Getting past widgets and digits: the fundamental transformation of the foundations of nursing practice

Health reform and transformation now call for the creation of a new landscape for nursing practice based on intentional translation application of value-driven measures of service, quality, and price. Nursing is a central driver in the effective recalibration of health care within the rubric of health transformation under the aegis of the Patient Protection and Affordable Care Act. Increasingly relying on a growing digital infrastructure, the nursing profession must now reframe both its practice foundations and patterns of practice to reflect emerging value-driven, health-grounded service requisites. Specific nursing responses are suggested, which position nursing to best coordinate, integrate, and facilitate health delivery in the emerging value-driven service environment.

Seventy-five years of policy on alcohol problems: an American perspective

OBJECTIVE

This article traces the evolution of alcohol-related social policy over the past 75 years.

METHOD

The literature was reviewed and is critically discussed.

RESULTS

The social history of alcohol policies over the last 75 years began with the scientific approach to alcohol in the 1930s and later shifted to a central interest in the disease of alcoholism. Beginning with the National Council on Alcoholism Education, advocates struggled to "mainstream" treatment for this disease into the health care system. Major steps included decriminalization of public intoxication, emphasis of the social respectability of persons with alcohol problems, development of a treatment system that was accompanied by health insurance coverage, and work-based programs to identify and attract employed patients with health insurance coverage. These structures were considerably altered by the War on Drugs, managed care, and the merger of drug and alcohol treatment. The Affordable Care Act, however, has the potential for achieving the mainstreaming goals for alcohol problems originally conceived in the early 1940s.

CONCLUSIONS

Responsible involvement of the alcoholic beverage industry could greatly enhance current activities but is not likely to occur. Stigma persists in part because of associations with prevention and treatment of illegal drug use problems. The Affordable Care Act offers opportunities and challenges to the specialty of treating alcohol use disorders.

Healthcare reform 101

The intent of the Affordable Care Act is to ensure that all Americans have access to quality, affordable healthcare while significantly reducing the cost burden for this country. It is estimated that an additional 32 million individuals will be covered. The Congressional Budget Office (CBO) estimates this legislation will reduce the deficit by $143 billion in the first 10 years (2011-2020) with an additional $1.2 trillion in savings during the subsequent decade. comprehend and change. That is why it has taken so long to pass any legislation related to this issue. We are almost 50 years post-introduction of Medicare and Medicaid and while there has been much dialogue and a number of infamous attempts to tackle the issue, the ACA is the first successful attempt to pass legislation. History will tell if Congress and the President "got it right" but the alternative of doing nothing was also unacceptable. One might predict that some of what has been legislated and already implemented will stand and result in positive change (i.e. the focus on preventive health and wellness) while other aspects will require change - some minor and some major. We are already seeing changes and timelines that are being modified and delayed. This is a topic that will require an ongoing assessment and look-back to see what was done correctly and what needs to be changed.

Implications of the Affordable Care Act for people with HIV infection and the Ryan White HIV/AIDS Program: what does the future hold?

There are numerous aspects of the Patient Protection and Affordable Care Act that will be important for people in the United States with HIV infection, including consumer protections and private insurance reforms, establishment of health care marketplaces in every state, new benefit standards, Medicare fixes, prevention enhancements, expansion of Medicaid, and health system improvements. However, it is unlikely that these changes will address all the needs of people with HIV infection in the United States. The Ryan White HIV/AIDS Program will thus remain crucial for the provision of adequate health care to HIV-infected individuals, but it will need to change. Changes in the role of the Ryan White HIV/AIDS Program will depend largely on state decisions on Medicaid expansion and health care marketplaces. This article summarizes a presentation by Jennifer Kates, PhD, at the IAS-USA continuing education program held in New York, New York, in April 2013.

Academic medicine in turbulent times

Long respected as centers of research and educational excellence, many traditional academic medical centers (AMCs) realize that their research and educational missions will be difficult if not impossible to sustain, if all the federal funding cuts discussed in anticipation of the "fiscal cliff" occur. To set the context for this perfect storm, we will review the many issues that will affect all hospitals and then focus on the three that will disproportionally affect academic medical centers ... and keep "CEOs up at night." Aside from a case of CEO chronic insomnia, how do we expect AMCs to weather this perfect storm? Whereas the fundamental emphasis remains on highly specialized and complex care, AMCs are increasingly developing innovative approaches for managing patients across the continuum of care and strengthening their ability to manage patients with high-cost, chronic conditions.