Answer

Access, Cost and Quality Environments

There are three overriding goals focused on implementing change to healthcare system in the US such as quality, access and quality variables. According to Cox (2009), no person argues that health care access needs to be improved as more than 45 million Americans lack health coverage.

Meaning

Access

                Access to health care suggests that the members of a community can have a timely use of Personal health services with an aim of achieving the best health outcomes. According to the Agency for Healthcare Research and Quality (AHRQ), the access to healthcare is composed of four primary components such as coverage, services, timeliness and workforce (AHRQ, 2020). Coverage facilitates an entry into the system of health. The less insured people in the community are less likely to obtain quality care and increasingly likely to have poor health status. Services provide a foundational bass for the source of care which is includes the adults receiving the necessary screening and prevention services for a better health outcome. Timeliness refers to the ability to offer health care in the events when need is recognized. Workforce provides an insight into the qualified, capable and culturally competent care providers (AHRQ, 2020).

Cost

                According to Burke and Ryan (2014), health care is highly costly in the United States. Despite the increase in the rate of growth in spending, per capital spending in healthcare is considered to be between 50 and 200 percent higher in the US in comparison to other countries which are developed economically. Although the US health system is ranked top in costs, the region ranks 26^th in the world when it comes to life expectancy and further ranks poorly on quality indicators (Burke & Ryan, 2014). The two variables provide an indication that the health care system of a low value and that the researchers should strive to identify the specific sources of the wasteful spending.

Quality

                The worsening quality indicators within the field of health influences the trust of the members the public. Despite the possibility that the quality of care provided in hospitals can be enhanced, the quality levels of the healthcare offered to the patients in institutions have remained to be operational and conceptually vague (Allen-Duck, Robinson & Stewart, 2017). In the health care field, quality refers to the means of offering the care required to satisfy the needs of the patient in a safe, affordable and effective manner. Healthcare quality also suggests engaging and involving the patient to ensure that he/she takes the ownership in the field of preventive care as well as in the treatment of the conditions already diagnosed (Allen-Duck, Robinson & Stewart, 2017).

Initiative

                One of the healthcare initiatives to be considered in this case is the AHCA Quality initiative. The national and the multi-year initiative are focused on the improvement of care in post care settings in America. Since the initiative was launched, the members have been challenged to meet the required quality challenges in the administration of services within the acute care settings such as antipsychotic usage and hospitalizations. With the initiative, significant improvement have been recorded within the American healthcare system as reflected by the reduction in the number of patient hospitalizations and customer satisfaction rates.

Relationship between the Quality Measures

                Cost and access are directly related concepts. Evidently, when the cost of health care is significantly high, the rate of the care services access will be limited. According to Burke and Ryan (2014), cost and quality of care have a complex relationship. Notably, in the US is it evident that cost of care influences the quality of services administered to the patients. Even with the existing policy consensus focused on containing the high costs of care in the US and improving on the critical quality factors, improving quality will always result to an increased cost of care. Inversely, a reduction in the costs also foresees a significant decline in the quality of the care services administered to the patients. Hussey, Wertheimer and Mehrotra (2013) argue that the quality improvements can also be effective in lowering the costs by reducing the potential complications likely to be experienced by the patient as well as the instances of hospital readmissions (Hussey, Wertheimer & Mehrotra, 2013). Generally, the association between the quality and costs of aspects such as patient falls between the two indicators suggests that the two concepts can have an inverse relationship.

                Cost and access measures in health care are also directly related constructs. Heath (2017) provides an indication of the fact that high out-of-pocket costs make it difficult for the patients to access health care. Studies have supported this finding by relaying that increasing the cost burden and the utilization of the health services suggests that when the patients are required to pay more for the health services while accessing treatment.

                Low access to care further influences a patient’s quality of health. Mosadeghrad (2014) argues that quality healthcare is not only subjective but also a complex multi-dimensional concept. Evidently, quality healthcare is defined as consistently delighting the patient through the provision of effective, efficacious and efficient health services based on the clinical standards and guidelines which satisfies the patient needs as well as that of the providers. Quality healthcare includes aspects such as accessibility, availability, affordability, privacy, timeliness, and confidentiality among others (Mosadeghrad, 2014). Access of care and quality are considered as directly related concepts. According to APNs Allen-Duck, Robinson and Stewart, (2017), access to care will influence the overall social, physical and mental health status of the quality of life. Different factors influence how people access health care services such as the lack of insurance coverage, the inexistence of a culturally form of competent care, and the availability of services.

The Relationship between Quality Measures and Evaluation and Role Development

                The quality measures in the field of healthcare should be provided with a priority in the field of healthcare especially when evaluating the effectiveness of the health care system. Notably, when the level of health care access in a particular destination is high, it can be derived that the system of health care is effective as most people in the region will obtain quality care to suggest an effective form of care administration to promote a positive health outcome. Moreover, the quality measure can be used to evaluate the effectiveness of the system in that a high rate of effectiveness provides a depiction of the fact that the system being analyzed is effective to deliver quality care to the to target population. High costs of healthcare services offered by a health care system suggests that the system is detrimental an ineffective especially to the members of the community.

                Quality measures such as the cost, quality and access to the health care system can be used by healthcare practitioners when it comes to role development. For instance, considering the role of the APNs, it is evident that the quality measures are effective in determining the role that the professionals will undertake in accomplishing their roles in the health care field. For instance, the high costs of health care direct health care professionals to take part in healthcare policy development to regulate the costs of healthcare for the benefit of the community members APNs (Allen-Duck, Robinson, & Stewart, 2017).

Describe this relationship and note how the role of the APN might change without effective quality measures.

                Factors such as the quality of care and productivity can be measured by how the nurses available in the advance practice are utilized. The global growth of the nurse practitioner workforce on an annual basis is higher than that of the physicians by at least three times. The primary role of the APNs is to take part in complex decision making processes in matters associated with patient care. The APNs are also directly responsible of ensuring that the primary care needs of the members of the underserved and rural population are met due to the lack of the primary care physicians. Primary care has a first contact with the patients and subsequently offers a continuity of care through the care coordination as guided with the needs of the community APNs (Allen-Duck, Robinson, & Stewart, 2017).

                The quality of care offered by the APNs should be comparable to that offered by the physicians to ensure that the primary care needs are met. This provides an indication that all the quality measures should be effectively met. For instance, the cost, access and quality care should be met when administering primary care to the members of the vulnerable community. Since the advance nursing practice was incepted in primary care, its role has been extended to the other acute care settings. The primary aim of the acute care settings is to ensure that the people are provided with a better access to healthcare. However, when the quality measures are lacking, a change is experienced in the role of the APNs (Allen-Duck, Robinson, & Stewart, 2017). For instance, the nurses will no longer take part in decision making regarding the requisite form of care to be administered to the patients to ensure that their healthcare needs are addressed.