Evolving practice of nursing and patient care delivery models

Evolving practice of nursing and patient care delivery models.

Since the formation of the Patient Protection and Affordable Care Act (PPACA) in 2010, new patient care delivery models have emerged in the United States and the roles of nurses are changing. Unlike the traditional medical approach of providing curative care, nurses are also providing preventive health care. They are now at the center of coordinating health care practices, particularly, in underserved regions. The PPACA advocated for the formation of delivery models such as medical homes, accountable care organizations, and nurse-managed health clinics.

Accountable care organizations (ACA)

Accountable care organizations were implemented after the enactment of PPACA. They are groups of hospitals, nurses, doctors and other health care providers that voluntarily provide health care to Medicare patients. ACA aims to provide cost-effective high-quality care to patients particularly those suffering from chronic diseases.

Medical homes

Medical homes are primary health caregiving centers that are patient-centered. They provide high-quality care that fully attends to patient needs.  Medical homes also provide ample and accessible health care. Nurses, physicians, and other health care professionals work together when providing care. The nurses are at the frontline. They engage in analyzing laboratory results, referring patients that need advanced care, providing primary care and promoting health. Although medical homes are not final destinations, they play a vital role in offering primary care at the right place and time.

Nurse managed health clinics.

Nurse managed health clinics are run by nurses. They focus on the provision of primary health care to the underserved and rural places. The nurses engage in diagnosis, pre-natal and post-natal care, and offering medical prescriptions. They also refer patients for advanced care. Examples of nurses who work in nurse-managed health clinics include nurse practitioners, nurse midwives, and clinical nurses. Students undertaking nursing courses are sometimes allocated tasks in such places. They mostly engage in health care education and patient data management. Nurse managed health clinics play a vital role in the provision of primary care to the vulnerable.

With the implementation of new delivery models, nursing practices are changing gradually. Unlike in the past where nurses focused on curative care only, they are also focusing on preventive health care. Nurses are at the backbone of these new models. They play a vital role in accountable care organizations, medical homes and nurse-managed health clinics that have improved care through the provision of cost-effective health care.


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Hofer, A. N., Abraham, J. M., & Moscovice, I. (2011). Expansion of coverage under the Patient Protection and Affordable Care Act and primary care utilization. The Milbank Quarterly, 89(1), 69-89.

Naylor, M. D., & Kurtzman, E. T. (2010). The role of nurse practitioners in reinventing primary care. Health Affairs, 29(5), 893-899.


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