please reply to each 
Mycha: 
Hello All,
CMS Quality Measures are designed to ensure that high-quality healthcare and best practices are adhered to across participating healthcare systems.  As discussed by CMS (2020), “Data on quality measures are collected or reported in a variety of ways, such as claims, assessment instruments, chart abstraction and registries” (para. 1). In hospital systems, electronic specifications gather information from the Electronic Health Record systems. E-specifications are a relatively easy method of obtaining information once proper coding systems are in place. More difficult measures to obtain are gathering information from patients and families related to their outcomes and patient satisfaction.  As discussed by (Deshpande & Schellhase (2015):

To make patient safety metrics and their presentation more meaningful, cross-sector input from patients, families, providers, and payers should be actively sought.  Patient-reported outcome measures may prove better metrics for patient safety and quality than any currently in use. (p. 295)

Measures related to outcomes and patient satisfaction are likely more difficult to attain due to stakeholders’ information regarding these measures is not captured within the EHR system.
References:
CMS. (2020, February 11). Quality Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures.
CMS. (2020, February 11). Electronic specifications for clinical quality measures. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Electronic_Reporting_Spec.
Deshpande, J.K., Green, A. & Schellhase, D.E. Measuring What Really Matters in Patient Safety. Curr Treat Options Peds 1, 286–297 (2015). https://doi.org/10.1007/s40746-015-0036-2
Paula:
The CMS Quality Measures Inventory compiles data for a number of specific conditions provided in a variety patient care settings (CMS.gov).  The measures address outpatient, inpatient and private office practices for specific conditions with data submission standards developed with the National Quality Forum (NQF). There are different aspects to consider for the ease or difficulty in collection of data for the quality measures.
The easiest data to collect is the concrete data such as length of admission for a specific disease process, particularly since this can easily be generated by the EHR. Data is more easily collected in an inpatient or outpatient setting of a healthcare institution secondary to available resources for data collection.
Data based upon patient actions can be more difficult to collect particularly if subjective such as perceived functional improvement post laminectomy or mental health screenings. Additionally, small private offices may lack the resources to generate electronic data or to send the quality measures data to the program. Quality measures based in these areas are more difficult to collect and the validity of the subjective data needs to be considered. 
Centers for Medicare & Medicaid Services (n.d.) Core Measures. https://www.cms.gov/Medicare/Quality-Initiatives-P…
Andrew:
The Centers for Medicare and Medicaid Services (CMS) core measures are designed to guide healthcare facilities and assure due diligence is done on behalf of the patient. Health care facilities that are in compliance with the CMS measures are provided funds for services rendered. While healthcare facilities not in compliance due to not receive funds for services rendered. The easiest compliance measure to collect is hospital readmissions. When it comes to patient discharges and readmission there is very little gray area. Patient readmittance can either be scheduled or not. Verifying as to why the patient was readmitted is more difficult and challenging. The most difficult standard to collect is admitting time for ED patients. In El Paso facilities it is not uncommon to admit non-citizen patients for emergency services.

Unfortunately when non-citizens are brought from border patrol services often the process is not entirely medical. Often admittance depends on Border patrol providing a sitter or guardian to oversee and watch the patient as well as a translator. These additional steps can often impede physicians from directly admitting a patient until service is verified with border patrol. Often the collection of numerical data is the easiest to collect however when admissions are based a multiple factors beyond simple acuity of illness, Numerical data can often be misleading or inaccurate.
Reference 
The CMS Measure Inventory Tool (CMIT)  retrieved August 7th, 2019  from https://cmit.cms.gov/CMIT_public/ListMeasures

“There are different types of quantitative research designs that justify or support themselves in nursing research. Choose one quantitative type design and identify a major advantage and a major disadvantage of this design. Give an example how this quantitative research design could be used in nursing practice to solve a clinical problem ”
1. Hello Class,
Quantitive  designs is used to explore the relationships among variables are classified into experimental or non-experimental. Experimental design is meant to explain casualties. While, non-experimental is used to describe relationship among variables.
In the case of cross-sectional, it is a non-experimental design where researcher use data from groups at a signal point in time. Using this design can help guide researchers into the speculation of the correlation and relationships of variables designated to the study. In terms of advantages to this design, cross-sectional design is more economical and easy to manage compared to to other designs. This is due to date being collected at a signle point in time for each realted subject of the design. On the other hand, a disadvantage is that it becomes increasingly difficult to make claims of correlation and cause and effect between subjects. This is because researchers can only collect data and can’t manipulate the variables to prove cause and effect.
One example of cross sectional study in the work setting was a study done on evidence based practice nursing in a hospital setting. This was done to properly implement evidence based practice into the work setting. The two subjects “showed that  Nurses’  evidence based practice beliefs scores were higher than their  evidence based practice implementation scores”. In terms, this study shows the mis-implication of the evidence practice system. As believing in the EBP is very different from implementation. The study let the hospital know and recognize this clinical problem and to follow up will make changes to implement more of evidence based practice within their organization.
References: 
A Cross-sectional Study on Evidence-Based Nursing Practice in the Contemporary Hospital Setting: Implications for Nurses in Professional Development. (2017). Journal for Nurses in Professional Development, 33(2). doi:10.1097/nnd.0000000000000346
Schmidt, N. A., & Brown, J. M. (2022). Evidence-based practice for nurses: Appraisal and application of research. Burlington, MA: Jones & Bartlett Learning.
2. Hi Class, 
This week we are discussing quantitative research designs and their importance in nursing research. One type of quantitative design that I think can help with understanding one major issue in healthcare is the causal-comparative/quasi-experimental research model. In this design type, a cause and effect correlation is trying to be established between certain factors (“Research Guides: Systematic Reviews in the Health Sciences: Types of Research within Qualitative and Quantitative,” 2021). This type of research relies on observing natural relationships in order to gain insight in their relationships. One of the major benefits of this research is that since these relationships are naturally occurring, there is not a lot of need for outside manipulation to gain results. Alternatively, one major downside of this type of research is that since naturally occurring relationships are needed, researchers have to find these variables in real life as opposed to being able to manufacture a scenario to observe. One issue in healthcare that might benefit from being studied under this model is the correlation between the wellbeing of nurses and the quality of the care that they provide. There is constant research being conducted regarding the welfare of healthcare workers and optimal working conditions, and one aspect that comes up repeatedly is the effect that poor mental and physical health and subpar working conditions have on patient outcomes. It has been suggested that nurses who are happier and feeling healthy and rested are able to provide better patient care leading to fewer return infections and larger discharge percentages, whereas nurses who were feeling burned out were less likely to provide quality care and thus risked the welfare of their patients. 
Research Guides: Systematic Reviews in the Health Sciences: Types of Research within Qualitative and Quantitative. (2021). Retrieved September 6, 2021, from https://libguides.rutgers.edu/c.php?g=337288&p=2273209 (Links to an external site.)
Stress, Fatigue, and Burnout in Nursing. (2019, March 1). Retrieved September 6, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S154608431830172X

A two-part discussion essayPart I: Film analysis. Write a well-developed short essay in which you analyze one important theme, or one central idea from “To Conquer or Redeem: Manifest Destiny, Act I and III,” or the podcast “1898 and Becoming America.” Describe that issuein detail. Make connections to our lecture materials and readings (and to provide further context).Clipped below are some of the themes this film deals withThe role of violence; How U.S. policymakers at the time rationalize the contradiction between empire and democracy; US economic collapse, expansion, and subsequent search for new “frontiers”; Alfred Thayer Mahan and the expansion of U.S. political and military power abroad; Cuban Independence movement, the role of the U.S. media and U.S. imperialism in Cuba and Puerto Rico; the Panama canal, expansion of U.S. economic and military power and the Sea Lanes of Communication and Transportation (SLOCTs); U.S. Domestic politics and imperialism; “Benevolent Assimilation”, Ideology, Race, Christianity and U.S. colonization of the Philippines (and consequences on Filipinos)Length of Part I: at least one well developed paragraph with specific examples.——————————————————————–Part II: Document/Primary Source Analysis. Write a well-developed essay in which you analyze ONE of the following primary sources or discuss the scholarly contributions of one of the following scholarly articles or podcasts:*Frederick Jackson Turner “The Significance of the Frontier in American History” (1893, Primary Source in Canvas) See films, lecture notes & “American Yawp” for context*Podcast “Constitutional”, episode “Ancestry (Links to an external site.),” on 1879 Court Case, Chief Standing Bear and the status of Native Peoples under the U.S. Constitution*Podcast “Constitutional,” episode “Nationality (Links to an external site.),” on 1898 Supreme Court case: are Asian Americans citizens?*The Platt Amendment, 1901 (Primary source in Canvas- U.S. & Cuba); (text, lectures, films for context)*Visual Primary Source: “School Begins (Links to an external site.),” by Puck, 1/25/1899 and one other political cartoon from my Powerpoint on Imperial Expansion Part III. See my articles & our readings & films for context*Statements of U.S. Foreign Policy: “The Monroe Doctrine,” and “The Roosevelt Corollary” (both, these are short primary sources in Wood & Alexander pp. 239-241; see my articles for context)*“Visual Source: Barbershop” (Wood & Alexander pp. 156-157 & PPT) and one other political cartoon from my Powerpoint on Imperial Expansion Part III. See my articles and readings for context*OR recommended Podcasts: “Saving a Language You’re Learning to Speak (Links to an external site.),” by NPR’s Code Switch, about how the Hawaiian language almost went extinct and Hawaiians’ efforts to rescue it*or Podcast “There Will be Bananas (Links to an external site.),” by NPR’s Throughline. US Railroad & Banana co’s & Empire”*or “To the Person Sitting in Darkness (Links to an external site.),” Mark Twain, 1901 (Primary source, satirical critique of US Imperialism)Address the following for the primary source you’re analyzing or the article/podcast you’re discussing:a) Provide historical context from our lectures, films, and articles. Tell us the history behind the primary source or document- what is going on in the region at the time this primary source is produced? If it is a scholarly article or podcast, discuss the historical context that your article/podcast deals with.b) Tell us all about the document that you’re discussing. Is it a primary source (eyewitness account), or a secondary source (scholarly article)? If yours is a primary source, tell us: who wrote or produced it? to whom? when? why? what was its purpose? If it is a scholarly article or podcast, discuss all of the contributions of this article or podcast to our understanding of this topic and time period (give us specific examples).c) Analyze the primary source and/or discuss the specific contributions your scholarly article or podcast makes to our understanding of the transformations of the AmericasLength of Part II: two well developed paragraphs for this partLength of the whole essay (both parts): at least three well developed paragraphsSubmit and Label each part of the essayFormat/Works cited. Because you’re using our films, our books and our documents, just cite which ones you’re using: which film; which book (page number); and which document (which book and what page). No need for a separate ‘works cited’ page here.

This assignment is intended to give you an opportunity to strengthen your skills in gathering and analyzing business-related information. It provides a deeper understanding of how companies can look at globalization as part of their strategic and operational plans. The assignment has two parts: one focused on information research and analysis, and the other is on applied analytics.  
Resources:?

Microsoft Excel® 
“How Netflix Expanded to 190 Countries in 7 Years” from Harvard Business Review
Call Center Waiting Time

Part 1: Globalization and Information Research 
Context:?Companies that perform well in their country of origin usually consider expanding operations in new international markets. Deciding where, how, and when to expand is not an easy task, though.  
Many issues need to be considered before crafting an expansion strategy and investing significant resources to this end, including:  

the level of demand to be expected for the company’s products/services 
presence of local competitors 
the regulatory, economic, demographic, and political environments 

Carefully researching and analyzing these and other factors can help mitigate the inherent risk associated with an overseas expansion strategy, thus increasing the likelihood of success. 
As a data analyst in your company’s business development department, you’ve been tasked with the responsibility of recommending countries for international expansion. You’ll write a report to the company’s executive team with your research, analysis, and recommendations. 
Instructions:  
Write a 525-word summary covering the following items: 

According to the article listed above, what were the most important strategic moves that propelled Netflix’s successful international expansion? 
The article mentions investments in big data and analytics as one of the elements accompanying the second phase of overseas expansion. Why was this investment important? What type of information did Netflix derive from the data collected? 
According to the article, what is exponential globalization? 
Not all international expansion strategies are a resounding success, however. Research an article or video that discusses an instance in which an American company’s expansion efforts in another country failed. According to the article/video you selected, what were the main reasons for this failure? Do you agree with this assessment? 
Explain some of the reasons why certain companies’ expansion plans have failed in the past. 

Part 2: Hypothesis testing  
Context:?Your organization is evaluating the quality of its call center operations. One of the most important metrics in a call center is Time in Queue (TiQ), which is the time a customer has to wait before he/she is serviced by a Customer Service Representative (CSR). If a customer has to wait for too long, he/she is more likely to get discouraged and hang up. Furthermore, customers who have to wait too long in the queue typically report a negative overall experience with the call. You’ve conducted an exhaustive literature review and found that the average TiQ in your industry is 2.5 minutes (150 seconds). 
Another important metric is Service Time (ST), also known as Handle Time, which is the time a CSR spends servicing the customer. CSR’s with more experience and deeper knowledge tend to resolve customer calls faster. Companies can improve average ST by providing more training to their CSR’s or even by channeling calls according to area of expertise. Last month your company had an average ST of approximately 3.5 minutes (210 seconds). In an effort to improve this metric, the company has implemented a new protocol that channels calls to CSR’s based on area of expertise. The new protocol (PE) is being tested side-by-side with the traditional (PT) protocol.  
Instructions: 
Access the Call Center Waiting Time file. Each row in the database corresponds to a different call. The column variables are as follows: 

ProtocolType: indicates protocol type, either PT or PE
QueueTime: Time in Queue, in seconds
ServiceTime: Service Time, in seconds
Perform a test of hypothesis to determine whether the average TiQ is lower than the industry standard of 2.5 minutes (150 seconds). Use a significance level of ?=0.05.  
Evaluate if the company should allocate more resources to improve its average TiQ. 
Perform a test of hypothesis to determine whether the average ST with service protocol PE is lower than with the PT protocol. Use a significance level of ?=0.05.  
Assess if the new protocol served its purpose. (Hint: this should be a test of means for 2 independent groups.) 

Assignment #1 Parent-Teacher Conference (20 points)The purpose of this assignment is to develop a plan for a parent-teacher conference to demonstrate how to enhance and maintain communication between families and the school or classroom. Prepare a plan for the parent-teacher conference and include the following information in your report. Make sure you highlight the student’s strengths when talking about his/her needs. The plan should address the following elements separately and extensively:Introduction: Describe the student’s background and the school-related issue the child is experiencing that requires parental involvement. (CEC 1. Learner Development and Individual Learning Differences – 1.1 Understanding influence of language, culture, and family background; 1.2 Understanding of development and individual differences)Part 1: Plan Development a. Identify school personnel who encounter the student and propose the types of questions that you would ask them for additional information about the child. (CEC 7. Collaboration – 7.3 Using collaboration to promote well-being of individuals with exceptionalities). b. Write a sample letter inviting the parents/family to have a conference with you about the child. (CEC 6. Professional Learning and Ethical Practice – 6.1 Using professional Ethical principles and professional Practice Standards)c. In addition to the letter, write a narrative that explains the purpose and expected outcomes for the parent-teacher conference to address this concern. (CEC 6. Professional Learning and Ethical Practice – 6.3 Understanding how complex human issues can interact with the delivery of special education services)d. To prepare the parents for the meeting, identify informational materials that would be helpful to the parents prior to the conference. These materials should be appropriate for all parents, including those from linguistically and culturally diverse backgrounds. Materials may include report(s) about the child and pamphlets/brochures about the issue. Include a list of these resources in your final report. (CEC 1. Learner Development and Individual Learning Differences – 1.1 Understanding influence of language, culture, and family background; 1.2 Understanding of development and individual differences; CEC 6. Professional Learning and Ethical Practice – 6.5 Engaging in advocacy and mentoring activities)e. In addition to the letter, write a narrative that explains the purpose and expected outcomes for the parent-teacher conference to address this concern. (CEC 6. Professional Learning and Ethical Practice – 6.3 Understanding how complex human issues can interact with the delivery of special education services)f. To prepare for the meeting and to organize your thoughts, write a parent-teacher conference script that includes a proposed dialogue between you and the parents. The script should be written in professional language that shows sensitivity and understanding of the parents’ concerns, but, at the same time, addresses the issue at hand. For example, the script should include a welcoming and introductory section, a highlight of the child’s strengths, a description of the child’s issues, and an explanation of possible outcomes. (CEC 6. Professional Learning and Ethical Practice – 6.1 Using professional Ethical principles and professional Practice Standards) Generated: 4/27/2021 Page 5 of 36Part 2: Mock Parent-teacher Conferencea. Demonstrate your ability to conduct a parent-teacher conference by role-playing with a colleague, using the prepared script. Record the conference with your colleague for further review. (CEC 7. Collaboration – 7.1 Using the theory and elements of effective collaboration)b. Listen to the recording between you and your colleague and write a commentary answering the following questions and describing your assessment of the conference (CEC 7. Collaboration – 7.1 Using the theory and elements of effective collaboration):*Did you use appropriate language while conducting the conference (e.g., lack of educational jargon, use of Standard English)?*Did you use a tone of voice that was appropriate for the setting? Did you use active listening and paraphrasing techniques to enhance the interaction and communication with the colleague/parent?*Were you able to adequately convey the educational message to the colleague/parent concerning the student with disabilities?*Did you follow your script or, as the conference progressed, was it necessary to deviate from the script? Why?Conclusion: Write a conclusion that summarizes the key points of the assignment. Make your own reflection based on the information.