NURSINGS RESPONSE TO THE CRISIS OF ACCESS, COSTS, AND QUALITY IN HEALTH-CARE

Changes now taking place in the structure of health care delivery in t he United States from regulatory models controlled by physicians to co mpetitive models driven by traditional market forces of cost and quali ty are beginning to open opportunities for innovative nursing practice models. This article reports on the cost-effectiveness of a community nursing center for persons living with HIV/AIDS. The potential cost i mpact of the nursing center is significant because of the nurses' abil ity to forestall hospital admissions and readmissions, decrease prolon ged lengths of stay, provide medically supportive outpatient treatment s, care for clients at a low cost per client per year, attract profess ional and nonprofessional volunteer services and donations, and increa se job satisfaction, thus reducing costly nurse turnover. The 1991 to 1992 costs of HIV/AIDS health care in the United States were used to e stimate conservatively that the center has saved more than $700,000 in 1991 and over $1 million in 1992 in hospital charges for HIV/AIDS car e. A rationale for the cost savings estimates is supplied by results o f quantitative and qualitative evaluation research projects conducted at the center. Finally, implications of this analysis for future direc tions in nursing practice and education are discussed.