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If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption? These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed. In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue. To Prepare: Review the Resources and select one current national healthcare issue/stressor to focus on. Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting. By Day 3 of Week 1 Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples. By Day 6 of Week 1 Respond to at least two of your colleagues on two different days who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor. Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message. Will be adding two discussions that will need at least three references all in APA 7 format each. will be included in this payment. The mail discussion will need at least 3 references and also in APA 7 format Adams Discussion Current Healthcare Issue National Healthcare Stressor The last decade in healthcare has been volatile at best with the adoption of the Affordable Care Act (ACA) and performance-based payment systems, the ever-increasing polar divide between our political party’s healthcare theories and the never ending back and forth political discord that threatens to blow it all up and start over with something better, but never explained in detail. One of the constants that I continue to see is the increase in psychiatric patients coming into the hospital that I work. A number of these patients are undiagnosed with a psychiatric diagnosis or cannot find a provider that is seeing new patients. Many providers that are seeing new patients currently have wait times four weeks out. Someone that is experiencing psychiatric symptoms this wait could have a derailing effect on the efficacy of the treatment.   The number of patients needing psychiatric treatment in the United States is increasing and roughly one-third of the 10 million Americans are diagnosed with a psychiatric disorder but not getting treatment. (Olfson, 2016) One of the reasons for this is the lack of providers in the psychiatric specialty. With reimbursement rates falling lower than many other specialty services many institutions are struggling to cover salaries. With more than 60% of current providers aged 55 years or greater, this is also adding to the decreasing numbers. Another factor, is the increase in acceptability in discussing mental health issues and seeking out treatment. According to Weiner, (2018), with more patients seeking treatment, current providers are unable to increase their treatment numbers.  Impact on work setting The institution that I work at is a safety net hospital that provides medical and social care to a population where 70% live at or below the poverty line. Many of these patients have undiagnosed or unmanaged psychiatric disorders that provide harm and are a detriment to their medical issues such as diabetes, cardiac issues and COPD. Working nights, I am accustomed to doing more with less. One of the challenges that I face constantly is the lack of psychiatric evaluations once a patient leaves the emergency department. Medical teams are forced to make psychiatric pharmaceutical decisions off the cuff until 7 AM when the psychiatric team rounds on a particular patient. This is particularly difficult on patients and staff alike. Respondence to the issue To create a discussion on this our staff used our unit council to speak to the Director of Critical Care, Nursing and Medicine, inviting the Psychiatric department to our monthly unit council meeting in hopes to better understand why this was not a priority as well as speaking to the Vice President of Nursing and the Medical Director about the importance of psychiatric services outside the emergency room on a 24 hour basis. After years of voicing concerns to upper Medicine and Nursing Management our institution increased inpatient psychiatric coverage to 24 hours per day.  Patients in need of psychiatric evaluations who have made in past the emergency room have an opportunity to be treated when they arrive on our unit. Our ICU team now has a partner when questioning what type of medication to give an irate patient who is a danger to himself or others. This intervention exemplifies the use of the quadruple aim approach with its increase in global health, improving patient experience, lowering costs and improving work-life for our staff. (Jacobs et al., 2018) References: Jacobs, B., Heinmiller, J., McGovern, J., & Drenkard, K. (2018). Engaging Employees in Well-Being: Moving From the Triple Aim to the Quadruple Aim. Nursing Administration Quarterly, 42(3). https://doi.org/10.1097/NAQ.0000000000000303 Olfson, M. (2016). Building The Mental Health Workforce Capacity Needed To Treat Adults With Serious Mental Illnesses. Health Affairs, 35(6), 983–990. https://doi.org/10.1377/hlthaff.2015.1619 Weiner, S. (2018, February 12). Addressing the escalating psychiatrist shortage. AAMC. https://www.aamc.org/news-insights/addressing-escalating-psychiatrist-shortage. Rebeccas Discussion Review of Current Healthcare Issues   National Healthcare Issue/Stressor          Healthy People is a set of strategic goals released by the U. S. Department of Health and Human Services designed to measure progress toward specific health objectives aimed at enabling people to live long and healthy lives. Healthy People 2020 is the fourth Healthy People initiative released.  It includes the goal of improving mental health through prevention and by ensuring access to appropriate, quality mental health services (Healthy People, 2020).  Mental health disorders such as anxiety, depression, and substance abuse are increasing in prevalence and most cases of mental illness occur earlier in life. The disease burden and costs associated with untreated or under-treated mental health disorders are rapidly increasing. Mental health disorders are a common cause of disability and suicide is the 10th leading cause of death in the U.S. In addition, our country will see a heavier mental health burden due to the COVID-19 pandemic (Stephenson, 2020). Therefore, it is crucial to include mental health objectives in the Healthy People goals, to measure our progress, and to recognize the importance of meeting these goals.     Impact on Work Setting           Currently, I work for a large health insurance company where I conduct medical necessity reviews of behavioral health treatment modalities to include both inpatient and outpatient care.  Our company has seen sharp increases in the need for behavioral health treatment to include inpatient mental health stays, inpatient detox stays, partial hospital stays, and intensive outpatient therapy.  More behavioral health clinicians had to be brought on and trained to meet this current demand. Another impact to my work setting involves the fact that poor mental health has negative impacts on physical health. Untreated mental illness can lead to chronic diseases which drive up the cost of health care.  Active treatment of mental health issues, as opposed to prevention and early intervention, is more costly.   Responding to the issue          Our company firmly believes in quality, cost-effective care and awards facilities that meet these milestones.  We continuously assess and update our guidelines and coverage policies to reflect this. The company recognizes that mental health treatment is not a one-size-fits-all approach.  Recently we changed guidelines for reviewing substance abuse treatment to the American Society of Addiction Medicine (ASAM) guidelines.  This approach looks at the whole patient by assessing 6 dimensions that consider a person’s needs and severity of illness to help develop a treatment plan. The premise is that patients can be assigned to treatments that “yield the best outcomes in the least restrictive and costly settings” (Stallvik et al., para 8). By reviewing against these guidelines, we are ensuring that patients get the appropriate treatment at the appropriate time.            The company has been educating staff on current behavioral health trends, new treatments, and the impact of the COVID pandemic. We have an active behavioral health case management team that reaches out to patients before, during, and after treatment to ensure they are set up with the necessary follow up. We encourage and assist patients with finding primary care providers.  Park et al. (2018) state that primary care produces a higher quality of care, improves access and outcomes, and lowers cost.  Additionally, one of our nurse leaders recently posted an informative series about the social determinants of health and the importance of helping our patients overcome barriers so they can achieve their best physical and mental health.  An organization needs effective leaders like this who can bring these issues to the forefront and encourage others to become active participants in the change process (Broome & Marshall, 2021). The company’s website includes links to many resources such as food pantries, ride- sharing, and mental health services.  By making this information readily available, we are making efforts to increase prevention and early intervention. As a whole, I believe the company has responded well to the national healthcare issue of mental illness and I feel confident that we will continue to look for ways to improve patient access and patient outcomes.     References  Broome, M., & Marshall, E.S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY:         Springer.   Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2020: Mental health and mental disorders. Retrieved November 28, 2020         from  https://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-disorders  Park, B., Gold, S.B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary care and its impact on the        Quadruple Aim. Journal of the American Board of Family Medicine, 31(4), 588-604.   Stallvik, M., Gastfriend, D.R., & Nordahl, H. M. (2015). Matching patients with substance use disorder to optimal level of care with the ASAM Criteria        software. Journal of Substance Use, 20(6), 389-398.  https://doi.org.ezp.waldenulibrary.org/10.3109/14659891.2014.934305  Stephenson, J. (2020). CDC report reveals “considerably elevated” mental health toll from COVID-19 stresses. Retrieved November 29, 2020 from         https://jamanetwork.com/channels/health-forum/fullarticle/2770050 

 
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