Establishing Interrater Reliability Within the Advanced Practice Nurse Peer Review Process.

BACKGROUND AND PURPOSE: The Advanced Practice Nurse (APN) Council refined the APN peer review to an objective, data-driven process. The purpose of the study was to assess the interrater reliability of APN peer reviews using the APN Rubric based on Hamric, Spross & Hanson's Model of Advanced Practice Nursing. METHODS: A quantitative single-site study with a convenience sample of 80 APN Portfolios. RESULTS: Analysis of six core competencies (direct clinical practice, leadership, consultation/collaboration, coaching/guiding, research, and ethical decision-making) within the APN Rubric demonstrated substantial and near perfect agreement levels in the APN peer review process. CONCLUSIONS: The application of APN core competencies within the peer review process demonstrated high consistency, thereby increasing the significance and objectivity of peer review outcomes.

The effect of a hybrid training program.

Improving nursing communication skills and HCAHPS scores.

The HackensackUMC Value-Based Care Model: Building Essentials for Value-Based Purchasing.

The Affordable Care Act, 2010, and the subsequent shift from a quantity-focus to a value-centric reimbursement model led our organization to create the HackensackUMC Value-Based Care Model to improve our process capability and performance to meet and sustain the triple aims of value-based purchasing: higher quality, lower cost, and consumer perception. This article describes the basics of our model and illustrates how we used it to reduce the costs of our patient sitter program.

An Example of Translating Value-Based Purchasing Into Value-Based Care.

The Affordable Care Act (ACA) (2010) launch of Medicare Value-Based Purchasing (VBP) has become the platform for buyers of health care to hold health care providers accountable for demonstrating high-quality, cost-effective care for Medicare recipients across the trajectory of care practitioners and settings (Gardner, 2013; VanLare & Conway, 2012). The Centers for Medicare and Medicaid Services (CMS), authorized under the ACA, specified quality measures that will best advance the National Quality strategic objectives and build upon the Hospital Inpatient Quality Reporting infrastructure (U.S. Department of Health & Human Services [DHHS], 2013). The quality performance measure domains for fiscal year 2013 focused on Clinical Process of Care and Patient Experience of Care domains. Strategically, quality measures will expand to include delivery of care models, and coordinated care focused on promoting health wellness and health maintenance within the community setting (VanLare & Conway, 2012). Value-based purchasing affords nursing the opportunity to lead the charge in developing innovative delivery of care models to improve the quality of care at a lower cost and shift from providing sick care toward population-focused, preventative, and health promotion care (Gofin, Gofin, & Stimpson, 2014; Marsh, Diers, & Jenkins, 2013).

Blueprint for nursing leadership: creating a culture of accountability.

Our "Blueprint for Nursing Leadership" emerged from dialogue with our nurse leaders on the daily challenges that managers encounter with competing and compelling priorities in the increasingly complex health care environment. Recognizing this as a transformational opportunity, the reorganized nurse executive council members were invited to a leadership retreat to further explore this topic. From this dialogue, 3 key components, distributed responsibility, nonstop skill development, and accountability became the framework on which the "Blueprint for Nursing Leadership" was created. The blueprint is to empower, engage, and sustain a culture of accountability.