Unit 2: Determining Priorities in Wellness & Health Promotion
Module Vocabulary and Key Questions
This unit focuses on the structured process of identifying priorities in wellness and health promotion across clinical and population-based settings. Emphasis is placed on evidence-based decision-making, preventive strategies, coordinated care models, and systems-level approaches that enhance patient outcomes, safety, and equity. The concepts explored in this unit support healthcare professionals in aligning clinical practice with research evidence, policy initiatives, and patient-centered values.
Evidence-Based Approaches to Primary Care
What is evidence-based practice, and why is it important in healthcare?
Evidence-based practice (EBP) is a systematic approach to clinical decision-making that integrates the best available research evidence, professional clinical expertise, and the values and preferences of patients. The importance of EBP lies in its ability to improve the quality and safety of care, minimize unwarranted variations in practice, and ensure that healthcare interventions are effective and cost-efficient. By applying rigorously tested evidence, clinicians can enhance patient outcomes, promote ethical care delivery, and support consistent standards across healthcare systems (Melnyk & Fineout-Overholt, 2019).
What are key elements of quantitative research designs and their distinguishing characteristics?
Quantitative research designs focus on the collection and analysis of numerical data to evaluate relationships, interventions, and measurable outcomes. Common designs include randomized controlled trials (RCTs), cohort studies, and case-control studies. These methodologies vary in their level of control, susceptibility to bias, and ability to establish causality. RCTs are considered the most rigorous design due to random assignment and controlled conditions, while observational studies are essential for examining long-term outcomes, risk factors, and conditions that cannot be ethically randomized. Understanding these distinctions enables clinicians to interpret findings accurately and apply them appropriately in practice.
How is evidence appraised using standard methods and grading scales?
Evidence appraisal is a structured process used to evaluate the quality, relevance, and applicability of research findings. The process begins with clearly defining a clinical question, followed by conducting a systematic literature search. Retrieved studies are assessed for methodological rigor, consistency of results, and potential sources of bias. Evidence grading systems are then applied to rank the strength of findings, assisting clinicians and organizations in determining whether practice changes are justified. This process ensures that clinical decisions are grounded in reliable and valid evidence.
What are common models used in implementation science?
Implementation science models provide structured pathways for translating research findings into routine clinical practice. These frameworks support systematic adoption, evaluation, and sustainability of evidence-based interventions.
| Model Name | Description |
|---|---|
| Iowa Model of Evidence-Based Practice | Guides clinicians through identifying practice issues, appraising evidence, implementing changes, and evaluating outcomes using continuous feedback |
| ACE Star Model of Knowledge Transformation | Illustrates five stages of knowledge movement from discovery to integration into practice and evaluation |
| Johns Hopkins Nursing EBP Model | Uses the PET process (Practice question, Evidence, Translation) to support efficient research integration |
| Stetler Model of EBP | Emphasizes individual clinician judgment and incorporates both internal data and external research evidence |
Patient-Centered Care and Value-Based Purchasing
What is the Patient-Centered Medical Home (PCMH)?
The Patient-Centered Medical Home is an advanced primary care model designed to deliver comprehensive, coordinated, and continuous care. It prioritizes long-term patient-provider relationships, interdisciplinary team-based care, and active patient engagement. The PCMH framework promotes improved access, enhanced care coordination, and reduced fragmentation, ultimately contributing to higher patient satisfaction and better health outcomes (Agency for Healthcare Research and Quality [AHRQ], 2020).
What is Value-Based Purchasing (VBP), and what are its goals?
Value-Based Purchasing is a reimbursement approach that links provider payments to performance on quality and outcome measures rather than service volume. Under the Centers for Medicare & Medicaid Services (CMS), healthcare organizations are evaluated on domains such as patient safety, clinical effectiveness, efficiency, and patient experience. The primary goal of VBP is to incentivize high-quality, patient-centered care while controlling healthcare costs and improving population health outcomes.
What are Accountable Care Organizations (ACOs)?
Accountable Care Organizations are networks of healthcare providers who collaboratively assume responsibility for the quality and cost of care delivered to a defined population, often Medicare beneficiaries. ACOs operate under shared savings and risk models, encouraging care coordination, data sharing, and adherence to quality benchmarks. Effective ACO participation requires robust health information technology infrastructure and ongoing performance reporting.
Transitional and Chronic Care Coordination
What is transitional care, and why is it important?
Transitional care involves the coordination and continuity of healthcare as patients move between settings, such as from hospital to home or to long-term care facilities. Poorly managed transitions increase the likelihood of medication errors, adverse events, hospital readmissions, and patient confusion. Effective transitional care includes discharge planning, medication reconciliation, patient education, and timely communication among healthcare providers.
What is coordinated chronic care, and what models support it?
Chronic care coordination focuses on organizing healthcare services to address the long-term needs of individuals with chronic conditions. The Chronic Care Model (CCM) provides a comprehensive framework that emphasizes proactive, patient-centered care.
| Core Element | Description |
|---|---|
| Community Resources | Integration of community-based support services |
| Health System Organization | Leadership and policies supporting quality care |
| Self-Management Support | Empowering patients to manage their conditions |
| Delivery System Design | Planned, team-based care delivery |
| Decision Support | Use of evidence-based guidelines |
| Clinical Information Systems | Data tracking and care coordination tools |
Lewin’s Change Theory and Its Application to Evidence-Based Practice
What are the stages of Lewin’s change theory?
Lewin’s Change Theory describes organizational change as a three-stage process. The unfreezing stage involves preparing individuals and systems for change by challenging existing behaviors. The movement stage introduces new practices or processes, while the refreezing stage stabilizes and integrates these changes into routine operations. This theory is frequently applied in EBP initiatives to facilitate adoption of new clinical guidelines and ensure sustainability of improvements.
Domains of Wellness
| Domain | Description |
|---|---|
| Physical | Maintaining bodily health through activity, nutrition, sleep, and preventive care |
| Emotional | Promoting emotional regulation, stress management, and psychological well-being |
| Spiritual | Supporting meaning, purpose, and alignment with personal beliefs |
| Social | Encouraging healthy relationships and community involvement |
| Occupational | Achieving balance, satisfaction, and growth in work roles |
| Environmental | Ensuring safe, sustainable, and health-promoting surroundings |
Risks in Transitions of Care
Transitions of care represent high-risk periods due to fragmented communication and incomplete transfer of information. Common risks include medication discrepancies, missed diagnostic results, post-discharge complications, falls, and inconsistent follow-up instructions. Reducing these risks requires standardized discharge processes, clear accountability, and effective interprofessional collaboration.
Chronic Care Coordination Models
| Model | Description |
|---|---|
| Patient-Centered Medical Homes | Team-based coordination for chronic condition management |
| Self-Management Programs | Patient education and empowerment interventions |
| Home-Based Primary Care | In-home care using in-person and virtual approaches |
| Distance Chronic Disease Programs | Telehealth-supported care for underserved populations |
Telemedicine: Synchronous vs. Asynchronous
| Type | Description | Examples |
|---|---|---|
| Synchronous | Real-time interaction between patient and provider | Video visits, live remote assessments |
| Asynchronous | Data collected and reviewed at a later time | Store-and-forward imaging, remote monitoring |
Telemedicine enhances access to care, improves continuity, and reduces geographic barriers, particularly for rural and underserved populations.
Social Determinants of Health
Social determinants of health include factors such as economic stability, education, access to healthcare, and neighborhood conditions. The Expanded Chronic Care Model incorporates these determinants, recognizing their influence on disease prevention, health behaviors, and long-term outcomes. Addressing SDOH is essential for reducing health disparities and improving population health.
National Initiatives to Improve Healthcare Quality
National initiatives aimed at improving healthcare quality include the National Notifiable Diseases Surveillance System, which supports disease monitoring and outbreak response, and Healthy People 2030, which establishes measurable objectives focused on prevention, health equity, and social determinants of health.
Disease Prevention Framework
| Level | Description |
|---|---|
| Primary Prevention | Preventing disease before onset through risk reduction |
| Secondary Prevention | Early detection through screening and assessment |
| Tertiary Prevention | Managing disease to prevent complications and disability |
Palliative Care
Palliative care focuses on symptom management, pain control, and psychosocial support for individuals with serious or life-limiting illnesses. It can be provided alongside curative treatment and emphasizes quality of life for both patients and their families through interdisciplinary care.
Epidemiologic Triad for Infectious Disease Causation
| Component | Description |
|---|---|
| Agent | The infectious or pathogenic organism |
| Host | The susceptible individual |
| Environment | Conditions that facilitate transmission |
Disease results from the interaction among these three components.
Current Screening Guidelines in Adults
Current adult screening recommendations, as outlined by the U.S. Preventive Services Task Force, provide evidence-based guidance for preventive care across the lifespan. These guidelines support early detection and risk reduction strategies tailored to age, sex, and risk factors.
Health Literacy, Disparities, and Culturally Responsive Care
Health literacy plays a critical role in patient engagement, adherence, and health outcomes. Disparities arise when individuals or populations encounter systemic barriers to care, including language, socioeconomic status, and cultural differences. Culturally responsive care addresses these challenges by respecting diverse beliefs, values, and practices, thereby fostering trust, improving communication, and enhancing care effectiveness.
References
Agency for Healthcare Research and Quality. (2020). Patient-centered medical home resource guide.
Centers for Disease Control and Prevention. (n.d.). Vaccines and immunizations.
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020–2025.
U.S. Preventive Services Task Force. (n.d.). USPSTF recommendations.
World Health Organization. (n.d.). Health literacy.