NURS 8404 Health Services Research & Policy for Nurses
Course Instructors:
Steven Sheingold, PhD ssheingo@gwu.edu
Andrea Brassard, PhD, FNP-BC, FAANP brassard@gwu.edu
Course Description:
Methods for evaluating the effectiveness, efficiency, and equity of health care and nursing services
delivery. Approaches to measuring the relevant structure, process, and outcome variables that can
be used to address effectiveness, efficiency, and equity issues are presented. Throughout the course,
linkages are made between nursing, health care policies and related health services research.
Course Objectives
1. Review federal and state health care laws and policies.
2. Analyze the meaning of cost, quality and access as organizing concepts for research on
health care systems.
3. Critically evaluate research design, methodological approaches, and conclusions of health
services research studies.
4. Utilize public datasets for health services and outcomes research.
5. Apply knowledge of the policymaking process and political action to current legislative and
regulatory issues.
6. Examine current issues in health care reform.
7. Critically analyze a current health policy issue.
Prerequisites:
NURS 6202: Concepts in Population Health
Required Texts
Bardach, E. (2012) A Practical Guide for Policy Analysis, 4th Ed. Washington DC: CQ Press
Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the
Institute of Medicine (2011).The Future of Nursing: Leading Change, Advancing Health. Washington,
DC: National Academies Press; 2011. Available as a free pdf at
http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change-advancing-health.aspx
Goudreau, K. & Smolenski, M., Eds. (2013). Health Policy and Advanced Practice Nursing. New
York: Springer.
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Supplemental Texts
Dickson, G.L & Flynn, L., Eds. (2008) Nursing Policy Research. New York: Springer.
Estes, C, Chapman, Dodd, & Hollister (2013). Health Policy: Crisis and Reform in the U.S. Health
Care Delivery System, 6th Ed. New York: Jones & Bartlett
Hamric, A.B., Hanson, C.M., Tracy, M.F. & O’Grady, E.T. (2013). Advanced Practice Nursing: An
Integrative Approach. St. Louis: Elsevier.
Harrington, C & Estes, C (2012). Health Policy: Crisis and Reform in the U.S. Health Care
Delivery System, 6th Ed. New York: Jones & Bartlett
Mason, D.J., Leavitt, J.K, & Chaffee, M.W. (2011). Policy and Politics in Nursing and Health
Care, 6th Ed. Philadelphia: Saunders.
Milstead, J.A. (2011). Health Policy and Politics: A Nurse's Guide, 4th Ed. Sudbury, MA: Jones
and Bartlett [in R2 library (PDA)]
Course Requirements
Components of the Final Grade
Individual Health Policy Analysis (7-10 pages) identifying a specific
health policy issue in student’s area of interest. The student will provide
a brief but complete policy analysis based on the first four of Bardach's
eight steps.
Health Services Research Article Review
A critical review (5 to 7) pages of a health services research article in
student’s area(s) of interest. Can be general health services research or
an economic (cost/comparative effectiveness) article. Instructor
approval required for article selection
Group Health Policy Analysis
Conduct a policy analysis of a current health issue. Paper will include:
a. Introduction, definition, background (4 to 6 pages)
b. Development and analysis of policy alternatives (6 to 8 pages)
c. Conclusion / recommendation including nursing actions and areas for
future health services research (3 to 4 pages)
Total pages no more than 20 of text
Short PowerPoint presentation
Executive Summary
Discussion / Class Participation
Total
35%
25%
30%
10%
100%
2
Grading Scale
Numeric Average
93-100
90-92
87-89
83-86
80-82
77-79
73-76
70-72
67-69
63-66
60-62
0-59
Grade
A
AB+
B
BC+
C
CD+
D
DF
GPA
4.0
3.7
3.3
3.0
2.7
2.3
2.0
1.7
1.3
1.0
.07
0
Reminder: C- is not a passing final grade.
Due Dates/Assignment Format/Policy for Late Assignments
 Assignments must be submitted in Blackboard by 12:00 Noon Eastern Time on the date they
are due.
 All assignments are to be submitted as Word files, as this allows us to include comments (as
needed). The only exception is of course the PowerPoint presentation which will
accompany your Group Health Policy analysis.
 Please name, save, and submit all individual assignment files as your last name.
 No abstracts are required for any assignment in this course. For the Group Health Policy
Analysis, you will submit an Executive Summary.
 All assignments should be written in your own words. Direct quotations should be kept to a
minimum and used only when those exact words are essential.
 If you encounter an unforeseen life event that will delay your assignment submission, email
us in advance of the due date and request an extension.
 Unexcused late assignments will be penalized by 10% per day.
Communication and Feedback
 If you have questions or other concerns, the best way to reach us is by email.
 We will do our best to respond to emails within 24 hours.
 Sometimes a quick telephone call can save hours of worry. Email your contact information
and call availability and we will call you.
 You can expect your grades to be posted within two weeks of submitting your assignments.
When we are in the process of grading, your assignment will not be visible.
 We will post an announcement when grades are complete.
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Discussion Participation
 Interaction and collaboration among instructors and students is essential to the learning
process and a key component of this course. Your participation in online discussions is
required, and constitutes 10% of the final grade.
 Please familiarize yourself and follow guidelines for online communication etiquette
(“netiquette”). See the School of Nursing Virtual Orientation for more information:
http://nursing.gwu.edu/virtual-orientation.
 You are expected to contribute meaningfully and professionally to the discussion forums.
 Your participation in online discussion will be evaluated cumulatively based on the
following criteria:
o Follows directions for posting in Weekly Session and Discussion Forum
o Initial post by Wednesday or Thursday; returns to the Discussion Forum on the
weekend to respond to classmates and instructors
o Follows instructions for required number of threads
o Uses correct spelling, grammar, use of abbreviations and their plural forms
o Responses incorporate session readings and resources
o Responses include pertinent insights or experiences from your professional life to
inform the discussion
o Responses reflect careful reading of classmates posts and are not repetitive or trite
o Questions from instructors and classmates are answered
o Statements, positions, and opinions are supported by course material or professional
experience
o Does not add new material or new references unless especially insightful
 In all discussion forums you can modify or remove your own post (as long as there are no
replies) so please correct typographical errors.
 In some forums you can start a new discussion thread; in other forums threads will be posted
to guide the discussion.
Technical Requirements



This course requires you to have basic computer skills, and a working knowledge of the
Microsoft Word, Powerpoint & Excel, or compatible software products. For assistance, refer
to Microsoft training for Office products.
If you are new to distance learning at GW, familiarize yourself with the Blackboard
Learning Environment. Blackboard’s help page for students provides on-demand training
and step-by-step instructions for all features and functions.
Be sure to check your computer’s readiness for distance learning.
Course Structure
 This course consists of 15 online sessions and includes a combination of self-directed and
interactive learning activities.
 Each session begin on Monday at 12:00 PM and ends on Monday at 11:59 AM.
 Learning activities and requirements for each session are detailed in the Weekly Session
area of Blackboard.
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
Detailed instructions for all assignments, along with links to submit them, are provided in
the Assignments area of Blackboard.
Schedule of Classes
Session
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
Week 11
Week 12
Week 13
Week 14
Week 15
Topic
Introduction to Health Policy
Policy Analysis
Political Advocacy
Health Services Research Methods
Health Care Financing and Cost Containment
Implementation of the Affordable Care Act
Delivery Systems and Payment Reform
Future of Nursing: Leading Change, Advancing Health
Future of Nursing: Workforce, Diversity, Scope of Practice
Cost Effectiveness Analysis in Health Services Research & Policy
Policy Issues: Long Term Care Financing
& Enhancing Palliative/Hospice Care
Utilizing Health Services Research in Policy and Legislation
Group Projects
Thanksgiving Break
Group Projects
5
Detailed Session Schedule
Session
Learning Objectives*
Readings
Week 1
Introduction to
Health Policy

Explore the multiple factors that
affect health policymaking in the
U.S. (5)
Discuss critical health policy
questions and the reasons for the
persistence of these questions over
time. (5,6)
Journal Articles:
Brown (2011), Freeden (2013),
Lurie (2002), Quadagno (2011),
Ridenour (2009), Murray (2010),
Hastings Center (2009)
Describe health policy problems and
issues (5,6,7)
Describe the concept of policy
analysis (7)
Identify Bardach’s eightfold path for
policy analysis (7)
Consider how to assemble evidence
for health policy analysis (7)
Differentiate between federal and
state policy targets (1,5,6,7)
Bardach (2012) A Practical
Guide for Policy Analysis
Journal Articles: DeMarco
(2014), Taft (2008)
Optional: Falk (2014)

Week 2
PolicyAnalysis





Week 3
Political
Advocacy


Describe the development of health
care laws and regulations (1,5,6)
Discern the respective roles of
Learning Activities &
Assessments
Lectures/Media:
Healthcare Policy in the US
(Parts 1 & 2)
Discussions:
 Our Learning Community
(Introductions)
 ACA/Factors that affect
health policy
making/Nurses role
Lectures/Media:
 Bardach’s Eight Steps
 What Public Health Policy
do YOU Personally want
to Change?
Explore Health Policy
Websites for Policy Analysis
ideas
Dickson & Flynn, Chapter 16
Milstead, Chapters 1 & 3
Journal Articles:
Graham (2010), Ray (2008),
Discussion: Individual Health
Policy Analysis – Your Ideas
Politics & You SelfAssessment Survey
Lectures/Media:
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Session
Learning Objectives*




federal and state government in
health policymaking (1,5)
Differentiate between legislation and
regulation (1,5)
Identify targets for health policy
change (1,5,6,7)
Value political advocacy as an
advanced practice nursing role (5)
Differentiate between policy analysis
and political analysis (5)
Readings
Carlson (2012), Spear (2006),
Clauveul
Learning Activities &
Assessments
 Narrated PowerPoint by
Sheila Burke “The US
Congress and Health
Policy” KaiserEDU
 Play to Win by Catherine
Dodd.
 Neelon, Federal vs. State
cs. Local Poly Approaches
to Obesity Prevention
Explore advocacy resources
from the ANA & AANP
Political Advocacy Discussion
Week 4
Health Research
Methods





Describe the relationship between
health services research and program
evaluation (3)
Identify different types of research
study designs utilized in health
services research (3)
Identify cost, quality, and access as
organizing concepts for health
services research (2)
Investigate public databases as data
sources for health services research
(4)
Investigate sources of outcomes data
Health Services Research:
 Stenwach, et. al., Chapter 8
 Dickson & Flynn Chapters 2
&3
Secondary Data Anaylysis:
 Boslaugh (2007)
 Park et. al. (2011)
Outcomes Research
 Goudreau & Smolenski,
Chapter 4
 Kane (2006
 Newhouse et.al. (2011)
Health Services Research:
 Explore websites
 Presentation by Linda
Burton: Intro to Health
Services Research
Secondary Data Analysis:
 Presentation by Needham,
Secondary Data
Outcomes Research
 Video: Use of Health
Economics & Outcomes
Research in Healthcare.
 Explore Websites: PCORI,
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Session
Learning Objectives*
Readings
for health services research (3,4)
Week 5
Healtcare
Financing & Cost
Containment





Discuss historical and current aspects
of public funding for health services
(1,5)
Differentiate between public and
private funding (1,7)
Discuss the challenges of financing
health care in the future (1,6,7)
Discuss cost containment methods
(1,2)
Identify the economic value of
nursing (2,6,7)
Unerstanding Health Policy
eText, Chapters 2,4,8,9
Goudreau and Smolenski,
Chapter 22
Articles/Reports: Smilth, et. al.
(2013), Kaiser (2012), Smith, et
al (2014), Misra & Sheingold
(2014), Bielaszka-DuVernay,
RWJF Policy Brief, Oberlander
(2011).
Optional Readings: Bodenheimer
& Fernandez (2005),
Bodenheimer (2005), Gawande
(2009)
Learning Activities &
Assessments
Hospital Compare,
Physician Compare.
 Physician Compare video
 NYTimes Vdieo: Medicare
Start Ratings Allow
Nursing Homes to Game
the System
Discussion: Health Services
Research
Lectures/Media:
 Healthcare Financing
Issues & Policy
 Health Care Cost
Management: Old and
New Approaches
Suggested Background –
KaiserEDU Tutorials:
 Private Health Insurance
 Medicare 101
 Health Coverage and the
Uninsured
 Consumer Directed Health
plans
Discussions:
 The recent cost slowdown
 Cost containment,
restructuring and APRNs
8
Session
Learning Objectives*
Readings
Week 6
Implementation
of the Affordable
Care Act

Goudreau & Smolenski, Chapter
9
Articles: Iglehart (2013), Hahn
et. al. (2013), Hahn & Sheingold
(2013); ASPE Issue Brief

Explore the Affordable Care Act and
the political environment during and
after its passage (1,5,6)
Identify and discuss key
implementation issues and challenges
for health reform (6)
Additional Suggested Readings:
Sacks (2012), Rasmussen et al
(2013), Dorn et al (2013),
Holahan et al (2012), Jost (2012),
Rosenbaum & Westmoreland
(2012); Health Affairs Policy
Brief, Alliance for Health
Reform (2010)
Week 7
Delivery Systems
& Payment
Reform


Explore the health system
transformation aspects of ACA
Describe the CMS Innovation
Center and its activities
CMMI articles: Issue Brief,
Statement of Jonathan Blum on
Delivery System Reform,
Goudreau & Smolenski, Chapter
21
ACO Articles: Larson, et al
(2012), Bartoline (2013), Gold
(2014), McClellan et al (2014),
Mostashari & White (2014),
Petersen & Muhlestein (2014)
PCMH Articles: Longworth
(2011), AHRQ (2010),
Ritennhouse et al (2009)
Learning Activities &
Assessments
Narrated presentations:
 ACA health Reform
American Style
 Implementing the
Affordable Care Act
 Legislative Origins of
ACA by Dr. Andrew
Bindman
Collaborate session for
questions
Discussion: The Affordable
Care Act
Explore CMMI Website
PowerPoint presentations
Discussion: Payment and
Delivery System Reform
9
Session
Learning Objectives*
Week 8

Cost
Effectiveness

Analysis is Health
Services Research
and Policy


Week 9

Future of
Nursing: Leading
Change,
Advancing Health 
Discuss the rationale and importance
of cost-effectiveness analysis (2,3)
Describe recommended practices for
conducting and critiquing a cost
effectiveness study (2,3)
Discuss the role of cost effectiveness
analyses in technology decisions
(2,6,7)
Describe comparative effectiveness
research and discuss some of the
policy issues concerning its use
(2,3,5
Identify the four key messages and
eight recommendations of The
Future of Nursing: Leading Change,
Advancing Health (6,7)
Describe the aims and activities of
Readings
Bundled Payment Articles:
Aligning Forces for Quality
(2013)
Welch (2012), Bach et al (2012)
Comparative Effectiveness
Analysis: Academy Health,
Garber & Sox (2010), Frick
(2011)
Assessing Costs Effectiveness
Studies: Weinstein et al (1996),
Drummond et al (1997)
Rationing: Bodenheimer &
Graumbach, Chapter 13;
Drummond & Sorenson (2009);
Sheingold & Sheingold (2010);
Rattner (2012).
Optional Readings & Resources:
Vanhook (2008); Vincent (2002),
Vincent & Mackey (2000)
The Future of Nursing: Leading
Change, Advancing Health (Full
Report, Report Brief, Report
Recommendations).
Learning Activities &
Assessments
Lectures/Media
 Economic Evaluation in
Health Care
 Medical Technology: Can
we make value-based
decisions
Optional: Feeny, Overview of
Cost-Effectiveness & Cost
Utilities Analyses; Stone,
What is CEA and Why is it
Important?
AHRQ Effective Healthcare
Program Website & Webinar
Discussion: Cost Effectiveness
Analyses
The Futre of Nursing
Campaign for Action Video
The IOM 2103 Richard &
Rosenthal Lecture Recording
10
Session
Learning Objectives*

Future of Nursing: Campaign for
Action (6,7)
Discuss progress and challenges to
implementation of the eight
recommendations
Readings
Related Readings: Strategic
Advisory Committee; Reinhard
Transforming Nursing; Fairman
& Okoye (2011); Cohen (2013);
Spetz (2013); Vilegas & Allen
(2012); Point/Counterpoint;
Fineberg & Lavizzo-Mourey
(2013).
Learning Activities &
Assessments
Campaign for APRN
Concensus – Video. Explore
APRN Maps.
Nurses on Hospital Boards
video.
Future of Nursing Discussion
Optional: The Future of Nursing
in NC
Removing Barriers to APRN
Practice & Care: Brassard
Publications
Nurses on Boards: Hassmiller
(2012); Optional – Mason et al
(2012).
Week 10
Future of
Nursing:
Workforce,
Diversity, and
Scope of Practice




Discuss the current RN and APRN
workforce and future projections
(4,6,7)
Discuss diversity in nursing (6,7)
Discuss barriers to RN scope of
practice (6.7)
Discuss tactics used to support
physician supervision of APRN
Diversity:
IOM Report – Diversity in
Nursing
Scope of Practice:
IOM Report
Djukic & Kovner (2010)
Diversity in Nursing:
IOM Report; Deadly Spin on NP
Workforce:
 Presentation: Salsberg,
Healthcare Workforce
Challenges in an Evolving
Healthcare System
 Explore websites: ANA
Workforce Resources; The
US Nursing Workforce
11
Session
Learning Objectives*
Week 11

Policy Issues:
Long Term Care
Financing
& Enhancing
Palliative/Hospice

Care

Week 12

Readings
Learning Activities &
Assessments
Trends in Supply &
Education, HRSA National
Sample Survey of Nurse
Practitioners
Diversity:
 Campaign for Action
website
 Campaign for Action
Diversity Committee
Webinar
Lectures/Media:
 Sheingold: Palliative and
Hospice Care in the U.S.
 Harriet L. Komisar, Ph.D.
- Financing Long-Term
Care: Policy Options for
the Future
practice
Practice; Kuntz (2011)
Physician’s Foundation Report
on Scope of Practice
Discuss the policy issues related to
financing long term care services,
how the U.S. currently differs in its
approach from other nations, and
why the CLASS program did not
succeed (1,5,6,7)
Describe palliative care in the context
of its potential value for patients,
families and the health care system
(1,6,7)
Discuss current issues regarding
Medicare's hospice benefit, and
consider policy options (1,6,7)
LASS Readings: National Health
Policy Forum (2013); Gleckman
(2010).
Palliative and Hospice Care
policy Issues: Aldreidge, et al
(2012); Frank (2011-12); Buck
(2011); Meier (2011). Gawande
(2010).
Discuss circumstances in which
Thompson & McClintock (2000): Interactive Module:
Discussions:
 Gawande Article case
study
 Directions US should
pursue
 How Medicare might
improve hospice benefit
12
Session
Learning Objectives*
Utilizing Health
Services Research
in Policy and

Legislation


health services research does or does
not influence policy (2,3)
Discuss how health services research
can be made more useful to policy
(2,3)
Discuss program evaluation methods
and their growing importance to
health policy (2,3)
Discuss the use of simulation models
for estimating costs and other policy
outcomes (2,3,5)
Readings
CDC eBook: Demonstrating
Your Program’s Worth;
Articles: Shrank (2013), Fain
(2005), Leibman (2013)
Making Research More Useful
for Public Policy: RWJF Grant
Watch Report, Kupersmith and
Atkins (2013),, Majumdar and
Sommerai (2009)
Dickson & Flin, Chapter 18
Learning Activities &
Assessments
Wakefield’s Factors
Influencing Public Policy
Presentation: The
Effectiveness of Nurse
Practitioner Chronic Pain
Service on Healthcare
Utilization by Patients with
Sickle Cell Disease. Okoye,
N.C. & Rahman, D.M.
Simulation, Budget & Legilative
Impacts and Health Services
Research: Summary of Health
Care Microsimulation Models;
Health Policy Roundtable:
Producing and Adapting
Research Syntheses; CBO
Legtter to Harry Reid
CDC Morbidity & Mortality
Weekly Report
Optional: Moat et al (2013)
Week 13
Group Projects

Begin work on group policy
analyses
None
Group Policy Analysis:
Group by group kickoff
13
Session
Learning Objectives*
Readings

Week 14
Week 15
Group Projects
Apply knowledge of the
policymaking process and political
action to current legislative and
regulatory issues (5)

Examine current issues in health
care reform (6)

Critically analyze a current health
policy issue (7)
Thanksgiving Break

None
Apply knowledge of the
policymaking process and political
action to current legislative and
regulatory issues (5)
 Examine current issues in health care
reform (6)
 Critically analyze a current health
policy issue (7)
* Note: number in parenthesis relates session objectives to course objectives.
Learning Activities &
Assessments
Collaborate sessions
Group Policy Analysis:
Submit/Share Presentatiions
14
Resources for Academic Support

Libraries
Both libraries provide a range of resources to support your research projects. The links
below have been specifically developed to aid distance learners in accessing the resources
from off campus.
o Himmelfarb Library Resources for Distance Students
o Gelman Library Services for Off-Campus Students

Writing Center
The GW Writing Center provides individual support to students who need one-on-one help
with their writing projects. If you need assistance, schedule an appointment through their
online system, and send your paper (at least 24 hours in advance of your appointment) to
gwriter@gwu.edu. Include the name of your tutor, time of your session, and number you
will be calling from at the time of your appointment.

English for Academic Purposes.
Students with non-English backgrounds who have the ability to travel to GW’s Foggy
Bottom campus can take advantage of GW’s EAP (English for Academic Purposes) Writing
Support Program. The program offers a free, one-on-one tutoring to support any stage of the
writing process. Tutors are trained to provide focused support for non-native speakers. Visit
the appointment website to make an appointment.

Graduate School Bootcamp
This short course includes five online lessons to assist you in preparing for graduate study,
including education focused on study skills, library skills, technology basics, academic
writing, and research.
Resources for Student Support

School of Nursing Student Services.
The School of Nursing’s Office of Student Services is available to support all of the
administrative aspects of your education. To contact the office or find information, forms
and resources, please visit the Student Services section of the SON website.

Office of Disability Support Services
Any student who feels s/he may need an accommodation based on the impact of a disability
should contact me privately to discuss specific needs. Please contact the Office of Disability
Support Services at 202-994-8250 in the Marvin Center, Suite 242, to establish eligibility
and to coordinate reasonable accommodations. For additional information please refer to the
http://gwired.gwu.edu/dss.
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Institutional Policies
Students in the course are expected to comply with all GW policies. Be sure to review and
familiarize yourself with the following:
 GW Code of Academic Integrity
 Code of Conduct for Users of Computing Systems and Services
 Student Rights and Responsibilities
GW Career Consulting
 Assists students and recent alumni in the areas of Medicine, Nursing, Public Health and
Health Services. Resume reviews, cover letter critiques, orientation to industry-wide
overviews, and internship considerations are available through consultation.
 Student Online Appointment Scheduling: You can schedule appointments on-line with
your career consultant, Kelly Lawton, by clicking on the "Request an Appointment" button
on your GWork profile home page.
 If you have any technical difficulties making an appointment, please email GWork Help at
gworkhelp@gwu.edu. If you have any other questions or concerns, please contact us at
gwcareercenter@gwu.edu. We hope that you find this service helpful as we continue to
support your connections to career opportunities!
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