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To critically analyse the federal Program of All-Inclusive Care for the Elderly (PACE) using the Integration Continuum Framework and the Conceptual Model for Nursing and Health Policy, identifying system-level strengths, equity gaps and nursing implications for long-term care reform.
The U.S. long-term care system remains fragmented and institutionally biased, disproportionately affecting dual-eligible older adults who account for outsized healthcare expenditures despite comprising just 17% of Medicare beneficiaries. Permanently authorised under the Balanced Budget Act of 1997, PACE delivers fully integrated, community-based care for individuals aged 55 and older who qualify for nursing home-level services but prefer to remain in their communities.
A policy analysis guided by dual conceptual frameworks assessing PACE structure, implementation and impact across four policy outcome levels: efficacy, effectiveness, equity and justice.
This policy analysis was conducted between May and July 2025. Two conceptual frameworks were applied to examine PACE structure, implementation and outcomes. Data sources included peer-reviewed studies, federal legislation, policy documents and grey literature published between 2020 and 2025, supplemented by international integrated care literature.
PACE demonstrates strong efficacy and effectiveness, with fully integrated interdisciplinary teams and reduced institutionalisation for enrolled older adults. However, the program falls short on equity and justice due to limited geographic reach, racial and ethnic disparities in enrollment, exclusion of Medicare-only populations and persistent nursing workforce challenges.
PACE exemplifies a high-functioning integrated model of community-based long-term care, but current policy constraints prevent it from achieving scale and equity. Without eligibility expansion, financing reform and workforce investment, its transformative potential will remain unrealised. Nurses are central to this vision and must be empowered as clinical leaders and policy advocates to sustain care coordination and advance health equity in aging populations.
To examine the American Cancer Society's HPV vaccination guidelines through a nursing policy analysis framework, assessing justice and equity outcomes in cancer prevention policy implementation.
Human papillomavirus vaccination remains critical for cancer prevention, yet persistent health disparities undermine equity goals despite evidence-based policy recommendations. Limited research has systematically applied nursing conceptual frameworks to analyse vaccination policy through an explicit equity lens.
Policy Analysis Using the Russell and Fawcett Conceptual Model for Nursing and Health Policy, Focusing on Level 4 Outcomes Addressing Justice, Social Changes and Market Interventions.
Systematic analysis of policy sources (public, organisational, professional), components (personnel, services, expenditures) and outcomes across quality, cost and access dimensions. Data sources included primary policy documents, implementation reports and peer-reviewed literature from 2015 to 2024. Thematic analysis examined policy effectiveness through distributive and procedural justice lenses.
Critical policy fragmentation creates systematic equity barriers, with only five jurisdictions (Virginia, District of Columbia, Rhode Island, Puerto Rico, Hawaii) achieving > 70% vaccination coverage through school-entry mandates and 46 states and territories demonstrating substantially lower rates. Rural adolescents experience 15%–20% lower vaccination rates, while Black adolescents show 10 percentage points lower coverage than white adolescents despite federal Vaccines for Children (VFC) program investment of $4.2 billion annually. Provider training gaps and cultural competency limitations disproportionately affect communities of colour. Healthcare system transformation remains concentrated in well-resourced organisations, creating two-tiered implementation that reinforces existing disparities.
Achieving cancer prevention equity requires coordinated interventions across multiple policy levels, enhanced provider training emphasising cultural competency, community-based service expansion and equity-focused resource allocation. Federal leadership establishing minimum vaccination requirements linked to education funding, respecting state constitutional authority, sustainable funding models and nursing leadership represent essential actions for advancing health equity.
Demonstrates nursing frameworks' utility for rigorous health policy analysis while providing evidence-based recommendations for strengthening vaccination policy to achieve cancer prevention equity across diverse populations.
This study did not include patient or public involvement in its design, conduct or reporting.
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