Leadership for Advanced Nursing Practice|My course tutor

Posted: February 26th, 2023

DNP-840A Leadership for Advanced Nursing Practice

QUESTION: The health care landscape is rapidly changing. This environment creates opportunities for innovative care delivery models and processes. Provide an example of a change in a health delivery model or process that has occurred in the past 3 years at the micro, meso, and macro system levels.

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Shabnampreet Kaur

The healthcare environment is ever-changing, and the Covid-19 pandemic brought many changes to the healthcare landscape. It has transformed healthcare delivery systems and processes. One of the recent innovative care processes that became very popular after the pandemic is patient engagement with mHealth. Although people were using mobile health technology earlier, after the pandemic, rapid growth in the use of the mHelath technology was witnessed. National Institute of Health (NIH) defines mHealth as “the use of mobile and wireless devices (cell phones, tablets, etc.) to improve health outcomes, health care services, and health research” (National Institute of Health, 2022, Part 2). This technology focuses on self-care using mobile phones or tablets using apps. With mHealth apps, patients can track their health records, interact with the apps, and connect to the providers. Mhealth provides health benefits in terms of improved healthcare and patient involvement.

All kinds of patient populations, such as pregnant women, older adults, patients dealing with psychiatric diseases, and patients with poor medication adherence, can achieve benefits. This kind of patient care delivery process helps in providers’ rapid screening of patients, behavior change for patients dealing with different diseases through education, and improving self-care and patient engagement(Rowland et al., 2020). The mHealth technology process has a response at the level of patient care, i.e., micro, the organization, which is meso, and the macro healthcare policy. As discussed earlier, the mHelath delivery process at the micro level deals with the patient as an individual. The patient interacts with the technology and has an insight into their health with a deeper understanding; therefore, it improves the self-reported health and patient-reported outcome measures(PROM).

The meso level includes the development of guidelines and how the organization’s administrators and managers use PROMs for quality improvement in healthcare, reimbursement purposes, and monitoring the growth of the organization and its performance(Sawatzky et al., 2021). The organizations analyze the outcome reported by the patients. For example, a primary care doctor’s office records incidences of excessive polypharmacy and poor patient-reported outcomes with medication use. At the meso level, using the trend in the mHealth app by the patient, the clinic will run a quality improvement initiative to improve medication adherence using the mHealth app. At the macro level, mHealth apps must adhere to the HIPAA law and Federal Food, Drug, and Cosmetic Act.

The HHA office of the National Coordinator for Health Information Technology (ONC) maintains certification programs and regulations for the mHelath apps via the 21st Century Cures Act and ONC Information Blocking regulations. Federal Trade Commission Act(FTC act) also safeguards the patients’ information. The Children’s Online Privacy Protection Act(COPPA) grants parental control over the flow of health-related information about their children (Federal Trade Commission,2023). A trend by the IQVIA Institue shows that the app Doximity recorded 7000 downloads (approximately) on the Google Play store following the pandemic (Vaidya,2022). So, overall, mHealth technology has changed the level of patient engagement and patient care. At the learner’s workplace mHealth app has tremendously improved the issues of excessive polypharmacy and reduced the rate of falls.


Federal Trade Commission. (2023, January 18). Mobile health app interactive tool. FTC. https://www.ftc.gov/business-guidance/resources/mobile-health-apps-interactive-tool

National Institute of Health. (2022, November). PAR-14-028: Mobile health: Technology and outcomes in low and middle-income countries (r21). NIH. https://grants.nih.gov/grants/guide/pa-files/PAR-14-028.html

Rowland, S. P., Fitzgerald, J. E., Holme, T., Powell, J., & McGregor, A. (2020). What is the clinical value of mHealth for patients? Npj Digital Medicine, 3(1). https://doi.org/10.1038/s41746-019-0206-x

Sawatzky, R., Kwon, J. Y., Barclay, R., Chauhan, C., Frank, L., Van Den Hout, W. B., Nielsen, L. K., Nolte, S., & Sprangers, M. a. G. (2021). Implications of response shift for micro-, meso-, and macro-level healthcare decision-making using results of patient-reported outcome measures. Quality of Life Research, 30(12), 3343–3357. https://doi.org/10.1007/s11136-021-02766-9

Vaidya, A. (2022, May). Key features of mHealth apps & trends in use. Mhealthintelligence. https://mhealthintelligence.com/features/key-features-of-mhealth-apps-trends-in-use

Veronica Montemayor

Feb 24, 2023, 10:59 PM

The healthcare landscape is continuing to evolve, as is common in medicine. COVID-19 has been the worst pandemic in the past years to have happened; the pandemic forced our current environments to change how patients would receive care. At the beginning of the pandemic, so little was known, and precautions were taken to prevent the spread of the virus. Healthcare providers were innovative with their care delivery models and processes while delivering care to the patients. Sawatzky et al. (2021) noted that patient-reported outcomes (PROs), and by extension, patient-reported outcome measures (PROMs), are increasingly used to inform healthcare decision-making. The decisions that PROs inform can be considered at the level of patient care (micro), the healthcare organization (meso), and health policy (macro). The author’s goal was to provide a framework regarding the impacts of response shift at micro-, meso- and macro-levels of healthcare decision-making. This was evident when the decision to use technology, mobile applications, and telemedicine for consultations instead of in-person visits was initiated. At the meso level in my organization, telemedicine for primary doctors was not thought about twice but rather implemented quickly.

At the patient level, the delivery of care given to them was changed drastically in an attempt to keep them safe. Patients were scared of coming to the hospital, fearing they would contract the virus. This fear led to the implementation of the Hospital at Home (HaH) program. In my organization, the PROs helped us implement the latest recommendations from the Centers for Disease Control and Prevention (CDC) that were checked daily for updates. Kaplan (2022) noted that telehealth and telemedicine literally had been lifesaving during the COVID-19 outbreak, and clinicians can serve patients near and far at any time of day or night without fear of contagion for either patients or clinicians. Kaplan (2022) stated that telemedicine was facilitated by regulatory changes that permitted service reimbursement at the micro level as well as relaxed enforcement of privacy and data sharing rules and requirements for licensure, credentials, supervision of nonphysician providers, and requirements for previously established doctor-patient relationships also enabled telemedicine’s rise. During a worldwide pandemic, expectations are made to ensure that we can improve patient outcomes; in the beginning, we had so many patients die from this virus that they varied in age, ethnicity, and medical history. The delivery care model shifted from in person to virtual appointments unless it was extremely vital to be seen physically; very soon after, we had an overwhelming number of patients going to the emergency department to be seen rather than call their primary doctor; some felt it was safer since it was a hospital.



Kaplan, B. (2022). Ethics, Guidelines, Standards, and Policy: Telemedicine, COVID-19, and Broadening the Ethical Scope.  Cambridge Quarterly of Healthcare Ethics31(1), 105–118. https://doi-org.lopes.idm.oclc.org/10.1017/S0963180121000852

Sawatzky, R., Kwon, J.-Y., Barclay, R., Chauhan, C., Frank, L., van den Hout, W. B., Nielsen, L. K., Nolte, S., & Sprangers, M. A. G. (2021). Implications of response shift for micro-, meso-, and macro-level healthcare decision-making using results of patient-reported outcome measures.  Quality of Life Research30(12), 3343–3357. https://doi-org.lopes.idm.oclc.org/10.1007/s11136-021-02766-9


Question: Discuss two regulatory organizations that provide oversight within the health care delivery system. Contrast this with a country that does not have regulatory oversight of health care. What influence does the selected regulatory organization have on your DPI Project and patient outcomes?



Bonnie Flores

Having safe access to healthcare is essential. Therefore, it is necessary that regulatory bodies oversee new medications, treatments, and protocols. The United States has many regulatory bodies tasked with the purpose of keeping the population safe and healthy. There are threats that arise continually, from a simple infection to a bloodstream infection, to a global pandemic. Therefore, having safe and effective treatments that have been tested is vital so people do not use medications that are not effective. As people continue to age and develop chronic conditions, more medications may be needed to maintain a quality and healthy life. The U.S. Food & Drug Administration (FDA) regulates many different aspects of healthcare, including drugs, medical devices, vaccines, blood, and biological products. The Center for Drug Evaluation and Research (CDER) is the agency that ensures safety and efficacy for people within the United States (FDA, n.d.). They examine side effects, adverse reactions, drug interactions, and risk of death (Kesselheim et al., 2019). Therefore, providing a crucial role in determining how and when medications should be used

Another agency that works to keep protecting the health of the United States population is the Centers for Disease Control and Prevention (CDC). They are an organization under the umbrella of the U.S. Department of Health and Human Services. They help to respond to and fight disease by bringing forth new knowledge (Centers for Disease Control and Prevention, 2022). When the Covid pandemic erupted, the CDC provided prevention strategies on their website to inform the public. They also played a key role in helping healthcare workers understand how to don and doff personal protective equipment (PPE) for reduced exposure and transmission. The CDC continues to provide data that tracks transmission rates that are used by local community public health departments (Christie et al., 2021).

These departments help to ensure the safety of the American people. This is contrasted to the 18 million people living in small Caribbean countries with no regulatory systems (Preston et al., 2020). Thus, it is vital for these countries that all medications and medical devices entering their county are screened for safety and efficacy (Preston et al., 2020). If there are no regulatory bodies, then the population is at risk of receiving resources that are not safe and have the potential for harm (Preston et al., 2020). With regard to my direct practice improvement (DPI) project, it will be necessary to follow the strict guidance of the clinical practice guidelines, organizational policies and procedures, and the guidelines of the Institutional Review Board IRB). These protocols are in place to protect patients from harm, and it is incumbent upon me to act with beneficence, nonmaleficence, and justice when rendering care to my patients.


Centers for Disease Control and Prevention (CDC). (2022). CDC 24/7. Centers for Disease Control and Prevention. Retrieved on February 25, 2023, from https://www.cdc.gov/about/index.html

Christie, A., Brooks, J. T., Hicks, L. A., Sauber-Schatz, E. K., Yoder, J. S., Honein, M. A., … & Team, R. (2021). Guidance for implementing COVID-19 prevention strategies in the context of varying community transmission levels and vaccination coverage.  Morbidity and mortality weekly report70(30), 1044.

Kesselheim, A. S., Sinha, M. S., Campbell, E. G., Schneeweiss, S., Rausch, P., Lappin, B. M., … & Dal Pan, G. J. (2019). Multimodal analysis of FDA drug safety communications: lessons from zolpidem.  Drug Safety42, 1287-1295.

Preston, C., Dias, M.F., Pena, J., Pombo, M.L. & Porras, A. (2020). Addressing the challenges of regulatory systems strengthening in small states. BMJ Global Health, 5(2), e001912.

U.S. Food & Drug Administration (FDA). (n.d.). Drugs. U.S. Food & Drug Administration. Retrieved on February 25, 2023, from https://www.fda.gov/drugs



At the meso level, the use of mHealth technology has a significant impact on healthcare organizations. It enhances patient satisfaction by providing real-time access to healthcare providers and reducing healthcare costs. mHealth technology also improves communication and collaboration among healthcare professionals, leading to better coordination of care and improved patient outcomes. Additionally, the use of mHealth technology can help in reducing healthcare disparities and improving the quality of care delivered.

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