How to write a nursing essay on Access, Cost, and Quality for APNs (Solved)

How to write a nursing essay on Access, Cost, and Quality for APNs (Solved)

Healthcare is among the fastest-growing sectors in the US economy striving to provide quality services to the people. As this department grows and expands, there is more attention towards the creation of quality environments for the improvement of services and to address observed competition from various institutions. A healthcare work environment is one that is safe, empowering, and satisfying. Maintaining quality environments reflects a level of compassion and vigilance that is consistent to improve health care. Advanced practice nurses (APNs) are in a better position to improve the quality of healthcare environments because of their expert knowledge base and clinical competencies (Sarzynski & Barry, 2019). APNs should pay particular attention to healthcare services and strive to improve the three key elements of the healthcare system triangle including cost, access, and quality.


A person’s ability to access healthcare can have a profound effect on maintaining and ensuring good health. Despite its importance in achieving quality, studies demonstrate that almost 1 in 4 Americans do not have proper access to healthcare services. The Agency for Healthcare Research and Quality (AHRQ) defines access to health as the timely use of personal health services to achieve the best health outcomes. Joel (2017) defines access as the ability to obtain care or health and related services. In the past, the concept of access has been defined based on five key characteristics including affordability, availability, accessibility, accommodation, and acceptability. The relationship between these factors makes it possible for healthcare systems to address issues with healthcare access.

The growing demand for quality requires attention to be given to access because it affects how individuals get healthcare services. A quality environment is defined by the ability of patients and providers to access major factors in healthcare that affect outcomes. One of the key points that nurse practitioners and other healthcare providers work to improve is the health insurance coverage (AHRQ, 2018). In the United States, the ability to access desired primary care providers and services is entirely dependent on health insurance coverage. This explains why individuals in the coverage gap experience problems with healthcare access and quality health outcomes. The APN should pay particular attention to and justify the needs and benefits of accessing healthcare services.


As the demand for healthcare services outstrips available resources, there is an increasing focus on cost. Joel (2015) explains that cost is a component that establishes the value of health care. Cost represents the expenses incurred to deliver health care services to patients. From a society perspective, cost represents the percentage of dollars used for healthcare expenditure. Globally, the cost can represent aspects like provider services, insurance, goods and supplies, pharmaceuticals, education, and institutional costs to deliver healthcare services (Joel, 2017). healthcare costs can be divided into direct and indirect costs and this determines interventions that can be put to improve on this aspect. Direct costs include things like pharmaceuticals, inpatient and outpatient services, and costs on equipment purchase. Indirect costs involve things like lost wages to patients and opportunity costs that depend on the patient’s condition and length of hospitalization.

Addressing the issue of cost can help in promoting service delivery in quality healthcare environments. Just like the aspect of access, affordability of healthcare services influences the flow of patients and profitability in institutions. While patients are required to cover different costs, APNs can influence the amount of healthcare spending to avoid stress on the consumer and the government. As an administrator, the APN is concerned about insurance costs and the percentage of expenditure needed to conduct business (Jamalabadi et al., 2020). The APN, through policy, has the chance to address issues with healthcare expenditure and reimbursements to ensure healthcare organizations provide quality healthcare services. The individual should be focused on expenditures like supplies and equipment, personnel education and training, administration, and the physical environment.


Providing high-quality healthcare services at an affordable cost is among the main policy goals in the country and the outside world. The increasing demand for healthcare services and competition among healthcare organizations makes quality the central factor that will differentiate services given to patients. Quality is a measure that represents the degree to which services given to the people increase the likelihood of desired health outcomes (Agency for Healthcare Research and Quality (AHRQ), 2020). Quality environments provide exemplary services that increase the chance of meeting desired health outcomes with a significant effect on patient satisfaction. Growing acknowledgment demonstrates that quality services should be effective, safe, and people-centered. To achieve quality, institutions must provide health care equitably, efficiently, and in a timely manner.

Healthcare systems are of high quality when they achieve overall goals of improved healthcare, financial protection, and efficiency (Jamalabadi et al., 2020). Quality environments have well-designed measures to address healthcare problems and projects to improve processes. Achieving quality in healthcare requires evidence-based strategies and a professional body of knowledge to guide institutions accordingly (AHRQ, 2020). APNs are in a better position to address the issue of quality because of their knowledge and expertise. Through research, APNs can recommend changes in healthcare institutions to improve cost, access, and quality. Joel (2017) explains that quality can be viewed from a micro perspective that involves patients and providers and from a macro perspective that involves professional organizations and commissions. Regardless of the viewpoint, APNs can influence policy at the institutional level and collaborate with national or state organizations to formulate policies that can improve quality in care environments.

Recent Quality Initiatives

Quality healthcare for people is a high priority for the department of health, health organizations, and the national government. To assure citizens about quality, various initiatives have been launched since 2001 and have focused on accountability and public disclosure (Centers for Medicare and Medicaid Services (CMS), 2021). A quality initiative (QI) involves a set of focused activities designed to monitor, analyze, and improve the quality of processes in healthcare. These initiatives target institutions like nursing homes, home health agencies, and hospitals with a core mission of improving healthcare outcomes (CMS, 2021). To ensure cost-effective care and quality, performance expectations must be defined, specified, and measured (Joel, 2017). Most initiatives are developed and monitored by organizations like AHRQ and CMS. These agencies address patient safety, increase access to effective services, and ensure cost-effective care.

In response to the demand for quality, performance measurement, and accountability, actions have been taken through the formulation of quality initiatives. An example is a recent project by AHRQ to answer questions about which prescriptive drugs reduce costs and improve outcomes (Joel, 2017). Such initiatives disseminate research to clinicians to aid in addressing cost and to improve outcomes among patients. Another example is the CMS program to assess quality and performance in hospitals using HCAHPS scores. Accreditation organizations like TJC have also launched initiatives to assess structures and processes of care to outcome evaluation. APNs must be able to define quality between their healthcare organizations and guide other providers in reporting measures to the CMS and other commissions.

Quality Measures and Evaluation and Role Development

Quality measures are standards used to measure the performance of healthcare providers during the care to patients and populations. Quality measurement targets structures and processes to demonstrate a relationship to positive health outcomes (CMS, 2021). Reflecting on these measures, APNs should be aware that evaluation can be done at the individual practice level, group level for organizations, and societal level. Additionally, the provider should understand indicators of quality like mortality rates, hospital readmissions, and a patient experience that are part of the evaluation measures by healthcare groups.

At the individual level, the nurse should assess their ability to meet expectations for advanced practice nursing by using core competencies from NONPF (Joel, 2017). The APN’s role is to measure individual performance and improve care processes that can lead to quality outcomes. At the group level, APNs participate in evaluating specific outcomes for target patients to address the aspects of safety and quality. At the systems level, using measures from the CMS to assess healthcare worker performance and patient satisfaction are available. State Medicaid evaluation programs are also available to assess the performance of care provided to beneficiaries. At the societal level, APNs should be conversant with the healthy people goals that identify indicators and measures of performance evaluation (Joel, 2017). Annual reports from organizations like AHRQ can be used to assess organizational performance and the overall well-being of the nation.

Relationship and APN Role Change

The quality and performance measures discussed above indicate how advanced nurse practitioners can help in promoting quality healthcare environments. The measures provide an opportunity to gauge individual and organization performance in meeting set institutional and national goals. When performance is measured at the group or societal level, the APN is better positioned to justify the role and demonstrate contribution to care outcomes (Joel, 2017). The nurse understands that quality measurement functions to develop new and adapt existing data collection methods. The APN understands that the essence of evaluation is to compare individuals practice with other providers and improve performance based on evidence.

Quality measures form the background of evaluating individual and institutional performance to support resource utilization and improvement of care. Without quality measures, APN’s role of evaluating clinical practices and recommending evidence-based changes will be compromised. Without comparative data generated from evaluations, individual-level performance will be difficult to assess and it will be difficult to justify the role of APNs in quality environments (Sarzynski & Barry, 2019). The nurse will not be able to utilize research skills, clinical and professional leadership, collaborative care, consultation, and expert-decision making that are required to drive today’s healthcare to achieve quality.





Agency for Healthcare Research and Quality. (2018). Chartbook on access to healthcare: Elements of access to health care.

Agency for Healthcare Research and Quality. (2020). Understanding quality measurement.

Centers for Medicare and Medicaid Services. (2021). Quality initiatives-General information.

Jamalabadi, S., Winter, V., & Schreyögg, J. (2020). A systematic review of the association between hospital cost/price and the quality of care. Applied Health Economics and Health Policy, 1-15.

Joel, L. A. (2017). Advanced practice nursing: Essentials for role development. FA Davis.

Sarzynski, E., & Barry, H. (2019). Current evidence and controversies: Advanced practice providers in healthcare. The American Journal of Managed Care25(8), 366–368.

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