Raising Nursing’s Voice for Health Care Reform

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Pamela H. Mitchell, RN, PhD, FAAN, FAHA

The rhetoric of the current Presidential nomination political campaigns is all about financing of health care, but it is clear that Americans want to reform more than just the financing. Fox Business News summarized the results of a recent Consumer Reports poll of Americans about health care. The overwhelming majority want changes in how care is delivered and financed. The story notes: “Consumer Reports will be pressing for changes that ensure that all Americans can get high-quality health care at a price they can afford, including guaranteed access and improved delivery of care.”1 The full report can be found at: http://www.consumerreports.org/health/home.htm.

Although we don’t pretend to have a comprehensive program to reform the US healthcare non-system, the American Academy of Nursing members have developed some outstanding programs that are models of the kinds of changes in how care is delivered that could indeed “ensure high quality care at a price they can afford.” Through the Raise the Voice! campaign funded by the Robert Wood Johnson Foundation, the Academy is mobilizing its 1500 Fellows and their partners to ensure that Americans hear and understand possibilities for transforming health care delivery. This campaign highlights how nurses lead the way. In this column, I will highlight a small number of these “Edge Runners”—the practical innovators who have led the way in bringing new thinking and new methods to a wide range of health care challenges. As our website says: “…nurses are creating new, transformational options that help people stay healthy and cope better with illness. It’s a story that Americans need to hear.”2

Take the story of Ruth Watson Lubic, EdD, RN, CNM, FAAN, nurse, midwife, founder and chair emeriti of the Family Health and Birth Center, Washington, DC. After successfully developing childbearing centers and 2 freestanding birthing clinics in New York City, she moved to Washington, DC and turned her attention to the needs of young women and their children in that area. She used the money from her John D. and Catherine T. MacArthur Foundation “genius” fellowship to launch the Family Health and Birth Center in an abandoned supermarket in the low-income area of the District of Columbia. The Family Health and Birth Center provides midwifery and nursing services and health care for women and children—backed by hospital and obstetrical and gynecological consultants. The Center continues to deliver a record number of infants, 25% at the facility, with the rest at Washington Hospital Center. After < 6 years of operation, the preterm birth rate was substantially lower than in the overall DC area (9% at the center vs. 14.2% for all of DC). Low birth weight infants constitute only 7% of center births compared with 14.6 overall in DC ,and cesarean section rates were almost half of the overall DC rates (15.3% vs. 29%). Costs to the District of Columbia’s health care system were reduced by more than $1.15 million in 2005. Clearly a cost-effective, high quality endeavor! Ruth Lubic is now in her 80s and going strong in her passion to transform health care for women and their children who have been lost to our current illness-based “system.”3

Another “edge runner” is Mary Naylor, PhD, RN, FAAN. She is a Professor at the University of Pennsylvania who, along with colleagues at the University of Pennsylvania, has dedicated over 2 decades to research and practice that demonstrates the value of the transitional care model in improving the lives of Americans.4 The work that Naylor has led has focused largely on older Americans. Transitional care is an evidence-based model of hospital-to-home care in which advanced practice nurses (APN) work with families to ensure a smooth transition from hospital care to home care. These nurses establish a relationship with patients and their families soon after hospital admission; design the discharge plan in collaboration with the patient, the patient’s physician, and family members; and implement the plan in the patient’s home following discharge, substituting for traditional skilled nursing follow-up.

Several rigorous research studies have shown that transitional care reduces the incidence of poor communication among providers and health care agencies, reduces the incidence of inadequate patient and caregiver education and poor quality of care; and it enhances access to quality care. Compared to standard care, there are longer intervals before initial re-hospitalizations, fewer re-hospitalizations overall, shorter hospital stays, and better patient satisfaction. Further, this model can cut costs substantially. A study with older adults with heart failure showed a savings of > $500,000 compared with a group receiving standard care, or an average of $5000 per Medicare patient. Funding from the Commonwealth Fund, Jacob and Valeria Langeloth Foundation, the John A. Hartford Foundation, Inc., the Gordon & Betty Moore Foundation, and the California HealthCare Foundation is allowing a test of the “real world” application of this model in collaboration with Aetna, Inc., and Kaiser Permanente. This work was featured in the Wall Street Journal in December 2007.5

The news too often features the high costs of hospitals, physicians and pharmaceuticals. It is time to feature the cost savings and high quality of innovative programs such as those of our “Edge Runners.”