Integration of Health Systems

Note: Before completing this Assignment, please familiarize yourself with the Week 4 Assignment Rubric, located in the Course Information area of the course navigation menu.

Intermountain Healthcare is a high-performing integrated health system with facilities in Utah and Idaho. The health system has a long-standing clinical integration structure that encourages professional collaboration. Despite this, in 1999, many physicians at Intermountain Healthcare found it difficult to fulfill the needs of patients with co-occurring physical and mental health conditions. To efficiently and effectively address this issue, Intermountain Healthcare adopted a mental health integration model in many of its primary care facilities, as well as some of its specialty clinics and partner clinics. The team-based approach has improved the coordination of services, resulting in higher quality care at a savings of cost.

Consider the example above. What advantages does integration afford Intermountain Healthcare? Do other integrated health systems experience similar benefits? Are there disadvantages to integration? If so, what are they?

To prepare for this Assignment, review the information related to vertical and horizontal integration presented in the Learning Resources.

Select one of the following horizontally integrated health systems:

• National Surgical Hospitals
• Select Medical Healthcare
• Sunrise Senior Living
• Labcorp
• Quest Diagnostics
• Pfizer Pharmaceuticals

Also select one of the following vertically integrated health systems:

• Kaiser Permanente
• Mayo Clinic
• Cleveland Clinic
• MedStar Health
• Memorial Hermann Healthcare System Houston

As an alternative, you may use Becker’s Hospital Review resource to identify a vertically integrated health system.

Using the Walden Library and credible sources on the Internet, research your selected health systems. Investigate the rationale for pursuing integration and the strategies each health system has used to achieve integration. Note information related to the size of each health system, settings/locations, and types of services it provides.

Based on your research, consider the ways in which the two health systems are similar to and/or different from one another.

Assess the business and health care-related implications of horizontal and vertical integration of your selected health systems. How does integration impact the management of your selected organizations and the patients/consumers they serve, especially in terms of cost, quality, and access?

Consider any applicable insights you have gained through the Discussion for this week.

The Assignment

Write a paper in which you:

• Compare the horizontally integrated health system and the vertically integrated health system you have selected (e.g., size, settings/locations, and types of services).
• Explain each health system’s rationale for pursuing integration and the strategies it has used to achieve integration.
• Assess the business and health care-related implications of integration for your selected health systems, including how integration impacts the patients/consumers the organization serves.

General Guidance on Assignment Length: Your Assignment should be 3–4 pages, excluding a title page and references. Refer to the Week 4 Assignment Rubric for grading elements and criteria. Your Instructor will use the rubric to assess your work.

Required Resources

Readings

• Shi, L., & Singh, D. (2015). Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett.
  • Chapter 9, “Managed Care and Integrated Organizations” (pp. 361–368)
• Cohen, A., Klein, S., & McCarthy, D. (2014). Hill Physicians Medical Group: A market-driven approach to accountable care for commercially insured patients. Retrieved from http://www.commonwealthfund.org/~/media/files/publications/case-study/2014/oct/1770_cohen_hill_physicians_aco_case_study.pdf
• Cutler, D. M., & Morton, F. S. (2013). Special communication: Hospitals, market share, and consolidation. JAMA, 310(18), 1964–1970.
  Retrieved from the Walden Library databases.
• Sanford, K. D. (2013). Integration requires new roles and responsibilities. Healthcare Financial Management, 67(3), 56–60.
  Retrieved from the Walden Library databases.
• Summer, L. (2014). Research insights: Integration, concentration, and competition in the provider marketplace. Retrieved from http://www.academyhealth.org/files/publications/AH_R_Integration%20FINAL2.pdf

Use the following resources to select integrated health systems on which to focus for your Assignment. You may also use this list to develop background information as you research health systems in your area for the Discussion.

• Rodak, S. (2013). 100 integrated health systems to know. Retrieved from http://www.beckershospitalreview.com/lists/100-integrated-health-systems-to-know.html

Vertically Integrated Health Systems

• Cleveland Clinic. (n.d.). Retrieved March 27, 2015, from http://my.clevelandclinic.org
• Kaiser Permanente. (n.d.). Retrieved March 27, 2015, from http://kp.kaiserpermanente.org/
• Mayo Clinic. (n.d.). Retrieved March 27, 2015, from http://www.mayoclinic.org
• MedStar Health. (n.d.). Retrieved March 27, 2015, from https://www.medstarhealth.org/
• Memorial Hermann Healthcare System Houston. (n.d.). Retrieved March 27, 2015, from http://www.memorialhermann.org

Horizontally Integrated Health Systems

• Labcorp. (2014). Retrieved March 27, 2015, from https://www.labcorp.com/
• National Surgical Healthcare. (n.d.). Retrieved March 27, 2015, from http://www.nshinc.com
• Pfizer Pharmaceuticals. (n.d.). Retrieved March 27, 2015, from http://www.pfizerrxpathways.com/
• Select Medical. (n.d.). Retrieved March 27, 2015, from http://www.selectmedical.com
• Sunrise Senior Living. (n.d.). Retrieved March 27, 2015, from http://www.sunriseseniorliving.com/
• Quest Diagnostics. (n.d.). Retrieved March 27, 2015, from http://www.questdiagnostics.com/

Discussion: Discussing End-of-Life Care

There is a human tendency to postpone uncomfortable or unpleasant tasks.

—Nancy Kummer, geriatric patient

This human tendency to avoid the unpleasant makes end-of-life care and hospice decisions difficult for many patients to discuss with their families. Kummer is a former social worker who used to counsel patients with terminal illnesses, yet she avoided discussing her own end-of-life wishes with her children. While many Americans, like Kummer, agree that these discussions need to take place, few have actually had these conversations with their families (Lazar, 2012). Although initiating conversations about end-of-life care and hospice might be difficult for patients, as an advanced practice nurse, facilitating these conversations is an integral part of your geriatric nursing practice. For this Discussion, consider how you would facilitate care conversations with the patients and families in the following case studies:

Case Study 1

Mrs. Sloan, a 69-year-old widow, is about to enter the hospital for an elective cholecystectomy; she is being medically cleared by her primary care provider. During the discussion, she requests to be placed on a no code status during her hospitalization. Mrs. Sloan claims that besides her gallbladder problem, her general health status is good. She wishes to have the surgery to avoid any further attacks, which have been very painful. She states, however, that if during surgery or her postoperative period, she undergoes a cardiac arrest, she would prefer not to be resuscitated. She has read about the chances of successful resuscitation, and has determined that the risk of brain damage is too high. For this reason, she is requesting a no code status.

Case Study 2

Ms. Stearns is an 83-year-old nursing home resident with hypertension, coronary artery disease, arthritis, renal insufficiency, hearing impairment, and a previous history of stroke. She also has a foot deformity from childhood polio. She is disoriented at times. She has lived in the nursing home for 10 years and rarely leaves the chair beside her bed. She has recently developed urinary incontinence, but has refused a bladder catheterization to determine postvoid residual urine or possible bladder infection. She does not have a diagnosis of dementia; however, current testing reveals that she performs poorly on a standardized mental status examination. She can, however, identify all the staff in the nursing home, and she can describe each patient who has been in the bed next to hers over the past 10 years. When asked to explain why she does not want bladder catheterization, she gives several reasons. She states that the incontinence does not bother her, and that she has always been a very private person. She particularly dislikes and objects to any examination of her pelvic organs; in fact, she has never had a pelvic examination nor has she ever had sexual intercourse. She realizes that she has a number of medical problems and that any one of them could worsen at any time. She states she is not willing to undergo any treatment for any of her current problems should they become worse.

Case Study 3

Mr. Marley, age 91, is admitted to the intensive care unit following a stroke. The stroke progressed from mild hemiparesis and difficulty speaking to complete unresponsiveness and an inability to swallow. His daughter feels certain, based on prior explicit conversations with her father, that he would not want to have any treatment that would prolong his life and leave him in a severely disabled state. Mr. Marley’s oldest son disagrees with his sister’s assessment of their father. The son claims that their father still has a strong desire to live, and that he has been very active in his church until this stroke. Because Mr. Marley cannot swallow, he cannot be fed. The family is asked about insertion of a feeding tube. It is explained to the family that without food and fluids, their father will die fairly quickly. There are no existing advance directives or a designated health care decision maker noted for Mr. Marley.

To prepare:

• Review Chapter 14 of the Holroyd-Leduc and Reddy text.
• Reflect on the role of the advanced practice nurse in facilitating the discussion of end-of-life care with patients and their families.
• Think about how you, as an advanced practice nurse, would approach a family who wants “everything” done for a patient with only a limited time to live.
• Consider when it is appropriate to involve hospice and how to approach patients and/or families who refuse hospice services.
• Select one of the three provided case studies related to the end-of-life care of the frail elderly. Reflect on potential patient outcomes and how you would facilitate the discussion of care with this patient’s family.

By Day 3

Post an explanation of the role of the advanced practice nurse in facilitating the discussion of end-of-life care with patients and their families. Explain how you would approach a family who wants “everything” done for a patient with only a limited time to live. Then, explain when it is appropriate to involve hospice and how to approach patients and/or families who refuse hospice services. Finally, explain potential outcomes of the patient in the case study you selected and how you would facilitate the discussion of end-of-life care with this patient’s family.

Week Four Paper will address and answer the following three sets of questions:

•                                             FOR QUESTION ONE:

Read the  article, “Protecting Yourself from Malpractice Claims” found at

https://americannursetoday.com/protecting-yourself-from-malpractice-claims/ (Links to an external site.)Links to an external site.

Read the article, “Nurses, Negligence, and Malpractice” found at:

http://www.nursingcenter.com/journalarticle?article_id=423284 (Links to an external site.)Links to an external site.

Read the article, “7 Legal Tips for Safe Nursing Practice”    (you will need to copy and paste the link below into your browser)

7 legal tips.pdf  (INCLUDED AS ATTACHMENT)

1. In connection with the readings relating to negligence/malpractice answer the following:

a. What was the most important information you gained from these articles?
b. What are the elements that must be present for there to be a valid claim of negligence?

Comment on this scenario: A comatose patient is admitted with a UTI. The RN documents turning the patient every 2 hours, but actually did not. The UTI resolves and the patient is discharged without any other changes in prehospital condition.

c. Was the RN negligent? Why or why not? 
d. Was the RN’s behavior ethical, why or why not? 
e. Would any of your answers change, and if so how,  if the patient had developed a bedsore during the hospitalization?

                                                        FOR QUESTION TWO:

Read the summary of Supreme Court case that reviewed Oregon Death with Dignity Act found at:

http://en.wikipedia.org/wiki/Gonzales_v._Oregon (Links to an external site.)Links to an external site.

Read the story of Brittany Maynard found at:

http://www.washingtonpost.com/news/morning-mix/wp/2014/11/02/brittany-maynard-as-promised-ends-her-life-at-29/ (Links to an external site.)Links to an external site.

 Read the case of Gonzalez v. Oregon, found at:

http://scholar.google.com/scholar_case?case=17055043890936848595&hl=en&as_sdt=2&as_vis=1&oi=scholarr (Links to an external site.)Links to an external site.

Read “ Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls” found at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/ (Links to an external site.)Links to an external site.

Review State-by-State Guide to Physician-Assisted Suicide found at:

http://euthanasia.procon.org/view.resource.php?resourceID=000132 (Links to an external site.)Links to an external site.

1. In connection with the topics of Euthanasia and Assisted Suicide, address the following:

a.       What is the difference between Euthanasia and Assisted Suicide?
b.      Explore your thoughts and feelings on the legality of assisted suicide and euthanasia. Should Florida follow Oregon?
c.       What guidance on this topic is found in the ANA Code of Ethics (Hint: Interpretive Statement to Provision One)?
d.      What is ANA’s position on Euthanasia and Assisted Suicide as expressed in its Position Statement on the topic?

                                                          FOR QUESTION THREE:

Read the article, “How We Die” found at: and answer question three. 

http://tuftsjournal.tufts.edu/2010/03_2/features/03/ (Links to an external site.)Links to an external site.

1. What actions could have been taken to prevent this situation from occurring? Describe how refusing treatment differs from euthanasia or assisted suicide.

Refer to “Sallie Mae Fisher’s Health History and Discharge Orders” for specifics related to the case study used to inform the assignment.

Using “Home Visit With Sallie Mae Fisher” and “Sallie Mae Fisher’s Health History and Discharge Orders,” complete the following components of this assignment:

Essay Portion

After viewing the home visit, write an essay of 500-750-words in which you do the following:

1. Identify, prioritize, and describe at least four problems.
2. Provide substantiating evidence (assessment data) for each problem identified.
3. Identify and describe at least four medical and/or nursing interventions.
4. Discuss your rationale for the interventions identified.

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

Max Points: 150

Details:

Examine the high-risk nutritional behaviors associated with different cultures. Identify the historical perspectives, belief systems, and other factors associated with these high-risk nutritional behaviors for each culture. Write a 1,500-3,000 word paper on your findings in which you accomplish the following:

1. Summarize the high risk-nutritional behaviors practiced among 10 different cultures.
2. Discuss the historical perspectives and belief systems of these cultures that influence the high-risk nutritional behaviors.
3. Explore additional influencing factors on high-risk behaviors for each culture. These may include, but are not limited to (a) education, (b) family roles, (c) spiritual beliefs, (d) health care practices, and (e) drug and alcohol use.

This paper requires minimum of six outside resources in addition to the textbook, properly documented using APA guidelines.

Prepare this assignment according to the APA 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.