NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Name

Capella University

NURS-FPX 6218 Leading the Future of Health Care

Prof. Name

Date

Change Proposal Summary Report

Mental health, an integral part of overall health, is unfortunately underserved in many local and regional healthcare systems. The Appalachian Regional Healthcare System (ARH), which serves a predominantly rural population in Eastern Kentucky and Southern West Virginia, is a case in point. The mental healthcare system in this region is grappling with several challenges, including limited service access, extended wait times, and a need for integrated care. This Change Proposal Summary Report outlines a strategic focus on enhancing mental health services, with the overarching aim of significantly improving patient outcomes and overall community well-being in this underserved region. A comparative analysis of adequate mental healthcare strategies in other non-U.S. healthcare systems has been conducted. The findings from this analysis will facilitate the implementation of adequate changes to enhance the quality of mental health care delivered to patients in the ARH region.

Executive Summary

Proposed Change

The Appalachian Regional Healthcare System (ARH), serving a predominantly rural population across Eastern Kentucky and Southern West Virginia, faces significant challenges in its mental healthcare services. A critical aspect identified for change is the integration and enhancement of mental health services within the ARH. This includes increasing access to mental health professionals and establishing better integration of mental health care with primary care services. The decision to focus on this particular change stems from the acute need to address the mental health crisis in the ARH region. The region is characterized by high rates of mental health disorders, compounded by socioeconomic factors and limited access to care (Morgan et al., 2020).

Geographic isolation and a shortage of mental health professionals exacerbate the problem, resulting in long wait times for patients and a lack of coordinated care. The integration of mental health services within the primary care framework and the expansion of telehealth services are critical steps to mitigate these issues. The expectations for improvements are clearly defined and substantiated by credible evidence. Enhanced access to mental health professionals and telehealth services will reduce geographic and financial barriers to care (Moroz et al., 2020). Additionally, the integration of mental health services with primary care, supported by EHR systems, will facilitate comprehensive, coordinated care (Kariotis et al., 2022). These changes are expected to result in better patient outcomes, reduced healthcare costs due to early intervention, and overall improved mental health and well-being for the population served by the ARH (Torous et al., 2020).

Desired Outcomes

The first desirable outcome is enhanced access to mental health services across the Appalachian Regional Healthcare System (ARH). This improvement aims to address the shortage of mental health professionals and extend services to underserved areas through the recruitment of new professionals and the expansion of telehealth. The cost of care will primarily be covered by Medicaid, Medicare, private insurance, and potential federal grants. The rationale for this outcome is based on evidence showing that increased access to mental health services can lead to earlier intervention, reduced symptom severity, and overall better mental health outcomes (Moroz et al., 2020). However, limiting factors include regional workforce shortages and the existing technology infrastructure, which may impede rapid implementation.

The second desired outcome is better integration of mental health and primary care services. This involves promoting collaborative care models and ensuring shared access to Electronic Health Records (EHR) systems. Funding sources will include Medicaid, Medicare, private insurance, and hospital system investments. This integrated approach ensures comprehensive care, addressing both physical and mental health needs, leading to more holistic treatment plans. Studies have shown that integrated care models and EHR systems improve care coordination and patient satisfaction (Kariotis et al., 2022). Limiting factors include the costs of training and system integration, as well as resistance to changes in clinical practice.

Health Care System Comparative Analysis

Norway’s healthcare system excels in providing community-based mental health services that are deeply integrated into the primary care framework. Norwegian municipalities are responsible for organizing and delivering mental health care services locally, ensuring accessibility and reducing stigma associated with seeking help. These services are often multidisciplinary, involving psychologists, social workers, and psychiatric nurses who collaborate closely with primary care providers (Ruud & Friis, 2021). The emphasis is on prevention, early intervention, and ongoing support within the community. Additionally, Norway’s decentralized healthcare system exemplifies a patient-centred approach by distributing healthcare responsibilities to local municipalities. This structure empowers local authorities to manage healthcare services, ensuring that they are tailored to the specific needs of their communities. Decentralization enhances accessibility and responsiveness, making healthcare more adaptable to local conditions and individual patient requirements (Brkic et al., 2021). 

Australia has implemented innovative telehealth-based mental health services to improve access for rural and remote populations. Telehealth platforms connect mental health professionals with patients in remote areas, allowing for virtual consultations, therapy sessions, and ongoing monitoring. This approach addresses geographic barriers and shortages of mental health professionals in rural settings, ensuring timely access to specialized care and support. Australia’s telehealth initiatives are supported by robust infrastructure and government policies aimed at expanding telehealth services across the country (Hall Dykgraaf et al., 2021).

Appalachian Regional Healthcare System (ARH) currently faces significant challenges in providing equitable access to mental health services, particularly in rural and underserved areas. Geographic isolation and limited resources exacerbate disparities in access, leading to difficulties for residents in receiving timely and comprehensive mental health care. Furthermore, mental health services within ARH often operate independently from primary care, resulting in fragmented care delivery and gaps in service continuity. This disjointed approach contributes to suboptimal patient outcomes and fails to address the holistic needs of individuals requiring mental health support.

Rationale for the Proposed Change

The proposed changes to decentralize mental health services within the Appalachian Regional Healthcare System (ARH) and integrate them with primary care will address several vital barriers currently affecting the system. By adopting a decentralized model similar to that of Norway and leveraging telehealth initiatives as seen in Australia, ARH can effectively enhance access to mental health services, improve continuity of care, and foster a more personalized approach to treatment (Brkic et al., 2021). Norway’s community-based approach to mental health services has demonstrated improved accessibility, reduced stigma, and enhanced patient satisfaction through integrating mental health within primary care and local communities. Likewise, Australia’s telehealth initiatives have proven successful in extending mental health services to remote and underserved areas, ensuring timely support and better management of mental health conditions.

By implementing these models, ARH can expect to see increased access to mental health services, enhanced care coordination, reduced stigma, and overall improved patient outcomes (Morgan et al., 2020). These expectations are reasonable within the existing ARH framework, given the infrastructure already in place for primary care and the growing acceptance and implementation of telehealth technologies (Hall Dykgraaf et al., 2021). The integration of mental health services with primary care and the expansion of telehealth capabilities will make mental health care more accessible, personalized, and continuous, aligning with global best practices and addressing the unique challenges faced by ARH.

Financial and Health Implications

Implementing a decentralized mental health service model within the Appalachian Regional Healthcare System (ARH), integrated with primary care, will have significant financial and health benefits. Initial costs will be high due to establishing community-based clinics, expanding telehealth services, and training healthcare professionals. These expenses can be managed through federal and state grants, budget reallocations, and public-private partnerships. Long-term savings are expected from reduced hospitalizations, emergency room visits, and patient transportation costs. Health benefits include improved access to mental health services, early diagnosis, and intervention, leading to better management of conditions and overall quality of life. Integrating mental health with primary care ensures holistic, continuous care, reducing service fragmentation and improving treatment adherence. Increased accessibility and normalization of mental health services will also reduce stigma (Brkic et al., 2021).

Not implementing these changes will maintain high costs associated with emergency services and hospitalizations, and patients in rural areas will continue to face access barriers, leading to poorer health outcomes and ongoing stigma. Individuals may face copayments and insurance adjustments, while communities will need to invest in infrastructure. However, the benefits include better access to care, improved health outcomes, and long-term cost savings. In the short term, increased access to services and patient satisfaction are expected, with an initial rise in healthcare spending (Ruud & Friis, 2021). Long-term effects include sustained mental health improvements, significant cost savings, and a more robust healthcare system. Evidence from Norway and Australia supports these conclusions, showing the effectiveness of decentralized and telehealth models in improving mental health care ((Brkic et al., 2021; Hall Dykgraaf et al., 2021; (Ruud & Friis, 2021).

Conclusion

In conclusion, implementing a decentralized and integrated mental health service model within the Appalachian Regional Healthcare System (ARH) will enhance access to care, improve patient outcomes, and reduce stigma associated with mental health. Drawing on successful strategies from Norway and Australia, ARH can address current challenges through community-based clinics and telehealth initiatives. The proposed changes promise long-term financial savings and improved health outcomes, making them a sustainable solution for the region. Without these changes, ARH will continue to face high costs and poor mental health outcomes, particularly in underserved areas.

Appendix

Table 1: Health Care System Comparative Analysis

References

Brkic, A., Kim, J. G., Haugeberg, G., & Diamantopoulos, A. P. (2021). Decentralizing healthcare in Norway to improve patient-centered outpatient clinic management of rheumatoid arthritis – a conceptual model. BMC Rheumatology, 5(1). https://doi.org/10.1186/s41927-021-00215-1 

Hall Dykgraaf, S., Desborough, J., de Toca, L., Davis, S., Roberts, L., Munindradasa, A., McMillan, A., Kelly, P., & Kidd, M. (2021). “A decade’s worth of work in a matter of days”: The journey to telehealth for the whole population in Australia. International Journal of Medical Informatics, 151(151), 104483. https://doi.org/10.1016/j.ijmedinf.2021.104483 

Kariotis, T. C., Prictor, M., Chang, S., & Gray, K. (2022). Impact of electronic health records on information practices in mental health contexts: Scoping review. Journal of Medical Internet Research, 24(5), e30405. https://doi.org/10.2196/30405 

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Morgan, A. A., Thomas, M. E., & Brossoie, N. (2020). Trauma-informed care (TIC) as a framework for addressing the opioid epidemic in Appalachia: An exploratory interpretative phenomenological analysis. Journal of Rural Mental Health, 44(3), 156–169. https://doi.org/10.1037/rmh0000137 

Moroz, N., Moroz, I., & Slovinec D’Angelo, M. (2020). Mental health services in Canada: Barriers and cost-effective solutions to increase access. Healthcare Management Forum, 33(6), 282–287. https://doi.org/10.1177/0840470420933911 

Ruud, T., & Friis, S. (2021). Community-based mental health services in Norway. Consortium Psychiatricum, 2(1), 47–54. https://doi.org/10.17816/cp43 

Torous, J., Jän Myrick, K., Rauseo-Ricupero, N., & Firth, J. (2020). Digital mental health and COVID-19: Using technology today to accelerate the curve on access and quality tomorrow. JMIR Mental Health, 7(3), e18848. https://doi.org/10.2196/18848