Abstract
Objectives
This study focuses on whether and how Pioneer Accountable Care Organization (ACO)
leaders believe the deployment of the registered nurse workforce is changing in response
to the shared savings incentives.
Methods
Semistructured phone interviews with leaders from 18 of the original 32 Pioneer ACOs
were conducted.
Results
Narrative analysis suggests that all of the organizations are developing new and enhanced
roles for registered nurses across the continuum of care. Overall, eight types of
changes were reported: enhancement of roles, substitution, delegation, increased numbers
of nurses, relocation of services, transfer of nurses from one setting to another,
the use of liaison nurses across settings, and partnerships between nurses coordinating
care in primary and acute care settings.
Conclusions
This exploratory study suggests that Pioneer ACO leaders believe that payment models
are affecting the deployment of the health workforce and that these changes are, in
turn, driving outcomes.
Keywords
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References
- Guest editorial: Health reform system changes will impact all registered nurses.Nursing Matters. 2010; 21: 2-3
- Guided care: A new frontier for adults with chronic conditions.Professional Case Management. 2008; 13: 151-160
- Nursing: Scope and standards of practice.2nd Edition. Author, Washington, DC2010
- Educating nurses: A call for radical transformation.Jossey-Bass, San Francisco, CA2009
- Early effects of guided care on the quality of health care for multimorbid older persons: A cluster-randomized controlled trial.Journals of Gerontology Series A–Biological Sciences and Medical Sciences. 2008; 63: 321-327
- Guided care for multimorbid older adults.Gerontologist. 2007; 47: 697-704
- The effects of guided care on the perceived quality of health care for multi-morbid older persons: 18-month outcomes from a cluster-randomized controlled trial.Journal of General Internal Medicine. 2010; 25: 235-242
- A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults.Journal of General Internal Medicine. 2008; 23: 536-542
- Qualitative data analysis for health services research: Developing taxonomy, themes, and theory.Health Services Research. 2007; 42: 1758-1772
- Care coordination of the future and the nurse's role.Texas Nursing. 2012; 86: 4-5
- First national survey of ACOs finds that physicians are playing strong leadership and ownership roles.Health Affairs. 2014; 33: 964-971
- The care transitions intervention: Results of a randomized controlled trial.Archives of Internal Medicine. 2006; 166: 1822-1828
- Geriatric care management for low-income seniors: A randomized controlled trial.Journal of the American Medical Association. 2007; 298: 2623-2633
- Driving population health through accountable care organizations.Health Affairs (Millwood). 2011; 30: 41-50
- A framework for evaluating the formation, implementation, and performance of accountable care organizations.Health Affairs (Millwood). 2012; 31: 2368-2378
- Assessing workload in general practice in England before and after the introduction of the pay-for performance contract.Journal of Advanced Nursing. 2009; 65: 509-515
- 9 Pioneer ACOs jump ship after first year.2013 ([Web log comment]. Retrieved from)
- Developing ambulatory care registered nurse competencies for care coordination and transition management.Nursing Economic$. 2013; 31 (43): 44-48
- Accountable care organizations: The future of care delivery?.American Journal of Nursing. 2012; 112: 23-26
- The changing role of nurses.Hospitals & Health Networks. 2012; 86: 36
- Executive summary: Every patient needs a Shirley.Oregon Nurse. 2010; 2
- ACOs, PCMHs, and health care reform: Nursing's next frontier?.Policy, Politics and Nursing Practice. 2011; 12: 100-103
- Evolution of the chronic care role of the registered nurse in primary care.Nursing Economic$. 2010; 28: 409-414
- Los fundamentos logicos de la semiotica y su practica.Edicial, Buenos Aires1996
- Narrative, content and semiotic analysis.in: Denzin N. Lincoln Y.S. Handbook of qualitative research. Sage Publications, Thousand Oaks1994
- Finding dementia in primary care: The results of a clinical demonstration project.Journal of the American Geriatrics Society. 2012; 60: 210-217
- A national strategy to put accountable care into practice.Health Affairs (Millwood). 2010; 29: 982-990
- Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial.Journal of the American Medical Association. 1999; 281: 613-620
- Transitional care of older adults hospitalized with heart failure: A randomized, controlled trial.Journal of the American Geriatrics Society. 2004; 52: 675-684
- The first-year Pioneer ACO results: Predictable bumps in the road.2013 ([Web log comment]. Retrieved from)
- A comparison of two different team models for treatment of diabetes mellitus in primary care.Scandinavian Journal of Caring Sciences. 2000; 14: 253-258
- Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials.Journal of the American Medical Association. 2009; 301: 603-618
- Effectiveness of collaborative care for depression in human immunodeficiency virus clinics.Archives of Internal Medicine. 2011; 171: 23-31
- Changing the skill-mix of the health care workforce.Journal of Health Services Research & Policy. 2004; 9: 128-138
- What works in chronic care management: The case of heart failure.Health Affairs (Millwood). 2009; 28: 179-189
- Health care system reform and the nursing workforce: Matching nursing practice and skills to future needs, not past demands.in: The future of nursing leading change, advancing health. National Academies Press, Washington, DC2011: 375
- Improving hypertension control: A team approach in a primary care setting.Joint Commission Journal on Quality Improvement. 2000; 26: 623-632
- Asking women to see nurses or unfamiliar physicians as part of primary care redesign.American Journal of Managed Care. 2000; 6: 187-199
- Pioneer accountable care organization model: General fact sheet.2012 (Retrieved from)
Article info
Publication history
Published online: June 08, 2015
Accepted:
May 29,
2015
Received in revised form:
May 26,
2015
Received:
January 16,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
