Doctoral Degree in Nurse Anesthesiology
The Nurse Anesthesiology Program curriculum for the Doctor of Nursing Practice (DNP) degree teaches CRNAs to have sound professional, moral, and ethical standards and to be accountable for the quality of services they provide. It also prepares students to be leaders and understand their ever-evolving role in the health care delivery system.
Academic Calendar
The DNP degree is achieved in three years of courses broken into three 16-week terms, with each year’s courses beginning in May.
Year 1
Summer (May - August) 10 credits
Fall (September - December) 13 credits
Spring (January - April) 12 credits
Total: 35 credits
Year 2
Summer (May - August) 14 credits
Fall (September - December) 12 credits
Spring (January – April) 12 credits
Total: 38 credits
Year 3
Summer (May - August) 15 credits
Fall (September - December) 12 credits
Spring (January – April) 12 credits
Total: 39 credits
Total degree credits: 112
Course | Course ID | Length | Credits |
---|---|---|---|
Advanced Anatomy, Physiology, & Pathophysiology in Nursing Practice I | CNA 700-A | 16 weeks | 5 |
Advanced Pharmacology in Nursing Practice I | CNA 701-A | 16 weeks | 3 |
Advanced Health Assessment Across the Lifespan I | CNA 702-A | 16 weeks | 2 |
Course | Course ID | Length | Credits |
---|---|---|---|
Advanced Anatomy, Physiology, & Pathophysiology in Nursing Practice II | CNA 700-B | 16 weeks | 5 |
Advanced Pharmacology in Nursing Practice II | CNA 701-B | 16 weeks | 3 |
Advanced Health Assessment Across the Lifespan II | CNA 702-B | 16 weeks | 2 |
Biostatistics & Epidemiology | CNA 800 | 16 weeks | 3 |
Course | Course ID | Length | Credits |
---|---|---|---|
Acute Care Practicum in Advanced Nursing Practice | CNA 703-P | 16 weeks | 5 |
Acute Care Practicum Conference | CNA 703 | 16 weeks | 1 |
Basic Principles of Nurse Anesthesiology Practice | CNA 704 | 16 weeks | 3 |
Research & Evidence-Based Practice | CNA 801 | 16 weeks | 3 |
Course | Course ID | Length | Credits |
---|---|---|---|
Advanced Principles of Nurse Anesthesiology Practice I | CNA 705 | 16 weeks | 3 |
Nurse Anesthesiology Practicum I | CNA 706-P | 16 weeks | 4 |
Nurse Anesthesiology Practicum Conference I | CNA 706 | 16 weeks | 1 |
Transformational Inquiry & Nursing Theory | CNA 802 | 16 weeks | 3 |
DNP Scholarly Project I | CNA 803 | 16 weeks | 2 |
DNP Scholarly Project Practicum I | CNA 803 | 16 weeks | 1 |
Course | Course ID | Length | Credits |
---|---|---|---|
Advanced Principles of Nurse Anesthesiology Practice II | CNA 707 | 16 weeks | 3 |
Nurse Anesthesiology Practicum II | CNA 708-P | 16 weeks | 4 |
Nurse Anesthesiology Practicum Conference II | CNA 708 | 16 weeks | 1 |
DNP Scholarly Project II | CNA 804 | 16 weeks | 2 |
DNP Scholarly Project Practicum II | CNA 804-P | 16 weeks | 2 |
Course | Course ID | Length | Credits |
---|---|---|---|
Advanced Principles of Nurse Anesthesiology Practice III | CNA 709 | 16 weeks | 3 |
Nurse Anesthesiology Practicum III | CNA 710-P | 16 weeks | 4 |
Nurse Anesthesiology Practicum Conference III | CNA 710 | 16 weeks | 1 |
DNP Scholarly Project III | CNA 805 | 16 weeks | 2 |
DNP Scholarly Project Practicum III | CNA 805-P | 16 weeks | 2 |
Course | Course ID | Length | Credits |
---|---|---|---|
Advanced Principles of Nurse Anesthesiology Practice IV | CNA 711 | 16 weeks | 2 |
Nurse Anesthesiology Practicum Conference IV | CNA 712-P | 16 weeks | 6 |
Nurse Anesthesiology Conference IV | CNA 712 | 16 weeks | 1 |
Leadership and the Professional Role in Advanced Nursing Practice | CNA 806 | 16 weeks | 3 |
Human Factors and Health Care Ergonomics | CNA 807 | 16 weeks | 3 |
Course | Course ID | Length | Credits |
---|---|---|---|
Comprehensive Examination Review I | CNA 713-A | 16 weeks | 2 |
Nurse Anesthesiology Practicum V | CNA 714-P | 16 weeks | 6 |
Nurse Anesthesiology Practicum Conference V | CNA 714 | 16 weeks | 1 |
Informatics | CNA 808 | 16 weeks | 3 |
Course | Course ID | Length | Credits |
---|---|---|---|
Comprehensive Examination Review II | CNA 713-B | 16 weeks | 2 |
Nurse Anesthesiology Practicum VI | CNA 715-P | 16 weeks | 6 |
Nurse Anesthesiology Practicum Conference VI | CNA 715 | 16 weeks | 1 |
Health Policy, Finance, Regulation and Reimbursement | CNA 809 | 16 weeks | 3 |
Year 1 - Summer
Course ID: CNA 700-A
Part one of a two-part course that provides a detailed and well-grounded knowledge base in normal and abnormal anatomic, physiologic, and pathologic mechanisms across the lifespan to inform clinical assessment, decision making, and safe patient management.
Course ID: CNA 701-A
Part one of a two-part course that focuses on basic pharmacological principles, including the pharmacodynamics and pharmacokinetic actions of drugs at the cellular level. Distribution, biotransformation, and elimination relative to clinical pharmacology in a broad category of drugs are presented. Common dosages and administration routes are explored. Students will analyze the relationship between pharmacologic agents and physiologic or pathologic responses, understand the variability of drug actions and disease states, and anticipate therapeutic actions and toxicities in order to provide safe, high-quality, and cost-effective care.
Course ID: CNA 702-A
Part one of a two-part course that teaches the skills for developing a comprehensive history and physical assessment on patients across the lifespan. Assessments will consider all pathophysiologic, psychosocial, and psychological influences. The cultural and developmental needs of the patient will be incorporated into the assessment. Communication and observational techniques will be utilized to achieve a thorough understanding of the patient so appropriate and effective care strategies can be developed.
Year 1 - Fall
Course ID: CNA 700-B
Part two of a two-part course that provides a detailed and well-grounded knowledge base in normal and abnormal anatomic, physiologic, and pathologic mechanisms across the lifespan to inform clinical assessment, decision making, and safe patient management.
Course ID: CNA 701-B
Part two of a two-part course that focuses on basic pharmacological principles, including the pharmacodynamics and pharmacokinetic actions of drugs at the cellular level. Distribution, biotransformation, and elimination relative to clinical pharmacology in a broad category of drugs are presented. Common dosages and administration routes are explored. Students will analyze the relationship between pharmacologic agents and physiologic or pathologic responses, understand the variability of drug actions and disease states, and anticipate therapeutic actions and toxicities in order to provide safe, high-quality, and cost-effective care.
Course ID: CNA 702-B
Part two of a two-part course that teaches the skills for developing a comprehensive history and physical assessment on patients across the lifespan. Assessments will consider all pathophysiologic, psychosocial, and psychological influences. The cultural and developmental needs of the patient will be incorporated into the assessment. Communication and observational techniques will be utilized to achieve a thorough understanding of the patient so appropriate and effective care strategies can be developed.
Course ID: CNA 800
Cover the principles, concepts, and procedures related to the surveillance, investigation, data collection, and reporting of health and illness in a population, with an emphasis on advanced nursing practice. Students develop the skills required to critically analyze scientific literature and to appropriately apply best-practice evidence in a health care setting. Topics include the use of various forms of research design, techniques of data collection, quantification and treatment of variables, methods of data analysis, and the use of computers in epidemiology and research. Acts as a foundation for all subsequent research coursework.
Year 1 - Spring
Course ID: CNA 703-P
Provides clinical experiences required to manage complex health problems in patients across the lifespan. Development of assessment and critical-thinking skills will be applied to theoretical principles and used to formulate appropriate differential diagnoses, clinical impressions, and evidence-based evaluations. Analysis, integration, and synthesis of pathophysiologic concepts will be utilized to develop patient-centered treatment plans. Builds on knowledge acquired in course prerequisites and applies that knowledge to patient care.
Course ID: CNA 703
Students participate in classroom-based discussions about clinical experiences with an emphasis on reflective learning. Faculty encourage discussions and offer clinical scenarios that reinforce an evidence-based approach to care of acute-care patients. Provides faculty and students an opportunity to maintain open communication regarding clinical rotations, preceptors, and CNA policy and procedures.
Course ID: CNA 704
Presents the underpinnings of the student’s role in administering anesthesia to patients across the lifespan. Provides a foundation in the physiologic, pharmacologic, psychological, and technologic concepts of nurse anesthesiology.
Course ID: CNA 801
Develops knowledge of the Triple Aim for health care. Students will identify gaps in the health care system, identify a researchable problem, and perform a Rapid Review of the literature to make recommendations for best practice. Prepares students to access, appraise, and utilize research to implement evidence-based practice in nursing and related fields. The Rapid Review performed in this course will serve as a needs assessment and foundation for the DNP scholarly project. This course acts as a foundation for all subsequent research coursework.
Year 2 - Summer
Course ID: CNA 705
Builds on the foundational knowledge gained during the first year of study and provides an advanced understanding of the physiologic, pharmacologic, psychological, and technologic concepts of nurse anesthesiology practice. Students will learn how to procure and analyze patient-health assessment and risk data and develop a plan of care, including the needs and predispositions of patients and their families, cultural and environmental factors, and evolving clinical practice.
Course ID: CNA 706-P
The first of six clinical courses designed to provide experiences in the development of providing safe anesthesia care. Students create individual written anesthetic care plans for patients based on a review of the patient’s health record. Students are supervised by a CRNA or anesthesiologist, who teach basic anesthesia responsibilities including preparing an anesthetic set-up, reviewing anesthesia and surgical consent, conducting a patient interview and physical assessment, performing basic airway management skills, and documenting an accurate anesthesia record. All practicum courses are viewed as a continuum whereby students master specific competencies in practice as the student progresses in the program. In CNA 706-P, students function at the “needs improvement” and “novice” levels. Students need to demonstrate progression of their anesthesia skill sets from “needs improvement” to the “novice” level in most outcomes to progress to CNA 708-P.
Course ID: CNA 706
Students participate in classroom-based discussions regarding the care of patients in different anesthesia settings with an emphasis on reflective learning and discussions of weekly clinical experiences. Faculty encourage discussions and offer clinical scenarios to reinforce learned didactic knowledge. Provides faculty and students an opportunity to maintain open communication regarding clinical rotations, preceptors, and CNA policy and procedures.
Course ID: CNA 802
Covers the skills needed to perform an evidence-based inquiry into a clinical, educational, or professional problem and supports future research coursework. Develops leadership skills required to implement an interdisciplinary quality improvement project. Helps students identify basic concepts of nursing and implementation theory and apply those concepts to their scholarly work.
Course ID: CNA 803
First in a series of three courses in support of a scholarly project to improve outcomes in nursing practice. To improve the health and well-being of populations, students will, directly or indirectly, influence nursing practice through research, innovation, or quality improvement processes. Student will perform a needs assessment, identify goals and outcomes and engage in study design and methodology. At the conclusion of this course, students draft a preliminary project proposal consistent with the Albany Medical College Institutional Review Board recommendations. Provides a foundation for future practice scholarship.
Course ID: CNA 803-P
Part of a series of scholarly project practicums focusing on practice immersion experiences that offer an opportunity for application, integration, and synthesization of the scholarly project by inter- and intra-professional collaboration. These experiences will cultivate skills in leadership, communication, and interdisciplinary teamwork.
Year 2 - Fall
Course ID: CNA 707
Builds upon the foundational knowledge gained during the advanced practice nursing student’s first year of study. Designed to provide an advanced understanding of the physiologic, pharmacologic, psychological, and technologic concepts of nurse anesthesiology practice. Students will understand how to procure and analyze patient health assessment and risk data. Synthesis of these data will be used in developing a plan of care for each patient. The plan of care will include the needs and predispositions of patients and their families, cultural and environmental factors, and evolving clinical practice. The knowledge gained in this course will be assimilated into all clinical experiences. Specific to CNA 707 is the understanding of pain, and the management of obstetric, neonatal, and pediatric patients.
Course ID: CNA 708-P
The second of six clinical courses designed to improve patient safety practices and develop perioperative anesthetic skills. Students develop individual written anesthetic care plans for patients based on a comprehensive review of the patient’s health record and physical health assessment. Students are supervised by a CRNA or anesthesiologist who teach basic and advanced anesthesia responsibilities. Responsibilities focused on during this course include ability to complete a comprehensive anesthetic set-up, ability to revise the anesthetic plan of care after the interview and physical assessment of the patient, the ability to recognize inadequate mask ventilation, ability to properly sequence the medications during induction, ability to adequately secure an airway, ability to accurately document on the anesthesia record, the ability to identify intraoperative issues and institute appropriate treatment, and the ability to develop an anesthesia skill set in emergence. Students may begin cardiac and obstetric clinical rotations during this clinical semester. All practicum courses are viewed as a continuum whereby students master specific competencies in practice as the student progresses in the program. In CNA 708-P, students function at the “novice” and “advanced novice” levels. Students need to demonstrate progression of their anesthesia skill sets from “novice” to the “advanced novice” in most skills to progress to CNA 710-P.
Course ID: CNA 708
Students participate in classroom-based discussions regarding the care of patients in different anesthesia settings with an emphasis on reflective learning and discussions of weekly clinical experiences. Faculty encourage discussions and offer clinical scenarios to reinforce learned didactic knowledge. Provides faculty and students an opportunity to maintain open communication regarding clinical rotations, preceptors, and CNA policy and procedures.
Course ID: CNA 804
Second in a series of three courses in support of a scholarly project to improve outcomes in nursing practice. Students will engage in interprofessional collaboration and use theoretical foundations to implement their research, innovation, or quality improvement project. Provides a foundation for future practice scholarship.
Course ID: CNA 804-P
Part of a series of two scholarly project practicums focusing on practice immersion experiences that offer an opportunity for application, integration, and synthesization of the scholarly project by inter- and intra-professional collaboration. These experiences will cultivate skills in leadership, communication, and interdisciplinary teamwork.
Year 2 - Spring
Course ID: CNA 709
Builds upon the foundational knowledge gained during the advanced practice Builds upon the student’s understanding of the physiologic, pharmacologic, psychological, and technologic concepts of nurse anesthesiology practice. Students will understand how to procure and analyze patient health assessment and risk data. Synthesis of these data will be used in developing a plan of care for each patient. The plan of care will include the needs and predispositions of patients and their families, cultural and environmental factors, and evolving clinical practice. The knowledge gained in this course will be assimilated into all clinical experiences. Specific to CNA 709 is the intraoperative management of patients with cardiac, vascular, respiratory, and endocrine disease processes.
Course ID: CNA 710-P
The third of six clinical courses designed to enhance patient-safety practices, improve perioperative anesthetic skills, and develop critical-thinking skills. Students develop individual written anesthetic plans of care for patients based on a comprehensive review of the patient’s health record and physical health assessment. Students are supervised by a CRNA or anesthesiologist who teach basic and advanced anesthesia responsibilities. Responsibilities focused on during this course include revising the anesthetic plan of care after the patient interview and physical assessment, developing induction sequence techniques, integrating advanced airway skill sets into practice, instituting appropriate intraoperative treatments with little need for direction, improving emergence skills sets, and applying knowledge to decision making and problem solving in anesthesia practice. Students will continue cardiac and obstetric clinical rotations. All practicum courses are viewed as a continuum whereby students master specific competencies in practice as the student progresses in the program. In CNA 710-P, students function at the “advanced novice” and “intermediate” levels. Students need to demonstrate progression of their anesthesia skill sets from the “advance novice” level to the “intermediate” level in most outcomes to progress to CNA 712-P.
Course ID: CNA 710
Students participate in classroom-based discussions regarding the care of patients in different anesthesia settings with an emphasis on reflective learning and discussions of weekly clinical experiences. Faculty encourage discussions and offer clinical scenarios to reinforce learned didactic knowledge. Provides faculty and students an opportunity to maintain open communication regarding clinical rotations, preceptors, and CNA policy and procedures.
Specific to CNA 710 will be the continuation of a pharmacology review of a specific drug class per week. The class of drug to be reviewed will be chosen by the clinical faculty member. Faculty will begin to incorporate the appraisal of various clinical case scenarios into the practicum conference discussions.
Course ID: CNA 805
Third in a series of three courses in support of a scholarly project to improve outcomes in nursing practice. This course completes the series with data collection and analysis on outcomes related to their research, innovation or quality improvement project. Students will disseminate their results in the form of a written manuscript, and poster or podium presentations at the institutional, state or national level. Provides a foundation for future practice scholarship.
Course ID: CNA 805-P
Part of a series of scholarly project practicums focusing on practice immersion experiences that offer an opportunity for application, integration, and synthesization of the scholarly project by inter- and intra-professional collaboration. These experiences will cultivate skills in leadership, communication, and interdisciplinary teamwork.
Year 3 - Summer
Course ID: CNA 711
Builds upon the student’s understanding of the physiologic, pharmacologic, psychological, and technologic concepts of nurse anesthesiology practice. Students will understand how to procure and analyze patient health assessment and risk data. Synthesis of these data will be used in developing a plan of care for each patient. The plan of care will include the needs and predispositions of patients and their families, cultural and environmental factors, and evolving clinical practice. The knowledge gained in this course will be assimilated into all clinical experiences.
Specific to CNA 711 is the intraoperative management of patients with neurologic disease, head and neck pathology, musculoskeletal disorders, mitochondrial disease, acute trauma, and burns.
Course ID: CNA 712
The fourth of six clinical courses designed to help students master their patient-safety practices, perioperative anesthetic skill set, critical-thinking skills, and communication skills. Students are supervised by a CRNA or anesthesiologist who teach advanced anesthesia responsibilities including how to revise an anesthetic plan of care after a patient interview, physical assessment, and surgical considerations; mastering induction sequence techniques; employing advanced airway skill sets into practice with superiority; instituting appropriate intraoperative treatments with minimal need for direction; displaying emergence skills sets that are advanced; applying evidence-based knowledge in decision making and problem solving in anesthesia practice; and utilizing effective communication skills in practice. Students will continue cardiac and obstetric clinical rotations. All practicum courses are viewed as a continuum whereby students master specific competencies in practice as the student progresses in the program. In CNA 712-P, students can function at the “intermediate” and “ semi-proficient” levels. Students need to demonstrate progression of their anesthesia skill sets from the “intermediate” level to the “semi-proficient” level in most outcomes to progress to CNA 714-P.
Course ID: CNA 712-P
Students participate in classroom-based discussions regarding the care of patients in different anesthesia settings with an emphasis on reflective learning and discussions of weekly clinical experiences. Faculty encourage discussions and offer clinical scenarios to reinforce learned didactic knowledge. Provides faculty and students an opportunity to maintain open communication regarding clinical rotations, preceptors, and CNA policy and procedures. Specific to CNA 712 will be anesthesia pharmacology reviews each week. The anesthetic drug to be reviewed will be chosen by the clinical faculty member participating in the practicum conference. Faculty will continue to incorporate the appraisal of various clinical case scenarios into the practicum conference discussions.
Course ID: CNA 806
Reviews the history of the advanced practice nurse and their leadership role within the health care system. Traits of effective leadership, organizational design, and theories of leadership will be covered, along with professional relationships and barriers to effective communication. Online forum discussions will involve students as an agent of change within and outside the health care system. Students will analyze contemporary health care issues and present to classmates.
Course ID: CNA 807
Explores the theoretical and practical foundation of medical errors, patient safety, perioperative risk reduction, and quality improvement. A comprehensive overview of the human factors involved in errors, crew resource management techniques, simulation, and the impact of team performance on safety is presented. This course will integrate the theories, methods, and statistical tools underlying the quality improvement process. Students gain the skills needed to design, implement, and evaluate evidence-based practices that reduce risk and promote safety in their areas of practice.
Year 3 - Fall
Course ID: CNA 713-A
Part one of a two-part course aimed at solidifying principles learned throughout the curriculum to prepare the student for entry to practice after graduation. Part one includes a review of pharmacology; equipment and monitors; neurological system; regional anesthesia; body fluids and blood; specialty populations including neonates, pediatrics, geriatric and obstetrical patient; physics and chemistry; obesity; positioning in the OR and nerve injuries; and professional issues.
Course ID: CNA 714-P
The fifth of six clinical courses that help students master their patient-safety practices, master their perioperative anesthetic skill set, master their critical-thinking skills, continue to develop their communication skills, grow in their profession role, and embrace the role of a leader. Students are supervised by a CRNA or anesthesiologist who teach advanced anesthesia responsibilities. Responsibilities focused on during this course include optimizing the anesthetic plan of care after the patient interview, physical assessment, and considering surgical, ethical, and cultural implications; mastering induction sequence techniques; mastering their ability to perform advanced airway skills; mastering their intraoperative management of patients with minimal need for direction; mastering their emergence skills set; evaluating the use of evidence-based
knowledge in decision making and problem solving in anesthesia practice; utilizing effective communication skills in practice; and embracing the professional role as a CRNA and a leader. All practicum courses are viewed as a continuum whereby students master specific competencies in practice as the student progresses in the program. In CNA 714-P, students can function at the “semi proficient” and “proficient” levels. Students need to demonstrate progression of their anesthesia skill sets from the “semi-proficient” level to the “proficient” level in most outcomes to progress to CNA 715-P.
Course ID: CNA 714
Students participate in classroom-based discussions regarding the care of patients in different anesthesia settings with an emphasis on reflective learning and discussions of weekly clinical experiences. Faculty encourage discussions and offer clinical scenarios to reinforce learned didactic knowledge. Provides faculty and students an opportunity to maintain open communication regarding clinical rotations, preceptors, and CNA policy and procedures.
Specific to CNA 714 will be the continuation of faculty-incorporated appraisal of various clinical case scenarios into the practicum conference discussions. The incorporation of evidence-based research connected with patients receiving an anesthetic will be introduced.
Course ID: CNA 808
Prepares students to utilize informatics and health care technologies in the management of individuals, groups, and organizations for the improvement of patient outcomes. Computer technology and health care technology platforms will be discussed, including their role in the management and organization of data in health care. Students will learn about how the need for cybersecurity and health data privacy shapes the information infrastructure that powers modern health care. Emphasis is on becoming knowledgeable and competent with available resources found in patient care and educational settings.
Year 3 - Spring
Course ID: CNA 713-B
Part two of a two-part course aimed at solidifying principles learned throughout the curriculum to prepare the student for entry to practice after graduation. Part two includes mock board type examinations, comprehensive examinations, a midterm examination, and password protected quizzes.
Course ID: CNA 715-P
The last of six clinical courses that help students master their patient safety practices, master their perioperative anesthetic skill set, master their critical-thinking skills, master their communication skills, and master their ownership of the CRNA profession role and role as a leader. Students are supervised by a CRNA or anesthesiologist who teach advanced anesthesia responsibilities. Responsibilities focused on during this course include mastering the anesthetic plan of care after the patient interview, physical assessment, and considering surgical, ethical, and cultural implications; mastering induction sequence techniques; mastering their ability to perform advanced airway skills; mastering their intraoperative management of patients with minimal need for direction; mastering their emergence skills set; mastering their use of evidence-based knowledge in decision making and problem solving in anesthesia practice; mastering effective communication skills in practice; and mastering their ownership of the CRNA professional role and role as a leader. All practicum courses are viewed as a continuum whereby students master specific competencies in practice as the student progresses in the program. In CNA 715-P, students function at the “proficient” and “advanced proficient” levels. Students need to demonstrate progression of their anesthesia skill sets from the “proficient” level to the “advanced proficient” level in most outcomes to meet the clinical graduation requirements.
Course ID: CNA 715
Students participate in classroom-based discussions regarding the care of patients in different anesthesia settings with an emphasis on reflective learning and discussions of weekly clinical experiences. Faculty encourage discussions and offer clinical scenarios to reinforce learned didactic knowledge. Provides faculty and students an opportunity to maintain open communication regarding clinical rotations, preceptors, and CNA policy and procedures. Specific to CNA 715 is the use of evidence-based research approaches to the care of the patients receiving an anesthetic.
Course ID: CNA 809
Examines the foundations of health care policy, the financial structure of health care systems, and the regulatory environments that have an impact on nursing practice and patient care. Emphasis will be on selected issues affecting health care policy and regulation. Explores general principles of planning, management, and evaluation of health care programs. Review of policies and interventions implemented by public and private organizations will also be explored. The basic conceptual frameworks underlying health care decision making and assessment of the financing, organization, outcomes, and delivery of health care services are presented.