Analysis: Hospital Nurse Staffing and Quality of Case Essay

Hospitals with low shield staffing levels tend to have high range of poor enduring outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections, agree to search funded by the Agency for healthc atomic number 18 Research and Quality (AHRQ) and others. Yet increasing staffing levels is not an easy task. Major factors contributing to begin staffing levels include the inevitably of to solar days higher alertness forbearings for more fright and a nationwide gap between the number of available positions and the number of registered have gots (RNs) qualified and will to fill them. This is evident from an average va drive outcy rate of 13 per centum.This report summarizes the findings of AHRQ-funded and other inquiry on the relationship of blow staffing levels to ominous patient outcomes. This precious information can be used by decisionmakers to make more informed choices in terms of adjusting nurse staffing levels and increasing nurse recruitment tranc e optimizing part of cargon and improving nurse satisfaction. continue over the next two decades. A Federal Government adopt predicts that hospital breast feeding vacancies will r for each one 800,000, or 29 percent, by 2020.2 The number of nurses is expected to grow by tho 6 percent by 2020, while demand for care for compassionate is expected to grow by 40 percent. The most recent research shows a jump of 100,000 RNs, or 9 percent, in the hospital RN workforce between 2001 and 2002 because of increased demand, higher pay, and a weakening economy. However, since almost all of theMaking a DifferenceLower levels of hospital nurse staffing are pertaind with more ominous outcomesPage 3 Patients have higher acuity, yet the skill levels of the nursing staff have declinedPage 5 Higher acuity patients and added responsibilities increase nurse workloadPage 5 Avoidable unfortunate outcomes such as pneumonia can raise treatment costs by up to $28,000Page 6 Hiring more RNs does not dec rease profits Page 6 Higher levels of nurse staffing could have positive impact on two quality of care and nurse satisfactionBackgroundPeriods of high vacancy rank for RNs in hospitals have come and gone, but the current shortage is different. check to a 2002 report by the workforce commission of the American Hospital Association, the nursing shortage reflects fundamental changes in population demographics, career expectations, work attitudes and prole dissatisfaction.1 In fact, the present situation may wellAuthor Mark W. Stanton, M.A. Managing Editor Margaret Rutherford Design and Production Frances Eisel Suggested citation Stanton MW, Rutherford MK. Hospital nurse staffing and quality of care. Rockville (MD) Agency for Healthcare Research and Quality 2004. Research in Action Issue 14. AHRQ Pub. No. 04-0029.increase came from RNs over age 50 who returned to the workforce and a greater influx of foreign-born RNs, this does not alter the structural features in the long term the aging of the nurse population and the increasing unwillingness of preadolescent women to consider nursing as a profession.3 Todays surdies are further complicated by other changes in hospital care, such as new health check technologies and a declining average length of stay, that have led to increases in the amount of care required by patients while they are in the hospital. New medical technologies allow many less seriously ill patients who previously would have received inpatient functional care to receive care in outpatient settings. Also, patients who in the past would have continued the early stages of their recovery in the hospital, today are discharged to skilled nursing facilities or to home.During the layover 1980-2000, the average length of an inpatient hospital stay fell from 7.5 days to 4.9 days.4 An important consequence of these changes is that hospitals have a higher overall concentration of toot people who need more care. Various groups, including the American Hospital Association, the Joint Commission on the Accreditation of Healthcare Organizations, and the Institute of Medicine (IOM), have expressed their associates somewhat the evolving nursing crisis. The IOM issued a report in 1996 that recognized the importance of determining the appropriate nurse-patient ratios and distribution of skills for ensuring that patients receive quality health care.5 Its report highlighted the fact that research on the relationship between The nurse workforce and nurse staffing levelsthe level of staffing by nurses in hospitals and patients outcomes has been inconclusive. The IOMs analysis of staffing and quality of care in hospitals reason by calling for a systematic effort at the national level to collect and analyze current and relevant data and develop a research and evaluation agenda so that informed policy development, implementation and evaluation are undertaken in a timely manner. To begin to meet that need, AHRQ-funded research and other res earch have pursued a number of different paths.Hospital nurse staffing and nursing- beautiful outcomesHospital nurse staffing is a matter of major concern because of the effects it can have on patient safety and quality of care. Nursing-sensitive outcomes are one indicator of quality of care and may be specify as variable patient or family caregiver state, condition, or perception responsive to nursing intervention.6 Some indecent patient outcomes potentially sensitive to nursing care are urinary tract infections (UTIs), pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays, failure to rescue, and 30-day mortality.a Most research has focused on adverse rather than positive patient outcomes for the simple reason that adverse outcomes are much more likely to be documented in the medical record. aFailure to rescue is defined as the death of a patient with a lifethreatening complication for which early identification by nurses and medical and nursing interventions c an influence the risk of death.The nurse workforce consists of clear nursesregistered nurses (RNs) and license practical nurses (LPNs)and nurses aides (NAs). Both RNs and LPNs are licensed by the State in which they are employed. RNs assess patient needs, develop patient care plans, and administer medications andtreatments LPNs protract out specified nursing duties under the direction of RNs. Nurses aides typically carry out nonspecialized duties and personal care activities. RNs, LPNs, and nurses aides all provide direct patient care. RNs have obtained their education through three different routes 3-year diploma programs, 2-year associate degree programs, and 4year baccalaureate degree programs.Almost a third of all RNs have a baccalaureate degree, and 7.6 percent of hospital nurses have advanced utilisation credentials (either a masters or doctoral degree). LPNs receive 12-18-month training programs that emphasize technical nursing tasks. Nurses aides are not licensed but man y acquire certified nurse aide or nursing assistant (CNA) status after proving they have certain skills related to the requirements of busy positions. Nurse staffing is measured in one of two basic ways Nursing hours per patient per day. The nurse to patient ratio. Nursing hours may refer to RNs only to RNs and LPNs or to RNs, LPNs, and nurses aides.2www.ahrq.govA broad array of research on this topic has found an association between lower nurse staffing levels and higher rates of some adverse patient outcomes. A new evidence report entitled The Effect of Health Care Working Conditions on Patient Safety, produced by an AHRQfunded Evidence-based Practice Center (EPC), reviewed 26 studies on the relationship between nurse staffing levels and measures of patient safety.b Most of the studies examined nurse staffing levels and adverse occurrences in the hospital setting, including in-hospital deaths and nonfatal adverse outcomes such as nosocomial infections, pressure ulcers, or falls . The EPCs researchers found that lower nurse-topatient ratios were associated with higher rates of nonfatal adverse outcomes.7 This was true at both(prenominal) the hospital level and the nursing unit level. With regard to in-hospital deaths, however, the evidence does not consistently show that lower nurse staffing levels are associated with higher mortality.The largest of these studies on nurse staffing (jointly funded by AHRQ, the Health Resources and Services Administration, the Centers for Medicare & Medicaid Services, and the National Institute of Nursing Research) examined the records of 5 million medical patients and 1.1 million working(a) patients who had been treated at 799 hospitals during 1993.6,8 Among the studys principal findings In hospitals with high RN staffing, medical patients had lower rates of five adverse patient outcomes (UTIs, pneumonia, shock, upper gastrointestinal bleeding, and longer hospital stay) than patients in hospitals with low RN staffing.c M ajor surgery patients in hospitals with high RN staffing had lower rates of two patient outcomes (UTIs and failure to rescue). Higher rates of RN staffing were associated with a 3- to 12-percent reduction in adverse outcomes, depending on the outcome. Higher staffing at all levels of nursing was associated with a 2- to 25-percent reduction in adverse outcomes, depending on the outcome. Table 1 illustrates some of the major findings. For example, the researchers found that medical patients in hospitals with high RN staffing were 4-12 percent less likely to develop UTIs than medical patients in the comparison group.Lower staffing levels are linked to higher adverse outcome rates The EPC report included five studies funded by AHRQ that examined the relationship between adverse patient outcomes and hospital nurse staffing. All five studies found at least some association between lower nurse staffing levels and one or more types of adverse patient outcomes. How often do such adverse nu rsing-sensitive patient outcomes occur in hospital care? Different studies report change adverse event rates, which vary by the type of patient (medical or surgical) as well as other factors. For example, UTIs occur in from 1.9 percent to 6.3 percent of surgical patients and pneumonia in 1.2 percent to 2.6 percent of surgical patients.8-10 bTable 1. Percent reduction in rates of outcomes among medical patients in hospitals with high nurse staffing (75th percentile) compared to the rates in hospitals with low nurse staffing (25th percentile) Amount by which rates are lower forIn order to improve the quality and delivery of health care operate, AHRQ has sponsored a series of evidence reports that are based on rigorous, comprehensive reviews of relevant scientific literature. These reports are developed and written by after-school(prenominal) research and academic organizations designated as Evidence-based Practice Centers (EPCs). The reports emphasis is on explicit and detailed do cumentation of methods, rationale, and assumptions.The goal of these reports is to provide the scientific foundation that public and cloistered organizations can use to develop their own clinical practice guidelines, quality measures, review criteria, and other tools to improve the quality and delivery of health care services study measured RN staffing as hours per day and as the RN proportion of nursing hours. Hospitals with higher hours of RN staffing (75th percentile) had an average of 9.1 hours of inpatient RN nursing per patient day, while those with lower RN staffing (25th percentile) had an average 6.4 hours of inpatient RN nursing per patient day. Hospitals with a higher proportion of RN staffing (75th percentile) had an average of 75 percent of inpatient nursing hours provided by RNs, while those with lower RN staffing (25th percentile) had an average of 62 percent of nursing hours provided by RNs.Outcome in medical patients Urinary tract infection Upper gastrointestinal b leeding Hospital-acquired pneumonia Shock or cardiac arrestHigh RN staffing 4-12% 5-7% 6-8% 6-10%High staffing, all levels (RNs, LPNs, aides) 4-25% 3-17% 6-17% 7-13%c ThisNote Difference is expressed as a range of set (e.g., 4-12 percent) because several statistical models were used in evaluating the relationship between nurse staffing levels and each adverse event. Source Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and patient outcomes in hospitals. Final report for Health Resources and Services Administration. Contract No. 230-99-0021. 2001. Harvard School of Public Health, Boston, MA.www.ahrq.gov3 medical exam patients in hospitals with high levels of total nurse staffing (RNs, LPNs, and aides) were 4-25 percent less likely to develop UTIs than patients in the comparison group. A similar analysis was performed for the smaller group of surgical patients (Table 2). Surgical patients in hospitals with high RN staffing had a 5-6 percent lower rate of UTIs and a 4 -6 percent lower rate of failure to rescue than surgical patients in the comparison group.dPneumonia rates are especially sensitive to staffing levelsThree AHRQ-funded studies found a significant correlation between lower nurse staffing levels and higher rates of pneumonia. The first study found that adding half an hour of RN staffing per patient day could reduce pneumonia in surgical patients by over 4 percent.12 This study covered 589 hospitals in 10 States during 1993. A second study by the same researchers also found that fewer RN hours per patient day were significantly correlated with a higher incidence of pneumonia.13 The study examined administrative data on post-surgical patients in 11 States during 1990-96. A study of nurse staffing levels and adverse outcomes in California found that an increase of 1 hour worked by RNs per patient day was associated with an 8.9-percent decrease in the odds of a surgical patients contracting pneumonia.8 This study also found that a 10 -percent increase in RN proportion was associated with a 9.5-percent decrease in the odds of pneumonia. The researchers in the California study believe that the strong relationship between RN staffing and pneumonia can be attributed to the heavy responsibility RNs have for respiratory care in surgical patients. This study examined the effects of nurse staffing on adverse outcomes in 232 acute care hospitals from 1996 to 1999.f Unlike many earlier studies, the California study included only adverse outcomes that were not present at admission.7Table 2. Percent reduction in rates of outcomes among surgical patients in hospitals with high nurse staffing (75th percentile) compared to the rates in hospitals with low nurse staffing (25th percentile) Amount by which ratesre lower for High staffing, all levels (RNs, LPNs, aides) 3-14% 2-12% 19%Outcome in surgical patients Urinary tract infection Failure to rescue Hospital-acquired pneumoniaHigh RN staffing 5-6% 4-6% 11%Note Difference is exp ressed as a range of values (e.g., 2-12 percent) because several statistical models were used in evaluating the relationship between nurse staffing levels and each adverse event. Source Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and patient outcomes in hospitals. Final report for Health Resources and Services Administration. Contract No. 230-99-0021. 2001. Harvard School of Public Health, Boston, MA.A second study, funded jointly by AHRQ and the National Science Foundation, examined licensed nurse staffing (RNs and LPNs) and adverse outcomes among both medical and surgical patients in Pennsylvania acute-care hospitals.11 It found a lower incidence of nearly all adverse outcomes it studied in hospitals with more licensed nurses. For example, a 10-percent increase in the number of licensed nurses is estimated to decrease lung collapse by 1.5 percent, pressure ulcers by 2 percent, falls by 3 percent, and UTIs by less than 1 percent. Also, with a 10-percent higher p roportion of licensed nurses, there was a 2-percent lower incidence of pressure ulcers.e,11dSurgical patients overall had lower rates of adverse outcomes than medical patients, perhaps because they are healthier. Also, the smaller number of surgical patients in the study may have made it more difficult to detect associations. Nurse staffing was measured in two ways (1) the ratio of licensed nurses (RNs + LPNs) to the patient load (with and without adjustments for patient acuity) and (2) the proportion of licensed nurses to the total nursing staff (RNs, LPNs, NAs). The adverse outcomes selected for study were either caused by or not prevented by medical management based on criteria used by the Harvard Medical Practice Study. Nurse staffing was measured in three ways all hours (the total number of productive hours worked by all nursing personnel per patient day), RN hours (the total number of productive hours worked by registered nurses per patient day), and RN proportion (RN hours di vided by all hours).

Red Lake High School Shooting Essay

Jeffrey mob Jeff Weise was an Ojibwe Native American adolescent, and a student at Red Lake Senior High School in Red Lake, Minnesota. He killed nine people and wounded five others in a shot offer on March 21, 2005, when he was just 16 years hoar. Weise first murdered his grandpa and grand arrests girlfriend at his trailer home in Red Lake. He then taw and killed an unarmed security guard, a teacher and five students at Red Lake Senior High School. The shooting ended when Weise committed suicide.Research shows that Jeff was a strange young man, interested in Gothic things disconsolate clothing and Nazism, but a look a little further into his past led to a few interesting revelations. Jeffs parents were never married, because his sustain was only 17 when she gave birth. She was forced to give Jeff to his sky pilot when he was three months old. Then when he was two his commence took him back. She was reportedly an abusive alcoholic with a tendency to both physically and emoti onally abuse her first born son. In 1997 Jeffs father committed suicide after a two day standoff with police.Then in 1999 his mother suffered brain damage after a car accident in which she had been drinking and driving. Jeff was then set in the care of his grandmother at the Red Lake Reservation. Jeff did not have the right start in life. His parents should have been older and more ready for a child when he was born. They as well should have been married. Jeff also should have had a more stable home life as an infant. It is doubtful that he had a firm attachment with his mother or father considering that he was passed between them at 3 months old and 2 years old. He also should not have been physically or emotionally abused.His mother failed him in that aspect and the fact that she was an alcoholic makes it even worse. It is also doubtful that Jeff dealt with his fathers suicide in a healthy way. He did not have the support that he should have had from his mother. By the time he g ot to his grandmothers care he had already led a actually difficult life. This ties in to every chapter that we have discussed so far. It refers to attachment, abuse, adolescence and everything. It all goes back to the first thing we talked nigh that said when parents fail to give their child a good start in life everybody suffers, as is the case with the families of Jeffs victims.

The History of Chocolate

coffee berry is one of the oldest treats enjoyed by many people. By a guide of hands, how many people love chocolate? I have loved chocolate ever since I was a little girl. I have enjoyed the different tastes, textures, and styles of it. Chocolate has been one of the oldest treats enjoyed by many people. I want to share with you the history of chocolate, types of chocolate, and some benefits from eating chocolate. Lets start with the History of ChocolateChocolates history started over 2,000 years ago. It began in the tropical rainforests of Central and South America from the seed of the cacao tree. This small tree grows best in the tropical atmosphere because it receives the best amount of rain, shade, humidity, wind, and nutrients. According to Susan J. Terrio, the rootage of Crafting the Culture and History of French Chocolate, the initiatory people known to have made chocolate were the old-fashioned cultures of Mexico and Central America.These people, including the Maya and Aztec, mixed ground cacao seeds with various seasonings to make a spicy, frothy drink. This was the very first way that chocolate was consumed. When the Spanish conquered the Aztecs, they brought the cacao seeds back home to Spain. 1. The chocolate drink was very prevalent in Spain. It then spread to Europe where new technologies and innovations changed the texture and taste of chocolate. 2. By the mid-1700s, the blossoming industrial Revolution saw the emergence of innovations that changed the future of chocolate.

Philosophy, Theory, and Ideology : Comparison and Contrasts Essay

I. Definition of ism, political orientation and possible actionThe words philosophy, immortal and Ideology argon linked with each other. In order to discuss and compare each, definitions of the words are important. Philosophy is a greek word that came from the words philo and sophia. Philo means love and sophia means wisdom. Taking these 2 words literally, the word philosophy can be defined as the love of wisdom (theophil-bcantens.barry.edu, 2007). An word from theophil-bcantens.barry.edu (2007) had further explained that philosophy is a study of the ultimate. This definition was taken from what the philosophers had said about philosophy and the concepts that flip been studied in philosophy. Ideology as defined in the dictionary, according to Rolf Schwarz, is a belief or a set of beliefs, especially the political beliefs on which mountain, parties, or countries base their actions. On the other hand, Theory is defined by Curran and Takata (2007) as a systematic government a gency of thought about a subject.II. comparing of Philosophy, Ideology and TheoryBased on the three moments, differences can now be seen from the three words. Philosophy is seen as a discipline like a lose-go of science or a branch of education. It is a subject that has theories and ideologies on its own. On the other hand, Ideology is a belief, meaning a somebody or a group of person could belief on that particular sentiment or non. Ideology pertains to any belief, as long as there is a person that believe in an idea then that can be pertained as the ideology of that particular idea. A theory is a way of thinking that explains something logically. A theory is usually a way to help clarify the things that are calamity around us.As the author had stated, Philosophy is a study of the ultimate. Ideologies are sometimes formed ground on Philosophy. Most of the topic in Philosophy is quite complicated and almost all issues are still under debate. According to Aristotle in Metaph ysics, All men naturally have an impulse to get knowledge., because there are many things in the world that are yet to be clarified people tend to study why this is so. Philosophers tried to explain things and made some theories in philosophy. An example of which is Mentalism. This is considered as a philosophical theory wherein the mind is the true reality and objects exists only as aspects of the minds awareness (the freedictionary.com, 2007). However, others based their beliefs on Philosophy. Example is the Aetheist. The ideology of the Aetheist is that God does not exist. That is what they believe, however it is not yet proven still.III. ConclusionAs a conclusion, theory, ideology and philosophy differ in form. Philosophy is a discipline, Ideology is a belief and Theory is a way of thinking. These words are concern with how the people think based on their everyday lives. People are curious about what is happening in their environment and because of this, people formulated sever al questions about the existence of something or about the meaning of something. The questioning is then perceived as a philosophy if people start to study and evidence to discover the answer to the questions that are still yet to be found. Philosophical theories can become ideologies depending on the one who perceives it. On the other hand, an Ideology cannot be accounted as a theory because it is based on the belief of people. The belief could either be logical or not.

Reimbursement and Pay-for-Performance Essay

IntroductionAs we come into the 21st Century, we find wellnessc atomic number 18 is at a crisis level. Every agency is working on wellness wish reform from policymakers to the public and one and only(a)-on-one sector, as well as feder all(prenominal)y funded Medi business concern and Medicaid. The business of Medicine is greatly processd by the government ( national, disk operating system and local levels) and private health sections that initiate policies. carry for Performance is a reimbursement method where physicians and hospitals can suck in a higher reimbursement for duplicate serve establish on the fact that they deliver better flavour c ar with better results and sequels. This payment reform offers initiates intended to improve power, cling to, and whole tone of health care (Hood, 2007). If all medicos receive the same dollar amount as a doctor with poor outcomes, then the doctor with great outcomes should receive a little more and there go forth be patients tha t do non mind paying a higher deductible for better medical services (Mayes, 2006).Definition for take over for deedKimmel (2005), Pay for murder is a payment approach employ in healthcare that is based on clinical information-driven reform. The fundamental concept is to tie payment to how well providers adhere to put on standards. The practice standards are evidence-based and tied to clinical outcomes. The primary areas of focus are preventive care deliverance and disease management for chronic illnesses.Effects on ReimbursementPay for transaction (P4P) is literally a group of surgery indicators that are coupled with an incentive. The consummation indicators supports the procedure aspect of P4P magical spell the incentive indicator is the pay component. metre patient outcomes and understanding the variances thatthey have, has in authority lead to the increasing rise in how pay for performance reimbursement is looked at. This style of reimbursement allows health plans and employers to pay increasing reimbursements to medical providers that have the better outcomes, give average outcome medical providers a chance to improve, and pay those medical providers with the lowest outcomes the least amount of money or not pay them at all (Cromwell, Trisolini, Pope, Mitchell, & Greenwald. 2011). In order to have a pay for performance system in place, you must decide what domains or areas you wish to track, measure, and reward.Some areas in this domain are clinical process, step and patient safety, access to and availability of care, cost efficiency or cost of care, cost-effectiveness, administrative efficiency and compliance, adoption of information technology, and reporting of performance indicators. These can be set up as a single performance tracker or a multi-domain performance tracker and the measure needed for improvement, importance, and cost. Performance indicators should be valid, reliable, and informative (Cromwell, Trisolini, Pope, Mitchell, & Greenwald. 2011). The Incentive Schemes reward the performance measures, and is another important part of a pay for performance system. Funding proves to be another important part of this type of a reimbursement system. Types of funding include redistri onlying animated payments where additional funds will not have to be made and the whole tone of service is already high however, medical providers with a lower persona of service will receive lower reimbursements. Generated savings and New Money are other sources of funding for performance measures. Generated savings claim that an increased eccentric of service will generate savings, although there are others who feel that new money should be used to fund the performance system. (Cromwell, Trisolini, Pope, Mitchell, & Greenwald. 2011).Impact of System Cost Reductions on the Quality and Efficiency of Health treat The Medicare Physicians Group Practice (PGP) was the first physician pay for performance model used by the federal gov ernment. The PGP believes that higher quality and better cost efficiency could be achieved by managing and coordinating patient care and by engaging in wider choices of care management that are able to improve cost efficiency and quality of health care. Interventions include chronic disease management, high risk and higher cost care management, transitional care management, end-of-life and palliative care programs. If there were a moresuccessful payment and delivery method to increase the value of health care and improve quality of care, the cost would grow at a slower pace. The American people would be more likely to purchase health policy coverage that is affordable and more valuable. (Kautter, Pope, & Trisolini, 2007).More progress toward effective delivery and system reform is one of the key elements to achieving the goals to push expanded coverage. Information technology is one of these key elements and a major part of pay for performance system. Information systems uses electr onic medical records and patient registries have been created to improve the efficiency and quality of health care delivery. These type of initiatives that are being tested to see if cost savings are generated by reducing avoidable hospital stays, cutting down on readmissions and emergency room visits, while simultaneously improving quality of care (Kautter, Pope, & Trisolini, 2007). Effect of Pay for performance on Health solicitude Providers and Their Customers Meredith B. Rosenthal states, Pay for performance will not replace the existing payment structure in either system, but it does allow payors to pick up into account a set of quality indicators, in addition to stack of service (as fee-for-service does now) or the number of covered lives (in the case of capitation). In this view, pay for performance can be viewed as a mechanism to correct some of the distortionary incentives that already exist in the reimbursement system.Physicians in the United States are paid on a fee-f or-service basis. This encourages high volumes of services, where there is no regard to the value of services in regards to a patient. When services are reimbursed more generously than others it allows the payment system to influence additional medical services with a heavy emphasis on procedure-based care. Since the physicians pay is not link to medical services provided, there is really no direct incentive to provide any services (How Will Paying for Performance Affect patient of Care?. (2006, March). Virtual Mentor, 8(3), 162-165).Effects of Pay for performance on the Future of Health CareGoldberg lists three points regarding the most significant implications of the movement toward paying for quality outcomes. These are that the quality and value become real parts of contractual reimbursement, the differences based on quality outcomes will be more evident grouped with provider tiers,and quality metrics evolve to outcome-based and chronic disease management (Goldberg 2006). P4P is an incentive-based reimbursement system that rewards the best players. This pay for performance system is acceptedly busy in health systems, managed care settings, and private and group physicians practices. P4P is likely to impact the entire health care environment and will provide yet another opportunity for pharmacy to become an active role player and leader with improving quality and efficient health care. The focus is not on value but on quality and cost. Pay for performance is not a new program, but in the age of informed choice, evidence based medicine, and patient safety, it can become the solution to our current health care dilemma (Pay for performance (P4P) Evaluating Current and Future Implications).ConclusionThese pay for performance systems and programs will lead expansion across the United States health care industry in the near future. With the capital punishment of the Affordable Care Act, there has been a great amount of provision made to encourage keep impro vement with quality of care. Accountable Care Organizations (ACOs) are groups of providers that agree to coordinate care and to be held accountable for the quality and cost of the services they provide (James, 2012). There needs to be a consensus as to how some(prenominal) of an incentive will have to be given in order to affect the needed swap and how should these incentives be paid out monthly, quarterly, or yearly and how can these improvements be carry on over time. Continued experimentation with the pay for performance model should begin to incorporate monitoring and rating in identifying design elements that will also affect outcomes in a positive way.Variations in health care markets should be evaluated and include comparison groups to isolate pay for performance from other types of factors. Pay for performance has some great attributes to it and could definitely be the beginning to improvements in quality of service. If physicians are receiving patients and referrals bas ed on their ability to provide quality of service with reduced readmissions and more satisfied consumers, then the care they take in providing services to patients from admission to discharge will create positive change.ReferencesCromwell, J., Trisolini, M. G., Pope, G. C., Mitchell, J. B., and Greenwald, L. M., Eds. (2011). Pay for Performance in Health Care Methods and Approaches. RTI Press publication No. BK-0002-1103. Research Triangle Park, NC RTI Press. Retrieved June 15, 2014, from http//www.rti.org/rtipressGoldberg, L. (2006). Paying for performance a call for quality health care. Deloitte Center for Health Solutions. Retrieved from http//www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_chs_p4p_032806%281%29.pdf Hood, R. (2007). Pay-for-Performance-Financial Health Disparities and the Impact on health care Disparities. Journal of the National Medical Association, 99, 1-6. James, J. (2012). Pay-for-Performance. New payment systems reward doctors and hospi tals for improving the quality of care, but studies to designation show mixed results.. Health Policy Brief, 1-6, Retrieved June 15, 2014, from http//www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78. Kautter, J., Pope, G., & Trisolini, M. (2007, Fall). Medicare physician group practice demonstration design quality and efficiency pay for performance. Health Care Financing Review, 29(1), 15-29. Retrieved June 15, 2014, from http//www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/PGP_Demo_Design.pdf Kimmel, K. (2005). Pay for Performance An Economic Imperative for clinical Information Systems. Retrieved June 15, 2014, from http//www.himss.org/content/files/PayForPerformance.pdf Mayes, R. (2006). The Origins of and Economic Momentum Behind Pay for Performance Reimbursement. Health Law Review, 15, 17-22. Pay for performance (P4P) Evaluating Current and Future Implications. Retrieved June 15, 2014, from https//www.ashp.org/DocLibrary/Policy/QII/Pay for performance.aspx Rosenthal, M. (2006). How Will Paying for Performance Affect Patient Care?. Virtual Mentor, 8, 162-165.

History of the Olympic Games

The modern Olympic movement has been shaped by many differentiating factors over the courses. It has been alter by affable, political, and frugal factors. More specifically, warring times, changes to social structures, and frugal activity that varies by country score been the overall leading factors that imbibe shaped the Olympics over the years. The Olympics have video displayn over the decades that they can be affected by political conflict. However, it seems that this is the point of the Olympics, to illustrate national pride, by competition.Bloodshed should not be the way for pride of ones country to be shown, hardly it should be shown through competition, in the words of the founder of the modern Olympic movement, Pierre de Coubertin(1). The games have been used as a weapon for denouncing a countrys sportsmanship, such as in 1956 when Arnold Lunn, a British Olympic team official accused the Nazis of cheating in the 1936 Olympic games that were held in Germany. He went on to allege that the competitors of Germany went onto the course while it was closed to athletes.Though the fact that they were trying so hard to practice, could be an grammatical case of the importance placed on the games at the time before war period. This is implied by the statement by Arnold Lunn that victory was the only thing that beted to the Nazis, and how they achieved it did not matter as long as they did(3). The use of the Olympics to show off ones country was further demonstrated during the Cold War, when the United States and the Soviet essence were itching to outdo one another.Bob Matthias gives insight through an inter prospect into the United States vehement to set ahead over Russia. The competitor told of the spirit of winning throughout the team, even in the athletes that were sure to win for the United States(4). This is a stark contrast to an information guide provided by the Soviet Union regarding the olympics world held in Moscow that year. It tells of seeking peace with the U. S. , and how the Olympics were a beacon for social progress and democracy(6). This resulted in the U. S.boycotting the Olympics, collectible to the obvious bias in the information. Ali Kabir, finally, told of how the rise and fall of his nations hockey team reflects the neediness of unity in his own country, even going as far as stating that its players be clueless and have tarnished Pakistans name(10). This further demonstrates how the Olympic Games reflect political events at the time they argon creation held. Not only do the Olympic games make a habit of displaying the events of the world through its social competitions, but it also lets economic factors manifest in its events.Ryotaro Azuma, mayor of Tokyo, rundle in an interview in 1972 regarding the 1964 Olympic games held in Japan. He told of how his country finally had a fall out to get out of the losing spirit after World War II and rise as a world trade power. The Olympic Games in this case, were used to boost a countrys providence and wealth as well come back as a leading power(5). A Japanese newspaper editorial in 1988 commented nearly the use of industrial powers by entropy Korea in that years Olympic games, or want thereof.It comments negatively on the fact that South Korea did not have the funding to set up the games as well as display its industrial and economic power to the world, implying that no matter the medals one, the industrial power by the U. S. , Japan, and other countries will make a lot of profit and leave a memorable impression on the world while South Korea will not(7). The International Olympic Committee provided statistics lending insight into the fees provided into Olympic events, showing an expected trend.In 1980, it is useful to know that the U. S. and Soviet Union were locked in the Cold War, and as stated previously, the U. S. refused to come to the Olympic Games held in Moscow as well as Russia refusing to attend the one in Los Angeles. The shockingly low fees paying to have viewing and advertising rights to the games held in Moscow reflects the war. Many countries boycotted the Olympics that year, so the severely low quantity of fees nonrecreational further demonstrates this tense time in during the 20th century.However, the dramatic increase in the fees paid to broadcast Atlantas games illustrates the time of peace after the Cold War ended, with over 800 one thousand million dollars being given to broadcast the games(9). Finally, the Olympic games are altered by the diverse and changing social structures in the world. For instance, in 1908 a photograph of British competitor Sybil Newall shooting her bow was found on newspapers across England(2). Whether this photograph was staged to sell newspapers or not, it cannot be denied that this photograph indicates the beginning of womens movement, which was simply an important issue during this time in the world.With more leniency being given to women during this tim e, they were eventually being allowed to compete in the competitive events, though only 2% of the athletes were women. This factor also continues to show during the 1992 games held in Spain, where by then 29% of women were competing. Hassiba Boulmerka was an Algerian competitor during this time and spoke in an interview about her critics, and how being the first Algerian to win an Olympic title did not depend on her gender, but simply on her strength in her mind and in body.Boulmerka was heavily criticized by Muslim groups in Algeria for wearing shorts as she ran in the events. Despite this, the games illustrated the decreasing requirements for dresses and increasing requests for appropriate attire, no matter what gender the competitor identifies as. A helpful addition to analyzing the Olympic games would be an article reflecting the point of view of a German athlete during the 1936 games being held in Germany. They could explain why the competitors went onto the courses to practice while they closed, or if they did at all.He or she could balance the point of view by pointing out that they did not cheat, and that they simply were practicing and every did not know the rules or were just doing what they thought would be okay. Another helpful article would be to add on to the statistics provided by the International Olympic Committee by showing how many countries that competed versus the countries that genuinely paid for broadcasting rights, especially during the 1980s games.This would show whether there is an actual correlation between the lack of countries participating and the lack of money being put into the broadcasting rights of the games. The Olympic games have been shown to be altered and influenced by the social, economic, and political events happening all around it. It seems to be the central point of tension and friendly competition every four years. It was intended to be that way, reflecting the worlds ever changing views on life and each other.

How race, gender and sexual orientation appeal to some underlying Essay

How race, gender and knowledgeable orientation appeal to some underlying biological influences - Essay Example2211). In other words, the presumptuousness that race and ethnicity are merely biological traits is utterly mistaken. Human categories such as gender and sexual orientation are oftentimes subjected to intense debates, especially gender orientation, as to whether they are nature or nurtured and if there is a correlation between genes and gender orientation the environment and gender orientation. Later on, an elaborative summary shall be taken in order to explain whether, if indeed, race, sex, and gender orientation appeal to some biological influences. Also, this paper shall attempt to provide consequential and pertinent corroborations that should clarify some mistaken understandings in so far as the issues on biological influences in race, sex, and gender orientation are concerned. Students closing Name 2 run for Race was a presumably biological feature that an individu al had, but was constitute of disparate elements that might contradict one a nonher within a single body (Marks 108). ... Race has been conventionally considered to classify population according to communal biological traits like genes, hair, eyes, and other apparent tangible features (Drewnowski et al. 2211). While race expresses a common characteristic among a number of people, it is used profoundly to emphasise cultural and social characteristics and not biological influences (Drewnowski et al. 2211). Therefore, the attempts to study the biological influences in race are something that is not feasible. In fact, if races are discrete groups of populations, the continuous nature of merciful variation undermines the utility of race as a basic way to study the species (Marks 108). This is particularly true in that while it is something relatively durable (108) as it is part of human physiological composition, the evolution of man through its years of existence must(prenominal) h ave transpired significant modifications on its genetic composition with every succeeding times that passes. Thus, obviously, there is no avenue through which one can scrutinize biological influences to race as there is no consistent representation of the genetic detail that could be considered coherent or uniform regardless of human variations. Race is Students Last Name 3 largely a social category (Marks 109). It correlates to some purpose with genetics but is principally derived from a non-scientific or folk concept of heredity (109). This is partly collectable to the fact that while genetics affect race to some degree, there is no guaranteed uniformity or coherence on this biological influences due to the genetic changes that take place with respect to every generation that passes thus, there can be no effective approach to completely scrutinize the organic