access involves getting entry into the healthcare system mainly through insurance coverage, getting a suitable location for health services, and getting a healthcare provider whom the patient can trust and rely on. Access to healthcare services has an overall impact on physical, social, and mental status and quality of life. Barriers to effective access to quality healthcare include great costs of services, inadequate or zero insurance, unavailability of care, and lack of competent services. Such barriers could cause unmet health issues, delays in the provision of quality healthcare, inability to access crucial preventive services, preventable hospitalizations, and financial burdens.

Access to healthcare involves coverage, services, and timeliness. Coverage enables the patient to gain entry to the healthcare scheme (Llewellyn, 2017). Inadequate coverage or lack of insurance makes it difficult for patients to access quality healthcare they need. If they get care, there are likely to encounter huge medical bills that are a burden to them.

Improving healthcare services means that individuals have a reliable and continuing source of healthcare where a patient can regularly receive care. Individuals with a common place of healthcare services have better health results, less disparities, and reduced costs. A primary service provider is especially essential for a patient as the arrangement helps develop meaningful and sustained relationships and provide integrated services. It fosters greater patient-provider trust, better communication, and lower mortality from all causes. It also increases the likelihood of the patient receiving appropriate care. Improving healthcare services increases access to preventive measures that prevent disease by supporting healthy activities, offering protection to individuals at risk, and recognizing and providing treatment to individuals who are asymptomatic but have risk factors.

Timeliness in healthcare access refers to the capability to provide care quickly when a need is recognized. In encompasses the availability of appointments and healthcare services when it is needed and the time spent while waiting for the physician’s care at offices and emergency departments. Delay in providing healthcare may negatively affect health and expense rate of care. Delays can lead to emotional distress and health complications.  Prolonged emergency department wait time reduces patient approval, rises the number of those who leave before being attended, and is associated with clinically substantial delays in healthcare.

Compared to other first world and developing nations, the cost of healthcare in the United States is extremely high. Per capita spending is estimated to be fifty to two-hundred percent higher than other economically developed countries. Although it ranks favorably in life expectancy, the United States ranks very poorly in other indicators of quality. This is an indication that despite the high cost of healthcare in the country, matching quality has not been met. Evidence points to wasteful spending and a disjointed relationship between treatment intensity and quality of healthcare. The cost of healthcare affects every aspect of the economy. The current rising costs of healthcare costs are not sustainable. Several measures taken to reduce healthcare spending include implementation of health information technology, changes in payment models, focus on quality improvement efforts, and a shift to evidence-based care. The association between costs and healthcare quality has been an ongoing debate.

The rising healthcare costs pose a serious danger to the future of the entire industry. The free-for-service healthcare model rewards providers according to the volume of patients they see and the tests and procedures they perform. The cost of care varies widely within hospitals and geographical locations. Healthcare providers may also be reimbursed differently by insurance companies for similar services delivered. Healthcare organizations need to find the right balance to improve the quality of care as costs are already high.

Recent Quality Initiatives

The Patient Protection and Affordable Care Act of 2010 expanded insurance coverage by more than 20 million people. Although the act increased the number of those covered significantly, millions of Americans still lack insurance coverage. There are also significant disparities in access to healthcare in regard to age, sex, race, education, and social class. Such disparities are found in all aspects of healthcare. Efforts should be made to increase and measure coverage and access to the entire continuum, address disparities, assess the capacity for newly insured individuals, and monitor the increased use of telemedicine and health as an emerging model of healthcare delivery.

There are ongoing and expanding initiatives to classify standards and anticipated results for access, costs, and quality of healthcare. Healthcare measurement goals include gathering and analyzing information to advise improvement efforts, informing stakeholders about changes and new decisions, and providing relevant information on different providers for consumers to compare. Those with best practices are rewarded and monitoring and reporting on quality are kept ongoing.

Patient-centered medical home I another initiative geared toward quality improvement. This is an integrated care model that focuses on offering high-quality care across the continuum. Another recent quality improvement initiative is telemedicine and telehealth. It allows faster response and saves on costs (Kieft, 2014). Quality improvement organizations and networks are private organizations (mostly not-for-profit) staffed with healthcare providers to review healthcare with complaints about care. They provide technical assistance, organize training and action networks for sharing best practices, and collect and analyze information for improvement. Health systems that embrace such systems are particularly incentivized to push for sustained quality improvement of healthcare.

APN Performance Expectations

The advanced practice nurse is involved in all fields of safety and quality movements including the development, implementation, and assessment of the performance measurement and reporting process. The nurses play a crucial role in the provision and coordination of healthcare, prevention of adverse occurrences, and optimization of health outcomes (ODPHP, 2020). They must try to accomplish these roles even in the absence of effective quality measures. Their responsibilities extend beyond providing safe care that meets clinical standards to participate in the organization of the safety infrastructure. They have a professional mandate to measure, monitor, and report on the effectiveness and appropriateness of care and advise on areas of improvement (Oldland, 2020). APNs play a critical role in support, implementation, and assessment of health applications designed to improve the quality of healthcare.

The diverse safety and quality role expectations of advanced practice nurses assume that the workforce has enough to fulfill responsibilities, and is cognizant of those responsibilities. In many cases, the quality of healthcare is low and compromised and nurses should be aware of their responsibilities in such an even (Llewellyn, 2017). APNs education should prepare them for discipline-specific knowledge and skills and competencies essential for high-quality care. This includes effective teamwork and leadership skills.

Several aspects greatly improve the quality of healthcare including clinically competent APNs, collaboration and teamwork, autonomous nursing practice, adequate staffing, and a patient-centered culture. If all these elements are incorporated in the service practice, it will result in improved quality care and satisfied patients. Current nursing policies are centered on transparency, external accountability, and cost-effectiveness. This may lead to administrative workload and pressure to increase productivity. Sustained and continuous quality improvement can be achieved through adaptive leadership, governance, and best practices. It is a priority for advanced practice nurses to sustain and improve the quality of care provided.









Girouard, S., DiFusco, P., Jennas, J. (2017). Measuring advanced practice nurse performance. Advanced Practice Nursing.

Kieft, R. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Services Research.

Llewellyn, A. (2017). Cost, Quality, and Access: The Three Ingredients for a Stable Health Care System.

ODPHP. (2020). Access to health services. Office of Disease Prevention and Health Promotion.

Oldland, E. (2020). A framework of nurses’ responsibilities for quality healthcare — Exploration of content validity. Elsevier.


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