Assessing the Problem: Quality, Safety and Cost Considerations Essay
Assessing the Problem: Quality, Safety and Cost Considerations
Chronic health problems, including diabetes and congestive heart failure, have immense implications for patients, their families, and communities as a whole. Often, patients incur high costs in seeking the care they need. Healthcare providers play essential roles in easing the burden that the affected patients and families undergo. They consider evidence-based interventions that are cost-effective, efficient, safe, and promote the delivery of high-quality care to their patients. Government and other institutions are also responsible for adopting policies and standards that address the healthcare needs of patients suffering from chronic health problems. Therefore, the purpose of this paper is to explore the impact of diabetes and congestive heart failure on the selected patient for the capstone project and the effect of the state board of nursing standards and policies on nursing actions in diabetes and congestive heart failure management.
Impact of Population Health Problem
Diabetes and congestive heart failure have affected significantly Mr. Y’s quality of life and health. Accordingly, Mr. Y noted that the conditions have increased the healthcare costs that he incurs in treating them. He faces the challenge of increased need for frequent hospital visits, hospitalization, and the purchase of expensive medications. He has also lost his social and occupational productivity due to health problems. He is worried that the medications he currently uses may predispose him to further adverse health outcomes. The increased demands due to the conditions have affected the social, emotional, and psychological wellbeing of his family. As a result, he expressed the need for interventions that can be implemented to reduce the disease burden that patients with chronic diseases experience.
Evidence-based data supports Mr. Y’s experiences with diabetes and congestive heart failure. According to the statistics by the National Institute of Diabetes and Digestive and Kidney Diseases, 10.5% (34.2 million people) in the USA have diabetes. Diabetes has high-cost implications for the state as seen from the statistics that the cost of diagnosed diabetes was $327 billion in 2017. The direct medical costs incurred due to diabetes in the same year were $237 billion and $90 billion lost in productivity among the affected populations(NIDDK, 2021). The Center for Disease Control and Prevention (CDC) also reports that diabetes contributes to a high rate of hospitalization among the affected populations. For example, diabetes with any other comorbidity contributed to 7.8 million hospital discharges in the USA in 2016. The statistics included 1.7 million discharges due to cardiovascular diseases, 130000 for lower-extremity amputation, 209,000 for hyperglycemia, and 57,000 for hypoglycemia (CDC, 2020).
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Diabetes also predisposes patients to several complications that affect their overall health, wellbeing, and quality of life. Patients with diabetes are increasingly predisposed to other complications that include hypoglycemia, diabetic ketoacidosis, diabetic foot, neuropathy, nephropathy, and cardiovascular complications such as stroke and ischemic heart disease. The statistics by the CDC demonstrate that the crude estimate for kidney disease in adults diagnosed with diabetes was 37.0% between 2013 and 2016. Diabetic retinopathy had a crude rate of 11.7% in the same year. Diabetes was ranked the seventh leading cause of death in the USA in 2017. The statistics show that 270,702 death certificates had diabetes listed as the contributing or underlying cause of death (CDC, 2020). Based on the above, it is evident that diabetes has an immense burden on patients and their families besides predisposing them to comorbid conditions that include cardiovascular complications.
The above evidence is consistent with what I see in my nursing practice. Patients with diabetes are highly predisposed to complications that include cardiovascular disorders, renal, and retinal problems. Patients also incur high costs in disease management and its comorbidities. The risk of poor outcomes is also high due to uncontrolled diabetes. Therefore, evidence-based data aligns with my practice experiences.
Effect of State Board of Nursing Standards and Policies on Nursing Actions
State board of nursing and organizational and government policies affect the impact of diabetes on quality of care, patient safety, and costs to the system and individual. The state board of nursing sets practice standards for nursing to optimize care outcomes for diverse populations. The standards serve to enhance the safety, quality, and efficiency of diabetes care that nurses offer. The state board of nursing also sets the minimum professional behaviors for nurses involved in the care of diabetes patients (Kaya &Karaca, 2018). For example, it requires nurses to have competencies in offering patient-centered, evidence-based care that minimizes the risk of harm and optimum care benefits. The state board of nursing practice standards also sets the ethical guidelines for patient care in nursing practice. Nurses have to ensure that the care given respects patients’ rights, protects their safety and quality needs, and empowers them to play a proactive role in disease management (Kaya &Karaca, 2018). Through the above influences, the state board of nursing improves the care experiences and outcomes of diabetic patients, hence, cost efficiency in the care process.
Government policies also affect the impact of diabetes on the population, costs, and patient safety. Governments implement policies that increase the populations’ access to their needed care. An example can be seen from healthcare policies that include the Affordable Care Act, which expanded the proportion of the population in the USA that could afford their needed care. The expansion of the population with medical insurance coverage implied that most of the vulnerable populations from low socioeconomic backgrounds could access the care that they need. Healthcare policies that include Health Insurance Portability and Accountability Act (HIPAA) support the meaningful use of technology in chronic disease management. It encourages the use of technologies that include telehealth in managing diabetes and its associated comorbidities. Studies have demonstrated that government policies are effective in improving the care outcomes for patients with diabetes. For example, the study by Huguet et al. (2018), demonstrated that the Affordable Care Act reduced the un-insurance rate in the county and increases the population’s access to preventive care, especially those considered pre-diabetic. Similarly, Casagrande et al. (2018) found that the policy decreased the costs incurred by low-income families in accessing their needed diabetic care.
The board of nursing standards and government policies will guide my actions in addressing care quality, patient safety, and costs to Mr. Y. First, I will ensure that I demonstrate professionalism in working with the patient in addressing his needs. I will respect his right to safety, quality, efficient, and informed care. I will also explore evidence-based interventions that can be adopted to improve his treatment outcomes. I will also utilize interdisciplinary interventions to ensure the care given to the patient addresses his actual and potential needs. I will also educate the patient about the importance of medical insurance coverage in reducing the healthcare costs that he incurs in managing his health problems (Kaya &Karaca, 2018). I will enroll him in the Affordable Care Act program to ensure that he had easy access to the care that he needs for his optimum health. I will also ensure data privacy and confidentiality are maintained when using health information technologies to improve his health outcomes.
Strategies to Improve Quality of Care, Patient Safety and Reduce Costs
Several strategies can be explored to improve the quality of diabetes care, patient safety, and reduce costs. One of the strategies is promoting patient-centeredness in diabetes management. Patient-centeredness in healthcare entails developing care plans that address the unique needs of the patients (Wollny et al., 2021). Patient-centeredness considers the patient as a whole being, with disease and non-disease factors influencing their experience with a disease. Patient-centeredness has been shown to promote patient engagement, satisfaction, and empowerment in diabetes management, hence, safety, quality, and efficiency in the care process (Poger et al., 2020).
The other strategy that can be considered to improve the quality of diabetes care, patient safety, and reduce costs is shared decision-making. Shared-decision making entails the healthcare providers collaborating with patients in choosing the best intervention to meet the patient’s needs. It comprises elements that include situation diagnosis, option clarification, choice awareness, discussion of benefits and harms, consideration of patient preferences, and making an informed decision (Wieringa et al., 2019). Shared decision-making improves care outcomes by encouraging patients’ active participation in the care process, empowerment, and increased patients’ understanding of their role in disease management (Jolles et al., 2019). As a result, outcomes that include improved knowledge and skills about diabetes and increased utilization of self-management practices are achieved with shared decision-making in diabetes.
The last strategy to improve the quality of diabetes care, patient safety, and reduce costs in diabetes care is self-efficacy health education. Diabetes management and its comorbidities are complex practices for patients. Often, patients have to adjust their routines to ensure optimum disease management. As a result, patients require education on self-efficacy to achieve optimum outcomes in the management process (Amer et al., 2018). Self-efficacy entails ensuring that patients with diabetes can engage in self-management activities with minimal assistance. Since self-efficacy is a prerequisite for behavioral change in diabetes management, patients should be educated to take actions that minimize harm and promote optimum outcomes in diabetes management (Eroglu & Sabuncu, 2021). Evidence-based data shows that self-efficacy education improves self-management practices for diabetes by patients. It also improves the patients’ self-esteem, optimism, and self-regulation, which minimize adverse outcomes associated with diabetes such as anxiety and depression (Jiang et al., 2019). Increased utilization of diabetes self-management practices also minimizes adverse events, hence, safety, quality, and efficiency of diabetes care.
In summary, diabetes and its comorbidities have adverse health effects on patients and their significant others. Patients incur high costs in disease management. They also lose their productivity, affecting their quality of life. State board of nursing standards and government policies influences the quality of diabetes care, costs, and patient safety. Healthcare providers are responsible for exploring strategies to improve quality of care, safety, and costs in diabetes management. They also empower patients to play a proactive role in diabetes self-management for enhanced care outcomes.
Amer, F. A., Mohamed, M. S., Elbur, A. I., Abdelaziz, S. I., Elrayah, Z. A., Amer, F. A., Mohamed, M. S., Elbur, A. I., Abdelaziz, S. I., &Elrayah, Z. A. (2018). Influence of self-efficacy management on adherence to self-care activities and treatment outcome among diabetes mellitus type 2. Pharmacy Practice (Granada), 16(4). https://doi.org/10.18549/pharmpract.2018.04.1274
Casagrande, S. S., McEwen, L. N., & Herman, W. H. (2018). Changes in Health Insurance Coverage Under the Affordable Care Act: A National Sample of U.S. Adults With Diabetes, 2009 and 2016. Diabetes Care, 41(5), 956–962. https://doi.org/10.2337/dc17-2524
CDC. (2020).National Diabetes Statistics Report 2020. Estimates of diabetes and its burden in the United States. 32.
Eroglu, N., &Sabuncu, N. (2021).The effect of education given to type 2 diabetic individuals on diabetes self-management and self-efficacy: Randomized controlled trial.Primary Care Diabetes, 15(3), 451–458. https://doi.org/10.1016/j.pcd.2021.02.011
Huguet, N., Springer, R., Marino, M., Angier, H., Hoopes, M., Holderness, H., &DeVoe, J. E. (2018).The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Visit Rates for Diabetes in Safety Net Health Centers.The Journal of the American Board of Family Medicine, 31(6), 905–916. https://doi.org/10.3122/jabfm.2018.06.180075
Jiang, X., Wang, J., Lu, Y., Jiang, H., & Li, M. (2019).Self-efficacy-focused education in persons with diabetes: A systematic review and meta-analysis.Psychology Research and Behavior Management, 12, 67–79. https://doi.org/10.2147/PRBM.S192571
Jolles, M. P., Richmond, J., & Thomas, K. C. (2019).Minority patient preferences, barriers, and facilitators for shared decision-making with health care providers in the USA: A systematic review.Patient Education and Counseling, 102(7), 1251–1262.
Kaya, Z., &Karaca, A. (2018).Evaluation of Nurses’ Knowledge Levels of Diabetic Foot Care Management.Nursing Research and Practice, 2018, e8549567. https://doi.org/10.1155/2018/8549567
NIDDK.(2021). Diabetes Statistics | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/health-statistics/diabetes-statistics
Poger, J. M., Mayer, V., Duru, O. K., Nauman, B., Holderness, H., Warren, N., Vasquez, C., Bibi, S., Rasmussen-Torvik, L. J., Hosseinian, Z., Shi, L., Wallace, J., Goytia, C. N., Horowitz, C. R., &Kraschnewski, J. L. (2020). Network Engagement in Action: Stakeholder Engagement Activities to Enhance Patient-centeredness of Research.Medical Care, 58, S66. https://doi.org/10.1097/MLR.0000000000001264
Wieringa, T. H., Rodriguez-Gutierrez, R., Spencer-Bonilla, G., de Wit, M., Ponce, O. J., Sanchez-Herrera, M. F., Espinoza, N. R., Zisman-Ilani, Y., Kunneman, M., Schoonmade, L. J., Montori, V. M., &Snoek, F. J. (2019). Decision aids that facilitate elements of shared decision making in chronic illnesses: A systematic review.Systematic Reviews, 8(1), 121. https://doi.org/10.1186/s13643-019-1034-4
Wollny, A., Löffler, C., Drewelow, E., Altiner, A., Helbig, C., Daubmann, A., Wegscheider, K., Löscher, S., Pentzek, M., &Wilm, S. (2021). Shared decision making and patient-centeredness for patients with poorly controlled type 2 diabetes mellitus in primary care—Results of the cluster-randomised controlled DEBATE trial. BMC Family Practice, 22(1), 1–15.
This is the second of five papers on the same subject matter of Diabetes with CHF patients seen in the ER:
In a 5-7 page written assessment, assess the effect of the patient, family, or population problem you’ve previously defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form. Report on your experiences during your first two practicum hours.
Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Health care organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.
In this assessment, youâ€™ll assess the effect of the health problem youâ€™ve defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 direct practicum hours working with the same patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts.
To prepare for the assessment:
Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.
Conduct research of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.
Review the Practicum Focus Sheet: Assessment 2 [PDF], which provides guidance for conducting this portion of your practicum.
Note: Remember that you can submit all, or a portion of, your draft assessment to Smarthinking for feedback, before you submit the final version. If you plan on using this free service, be mindful of the turnaround time of 24-48 hours for receiving feedback.
Complete this assessment in two parts.
Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 2 [PDF] provided for this assessment to guide your work and interpersonal interactions.
Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.
Whom did you meet with?
What did you learn from them?
Comment on the evidence-based practice (EBP) documents or websites you reviewed.
What did you learn from that review?
Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?
Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?
What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patientâ€™s, familyâ€™s, or groupâ€™s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
What changes, if any, did you make to your definition of the problem, based on your discussions?
What might you have done differently?
Update the total number of hours on the NURS-FPX4900 Volunteer Experience Form in CORE ELMS.
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Cite evidence that supports the stated impact.
Note whether the supporting evidence is consistent with what you see in your nursing practice.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problemâ€™s impact on the quality of care, patient safety, and costs to the system and individual.
Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.
Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.
Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form.
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your paper. Be sure to include:
A title page and reference page. An abstract is not required.
Appropriate section headings.
Length: Your paper should be approximately 5-7 pages in length, not including the reference page.
Supporting evidence: Cite at least 5 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.
Explain how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual and document the practicum hours spent with these individuals or group in the Core Elms Volunteer Experience Form.
Competency 5: Analyze the impact of health policy on quality and cost of care.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problemâ€™s impact on the quality of care, patient safety, and costs to the system and individual.
Competency 8: Integrate professional standards and values into practice.
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Practicum Focus Sheet
Note: Expect to spend at least 2 hours with the patient, family, or group youâ€™ll be working with
during this portion of your practicum, exploring issues of patient safety, quality, and costs
associated with the health problem youâ€™ve defined. This includes time spent in consultation with
subject matter or industry experts. Youâ€™ll report on the results of this work as part of your next
For this portion of your practicum, discuss, in depth, how the problem will affect patient safety,
quality of care, and costs. Consider the following questions to help guide your exploration of
quality, safety, and costs and to make the most of your time:
â€¢ Has the patient, family or group experienced any serious safety events because of the
â€¢ How many times have they gone to the emergency department (ED)?
â€¢ How many times have they been hospitalized?
â€¢ What is the frequency of ED visits or hospitalizations?
â€¢ How many medications are needed to manage the problem?
â€¢ Does insurance pay for these medications?
â€¢ Have the medications caused any side effects?
â€¢ How often are doctorsâ€™ visits or other therapies needed?
â€¢ Does insurance pay for these visits or treatments?