Nursing's response to the crisis of access, costs, and quality in health care.

Changes now taking place in the structure of health care delivery in the United States from regulatory models controlled by physicians to competitive models driven by traditional market forces of cost and quality 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 impact of the nursing center is significant because of the nurses' ability to forestall hospital admissions and readmissions, decrease prolonged lengths of stay, provide medically supportive outpatient treatments, care for clients at a low cost per client per year, attract professional and nonprofessional volunteer services and donations, and increase job satisfaction, thus reducing costly nurse turnover. The 1991 to 1992 costs of HIV/AIDS health care in the United States were used to estimate conservatively that the center has saved more than $700,000 in 1991 and over $1 million in 1992 in hospital charges for HIV/AIDS care. A rationale for the cost savings estimates is supplied by results of quantitative and qualitative evaluation research projects conducted at the center. Finally, implications of this analysis for future directions in nursing practice and education are discussed.