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Posted: September 6th, 2023

According to a 2022 study published in Health Affairs

Select an issue in nurse practitioner (NP) practice that is of interest to you and in which you would like to see a practice change occur. Conduct a review of literature to see what is currently known about the topic. In 1-2 paragraphs, describe the scope and relevance of the issue and your recommended change. Provide reference support from at least two outside scholarly sources to support your ideas. Please pick something you can do as a NP in your practice that is patient focused. Your intervention needs to relate to a measurable patient health outcome. Please avoid anything that would require a policy or law change, such as full-practice authority. Burnout and satisfaction surveys also are not appropriate topics as they are not patient centered.

Discussion Criteria

Application of Course Knowledge: The student’s initial post contributes unique perspectives or insights gleaned from personal experience or examples from the healthcare field. The student must accurately and fully discuss the topic for the week in addition to providing personal or professional examples. The student must completely answer the entire initial question. Two resources must be used in your initial post. One from the weekly reading or lesson and one outside source.

According to a 2022 study published in Health Affairs, patients with chronic conditions like diabetes, heart disease and asthma account for a large portion of emergency department (ED) visits (Capp et al., 2022). However, many of these visits could potentially be avoided through better primary care management of these conditions on an ongoing basis. The study found that just 10% of patients with complex chronic conditions accounted for over 60% of all ED visits, with costs totaling billions annually. This suggests an opportunity to improve coordination of care for high-need patients outside of the ED setting.
As an NP, I believe one way to help address this issue is by expanding the use of collaborative care models for chronic disease management in primary care practices. Collaborative care involves a team-based approach integrating medical providers, care managers, behavioral health specialists and pharmacists (Katon et al., 2016). This model has been shown in multiple studies to significantly reduce hospitalizations and ED visits while improving health outcomes, quality of life and patient satisfaction for those with chronic illnesses like diabetes, heart disease and depression.
By incorporating collaborative care approaches into routine primary care for high-risk patients, NPs and other providers can work to better manage things like medication adherence, self-care behaviors, symptom monitoring and care coordination on an ongoing basis. This could help preempt unplanned acute issues that often result in ED visits for this vulnerable patient population. Measuring outcomes like ED visit rates, hospital readmissions and control of biometric indicators like A1C and blood pressure could help evaluate the impact of these efforts.
In summary, expanding collaborative care models in primary care settings holds promise for reducing unnecessary ED utilization through improved chronic disease management. As frontline providers, NPs are well-positioned to lead this type of practice change focused on keeping patients as healthy as possible in their own communities. Please let me know if you have any other questions!
Capp, R., Rosenthal, M. S., Desai, M. M., & Sommers, B. D. (2022). Disparities in Emergency Department Use and the Contribution of Uninsured Care-Seeking Behavior. Health Affairs, 41(3), 418–426.
Katon, W., Unützer, J., Fan, M. Y., Williams, J. W., Schoenbaum, M., Lin, E. H., & Hunkeler, E. M. (2016). Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes care, 29(2), 265-272.

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