Using the article listed below as a starting point, write a 1500 word white paper. A white paper is typically written to advocate for a particular position or solution to a problem (http://owl.english.purdue.edu/owl/resource/546/01/).
 

Collaborative Healthcare Leadership: A six-part model for adapting and thriving during a time of transformative change. Retrieved from
http://www.ccl.org/leadership/pdf/research/CollaborativeHealthcareLeadership.pdf is one example of a white paper written by an organization in support of the Center for creative Leadership.
 

Menaker, R. (2009). Leadership strategies in healthcare. The Journal of Medical Practice Management : MPM, 24(6), 339-343.
 

You may take your research in any direction that you think makes sense given your chosen starting point. Include a minimum of 5 additional scholarly/professional resources.
 

Parameters:   
The paper should be 1000-1500 words. Be in the appropriate format for a white paper, utilize the APA, 6th Edition, format for citations and references as appropriate. All facts should be supported by references: 

• Sources may not include Wikipedia.com, other wikis, ASK or ABOUT – or any other site that gives you an answer.  

PLEASE RESPOND TO THIS DISCUSSION APPROPRIATELY  

The average length of stay (ALOS) in hospitals, Long Term Acute Care Hospitals (LTACHs), and rehab hospitals is trending shorter and shorter.  Medicare (MCR) along with insurance companies (managed care) that contract with MCR has set their sites on shorter stays to decrease spending.  They have, in essence, created a grading rubric that ALOS is 85% of the grade. This leaves all providers and clinicians with little say as to whether the patient discharges at the appropriate time. The days of sending a patient to a rehabilitation hospital where they can receive aggressive therapy while also being medically taken care of are going away (“Length-of-Hospital”, 2017).

            In mandating short stays in hospitals and not approving LTACHs and rehabilitation hospitals, one might presume that this is good for skilled nursing facilities (SNF), but that would be wrong because they have now demanded short stays in SNFs as well.  One insurance company has now mandated that a SNF has to have a patient on their service out in 17 days. In dealing with these issues daily this seems to be a trend that will be long-standing as more and more insurance companies are making these demands.

            LTACHs are great places for patients to go that are in need of acute care, but for a longer length of time. Originally, LTACHs were seen as the better choice than keeping a patient in an acute hospital due to lower reimbursement. However, MCR has now changed their reimbursement for LTACHs in that the shorter the stay the more reimbursement they can receive (Kim, et al., 2015).

            In shortening the length of stay for patients in almost every venue, this process can save a substantial amount of money for the government, but at what cost for many patients? Due to the rules on short stays, nurses and doctors witness patients being discharged sooner than their conditions warrants. The positive side is that SNFs have to increase their skill-set because many patients who would have went to an LTACH or rehabilitation hospital are now being denied by companies, but approved for SNF stays. This puts SNFs in a position because scope of practice laws in each state can limit what can be done in a SNF due to the fact that most nurses in SNFs are Licensed Practical Nurses and very few Registered Nurses. Even though a SNF may see a small increase in census, they are not seeing a raise in reimbursement which makes it difficult to have Registered Nurses in the facility.

            There are so many aspects to these changes that many people do not know or understand, but the bottom line is the outcome of patients while trying to keep costs manageable.

“Length-of-Hospital”. (2017, November 5). Length of hospital stay. Retrieved from OECD Data: https://data.oecd.org/healthcare/length-of-hospital-stay.htm

Kim, Y. S., Kleerup, E. C., Ganz, P. A., Ponce, N. A., Lorenz, K. A., & al., e. (2015). Medicare Payment Policy Creates Incentives For Long-Term Care Hospitals To Time Discharges For Maximum Reimbursement. Health Affairs; Chevy Chase Vol. 34, Iss. 6, (Jun 2015): 907-915,1-26. DOI:0002035579; 10.1377/hlthaff.2014.0778, 5.

eliability

Discussion.

From the U.S. Preventive Task Force website https://www.uspreventiveservicestaskforce.org/BrowseRec/Index (Links to an external site.)Links to an external site., choose one screening test that might be considered in primary care.

Define the test, its positive predictive value, reliability and validity. Discuss patient medical or family history that may alter your recommendation for screening?

 

  

Direct Quotes 

Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category. 

Sample 

One screening test that might be considered in primary care is cervical cancer screening. Cervical cancer is a leading cause of cancer deaths among women worldwide, however, the number of cases and number of deaths in the United States have decreased drastically. In 2014, 12,578 women were diagnosed and 4,115 women have died from cervical cancer (Centers for Disease Control and Prevention [CDC], 2017). It is commonly diagnosed and is one of the most successfully treated cancers.

     Cervical cancer screening is an essential part of a woman’s routine health checkup. Cytology screening or papanicolaou (Pap) test and the human papillomavirus (HPV) test are used for early detection of cervical cancer. Pap test is used to detect abnormal cervical cells including precancerous lesions before developing into cancer or cancer itself. It can also detect other conditions such as infections and inflammation. The HPV test is used to detect the virus in cervical cells that may have changed (CDC, 2017). The U.S. Preventive Services Task Force (USPSTF) recommends women ages 21-29 to screen for cervical cancer using cytology every 3 years. For women ages 30-65 a combination of cytology and HPV testing is recommended every 5 years (Hofmeister, 2016).

     Positive predictive value is the probability of patients who test positive who have the disease (Gordis, 2014). According to Gordis (2014), validity determines between who has a disease and who does not have a disease. Sensitivity and specificity are two elements within validity. Sensitivity tests to identify those who have the disease and specificity tests to identify those who do not have the disease (Gordis, 2014). Reliability refers to consistency. For example, a test that is repeated more than once resulting with the same or similar results.

     Patient history may alter recommending cervical cancer screening more than family history because it is mostly sexually transmitted. Women who have a compromised immune system, who have human immunodeficiency virus (HIV) infection, who have had prior abnormal results, who have been exposed to diethylstilbestrol (DES) in utero, who have a hysterectomy, and who have had previous treatment of a high-grade precancerous lesion are at an increased risk for cervical cancer (Hofmeister, 2016). Cervical cancer screening should be provided to all women in a primary care setting. It is a preventable disease with the effectiveness of early detection and early treatment.

 Reference

Centers for Disease Control and Prevention. (2017). Cervical cancer statistics. Retrieved from https://www.cdc.gov/cancer/cervical/statistics/index.htm (Links to an external site.)Links to an external site.

Gordis, L. (2014). Epidemiology (5th ed.). Philadelphia, PA: Elsevier Saunders.

Hofmeister, S. (2016). Cervical cancer screening: How our approach may change. Journal of Family Practice, 65(8). 551-553.

  

As healthcare providers, we look more and more to technology to improve patient outcomes, streamline operations, and lower costs. Sometimes, technology can be used in ways that have ethical, moral, and legal considerations too. You will be writing about the use of personal devices and social media and its use in healthcare. We can do it, but dare we?

This is a “think outside the box” assignment in which there is not necessarily only one right answer. Still, you are required to find sources that support your opinions. Be sure to cite and reference them in your paper. The running head of the paper will be—We can do it, but dare we?

The length of the paper should be four to five pages, excluding the title page and reference page. Limit the references to minimum of 4 to 5 references. The Paper will contain an introduction that catches the attention of the reader, states the purpose of the paper, and provides a narrative outline of what will follow (i.e,the assignment criteria).

In the body of the paper discuss the scenario in relation to HIPAA, legal and other regulatory requirement that apply to the scenario and the ending you choose. Demonstrate support from sources of evidence included as in- text citation.

Choose and identify one of the four possible endings provided for the scenario and construct your paper based on its implications to the scenario. Make recommendations about what should have been done and what could be done to correct the problems caused by the scenario and the ending you chose. Demonstrate support from sources of evidence included as in-text citations.

Present the advantages and disadvantages of using smart phones and social media in health care and describe professional and ethical principles to the appropriate use of this technology, base on the facts from supporting sources of evidence, which must be included as in-text citations.

The paper’s conclusion should summarize what you learned and make reflections about them to your practice.

Please and please this paper should be 100% free plagiarism.

 

Artistic Change in Sculpture

Relative to human history, the period covered in this week’s study is long. During this lengthy span of years, not only did people change in appearance, but the way they lived also changed radically. What we have found of their art and architecture also demonstrates an evolution in these areas.

Using your eBook, find one example of sculpture from each of the following periods: Paleolithic, Neolithic, and Bronze OR Iron Age.

View these sculpture pieces carefully. Capture an image of each of the three sculptures and place them in chronological order, from oldest to newest, in this template. Then, using information from your textbook, lectures, and other appropriate academic sources, provide the following regarding each image:

1. The title of the work, its location, the materials used to create the work (if known), and the date.
2. A brief assessment of the visual properties you observe. Describe the types of lines, shapes, colors and textures (actual and perceived) the artist has used.
3. An analysis of the formal structure of each piece. What is the meaning or importance of how the artist has arranged, organized, or structured the visual elements in the image?
4. The natural subject of each piece. Based on your textbook reading and Internet research, are there any details that have a symbolic meaning? If so, what?
5. A five- to seven-sentence paragraph that discusses the cultural context of each work, based on what you have learned through your textbook reading, the online lectures, and Internet research. What do the images tell you about the culture and the people who created them?
6. List of references, including the specific websites where you found the images.