NURS 6050 The Role of the RN/APRN in Policy Evaluation
NURS 6050 The Role of the RN/APRN in Policy Evaluation
Policy evaluation uses a range of research methods to systematically investigate the effectiveness of policy interventions, implementation and processes, and to determine their merit, worth or value in terms of improving the social and economic conditions of different stakeholders.
It is important to understand how policy evaluation fits into the larger policy process. Understanding this context provides an increased understanding of why policy evaluation is critical to advancing the field of policy. Although there are many theories regarding the policy process and mechanisms of policy change, the policy change process is often conceptualized in several key stages. Evaluation is an integral part of each step in the policy process. Although these steps are laid out in a row, in reality, the steps are circular in nature.
The three types of evaluation:
Evaluating Policy Content: Does the content clearly articulate the goals of the policy, its implementation and the underlying logic for why the policy will produce intended change? Evaluating the development of a policy helps to understand the context, content, and implementation.
Evaluating Policy Implementation: Was the policy implemented as intended? The implementation of a policy is a critical component in understanding its effectiveness. Evaluation of policy implementation can provide important information about the barriers to and facilitators of implementation and a comparison between different components or intensities of implementation.
Evaluating Policy Impact: Did the policy produce the intended outcomes and impact? Within injury prevention, the intended impact may be a reduction in injuries or severity of injuries. However, it is important to evaluate short-term and intermediate outcomes as well.
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The type of evaluation selected depends on many factors and often more than one type of evaluation will be needed. Each type of evaluation can provide valuable information for the planning and interpretation of the other types of evaluation (content, implementation, and impact) in addition to uncovering unintentional consequences. However, it is critical for each evaluation to be focused so the most appropriate design and methodology is selected. The team can develop an all-encompassing set of evaluation questions and then select specific evaluation questions and methods for each particular phase.
While all evaluations encounter challenges particularly relevant to policy evaluation and many of these challenges can be easily addressed by using an appropriate design, indicators, and methods. The challenges when conducting policy evaluation are:
- Lack of resources or clear responsibility for evaluation
- Lack of strong evidence base to support policy
- Fear of evaluation and lack of familiarity with policy evaluation methods
- External and contextual factors such as economic conditions or public awareness
- Rapid pace of policy
- Lack of appropriate measures
- Political scrutiny and desire for quick production of results
- Difficulty in identifying appropriate comparison communities
Brownson, R. C., Royer, C., Chriqui, J. F., & Stamatakis, K. A. (2009). Understanding evidence-based public health policy. American Journal of Public Health, 99, 1576–1583.
MacDonald, G., Starr, G., Schooley, M., Yee, S. L., Klimowksi, K., & Turner, K. (2001). Introduction to program evaluation for comprehensive tobacco control programs. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/tobacco/tobacco_ control_programs/surveillance_evaluation/evaluation_manual/pdfs/evaluation.pdf
I chose the Affordable Health Care Act Policy as this is well-known and has been a big part of the legislation. The Affordable Care Act (ACA) makes affordable health insurance available to more people. The law provides consumers with subsidies and tax credits that lower costs for households with incomes between 100% and 400% of the federal poverty level (Affordable Care Act, 2020). Politics plays heavily into policy making and evaluation. A video from Walden University (2018) featuring Joel Teitelbaum shares, “It is clear that politics is playing a vital role in the design of the outset and now the implementation and evaluation of the ACA.” A program could not be successful after many years if it were not being evaluated and adjusted.
There have been several ways the ACA has been evaluated over time. After evaluation, the ACA has changed from 2011-2022. The policy will always change as the population grows, presidents change, and the cost rises or falls over time. One of the first ways the policy has been evaluated is by the number of individuals enrolled from 2010 to 2022. The government calls this administrative data and has looked at how many people have enrolled through new health insurance marketplaces or the number of people who have enrolled in Medicaid. As numbers have increased over time, policymakers have assumed success. So, if fewer Americans lack health insurance, it will be a crucial indicator of how well the ACA is working.
Administrative data can be limited, so A lot of the policies evaluation has come from surveys over time. In 2014 before federal surveys were allowed, they launched, the Health Reform Survey, this is a quarterly survey of the nonelderly designed to provide timely information on implementation issues under the Affordable Care Act (ACA) and changes in health insurance coverage and related health outcomes (Long,2014). This looked at data, affordability, participation, and healthcare access. It helped give a good visual of implementation success. After that rolled out so did other surveys that had been given to private entities, which ask about health insurance by type of coverage and track changes over time. Another survey that is often a source of health coverage evaluation is the Annual Social and Economic Supplement (ASEC) to the Current Population Survey, which provides socioeconomic and demographic information, including health coverage status, for the non-institutionalized U.S. population (Montero,2022). The surveys look at insurance utilization and insurance status. The survey data received from the U.S. Department of Human Services and Medicare has been used for the evaluation and success of the policy.
Social determinants weigh heavily in the health world, especially regarding the ACA. The World Health Organization defines social determinants of health as the conditions in which people are born, grow, live, work, and age (Abrams,2017). Racism, poverty, unsafe neighborhoods, and lack of education are some of the many social determinants that create health inequity in our country (Leong & Roberts,2013). Not everyone had access to healthcare in 2010 due to the high costs of plans. Poverty greatly affected this over time as money was required to deliver efficient care safely. The Affordable Care Act expansion did lessen the consequences of socioeconomic status and healthcare access by assisting disadvantaged persons in receiving health services. The ACA has been a tremendous help to those falling at or under the poverty level.
Abrams, M. (2017). Chapter 7 – Social Determinants of Health. Alliance for Health Policy. Retrieved October 19, 2022, from https://www.allhealthpolicy.org/sourcebook/social-determinants-of-health/
Centers for Medicare & Medicaid Services. (2020). Affordable Care Act (ACA). Federal Poverty Level (FPL) – Glossary | HealthCare.gov. Retrieved October 19, 2022, from https://www.healthcare.gov/glossary/federal-poverty-level-fpl/
Leong, D., & Roberts, E. (2013). Social determinants of health and the Affordable Care
Act. Rhode Island medical journal (2013), 96(7), 20–22.
Long , S. (2014). What do we know about ACA implementation? introducing the Health Reform Monitoring Survey. Introducing the Health Reform Monitoring Survey. Retrieved October 20, 2022, from https://www.urban.org/urban-wire/what-do-we-know-about-aca-implementation-introducing-health-reform-monitoring-survey
Montero,A. (2022). Measuring Changes in Insurance Coverage Under the Affordable Care Act.
KFF. Retrieved October 19, 2022, from https://www.kff.org/health-reform/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act-and-the-supreme-court/
Walden University, LLC. (Producer). (2018). Introduction to Health Policy and Law with Joel
Teitelbaum [Video file]. Baltimore, MD: Author.
I like your choice of program for this discussion. The ACA has undergone quite a bit of change as it has changed hands throughout different presidencies. I agree that it has had many positive impacts on people below the poverty line and has led to many becoming insured that could previously not afford to be. I believe that evaluating this program in future years is key as the times change. What was the solution when the program was signed into law may not be the solution in future years. As the program changes hands and different presidents and congress staff changes, hopefully beneficial changes are made to allow this to continue to be a beneficial program. I do not think there is a perfect solution to healthcare, however those in charge must strive to continue to evaluate and amend this program.
Centers for Medicare & Medicaid Services. (2020). Affordable Care Act (ACA). Federal Poverty Level (FPL) – Glossary | HealthCare.gov. Retrieved October 27, 2022, from https://www.healthcare.gov/glossary/federal-poverty-level-fpl/
Effect of the Affordable Care Act in Maryland. (n.d.). ballotpedia.org/ Retrieved on 10/27/2022 from https://ballotpedia.org/Effect_of_the_Affordable_Care_Act_in_Maryland_(2009- 2017)
Affordable Care Act (ACA) can also be measured through the promotion of personal well-being. If ACA prevents and relieves pain suffering and disability and minimizes loss of life, then it’s doing what it was designed to do.
Affordable Care Act can also be measured through its effect on meeting people’s health needs as the disease is usually thought of as an adverse departure from the normal level of functioning. The ACA should therefore help people to maintain or restore normal functioning or to compensate for the inability to function normally.
Another way ACA is measured is through equitable access. Equitable access could be interpreted as access to whatever an individual needs or benefits from. For instance, if a given level of care is available to one individual, it must be available to all. ACA was designed to ensure that there is equitable access to healthcare for all individuals who enjoy healthcare benefits (Munson & Lague, 2016)
Milstead, J. A. (2014). Health policy and politics (5th ed.). Jones & Bartlett Learning.
Munson, R., & Lague, I. (2016). Intervention and reflection: Basic issues in bioethics (10th ed.). Cengage Learning.
Thank you for an excellent post. Advanced practice registered nurses is on the front lines of disseminating information to patients that directly affect their outcomes to treatments and medications. We constantly assess, administer treatment and medications and then evaluate that treatment, but seldom do we use those skills to evaluate the policies that have been enacted governing the treatments or medications we administer. Many healthcare policies and programs have been established, but it is critical to determine whether they have been efficient and effective. Efficiency details the number of patients helped, and effectiveness speaks to the quality of care. Evaluation reports are provided by the programs to share specific information that aids members of the legislature, community, and others in understanding how the program works and its impact on the targeted recipients (Walden University, LLC, 2018). Since 1992, more than $8 billion have been delivered for over 360,000 Virginians, almost 150,000 Virginians have received state-sponsored health insurance, almost 4 million patient visits have happened, and more than $16 million in grants given to expanding the state’s medical safety (Foundation, n.d.). The VHCF is very efficient with the number of Virginians it has supported in its 30-year presence. The program’s efficacy is evident by the evidence of expanded health care services to areas of the state that were previously under or not served. In 2021, the priority was on developing mental health care services for those without access to counseling services.
Foundation, V. H. C. (n.d.). RD441 (published 2021) – Virginia health care foundation 2021 Annual report. Retrieved October 28, 2022, from https://rga.lis.virginia.gov/Published/2021/RD441
Walden University, LLC. (Producer). (2018). The Importance of Program Evaluation [Video file]. Baltimore, MD: Author.
Health policies are frequently developed without the evidence of research conducted by nurses (Wakefield, 2004). I believe that by increasing nurse researchers’ understanding of the policy process and how research contributes to policy evaluation, nurse researchers will be more effective in contributing to policies that improve the health of the nation.
Evaluation is the final stage in the policy process. Policy evaluation according to the Centers for Disease Control and Prevention (CDC) applies evaluation principles and methods to examine the content, implementation or impact of a policy, it is the activity through which we develop an understanding of the merit, worth, and utility of a policy (CDC, 2016). Moreover, the use of research to health policy evaluation is to determine the effectiveness of the healthcare policy in improving aspects of targeted population’s health in terms of quality of care, the efficiency of care delivery, availability of access and the effect on health disparities.
As nurses being involved in the process of policy evaluation, nurses should be encouraged to engage more fully in health policy research. We believe that by increasing nurse researchers’ understanding of the policy process and how their research can contribute at each stage of the process, nurse researchers will be more effective in contributing to policies that improve the quality of health of the target population
Aday L. A., Begley C. E., Lairson D. R., Balkrishnan R. (2008) Evaluating the healthcare system: Effectiveness, efficiency, and equity, 3rd ed. Chicago, IL: Health Administration Press.
Braveman P. A., Cubbin C., Egerter S., Williams D. R., Pamuk E. (2010) Socioeconomic disparities in health in the United States: What the patterns tell us. American Journal Public Health 100(Suppl 1): S186–S196. doi:10.2105/AJPH.2009.166082.