NURS6053 Purdue University Pertinent Healthcare Issue Analysis Assignment: Analysis of a Pertinent Healthcare Issue The Quadruple Aim provides broad categ
NURS6053 Purdue University Pertinent Healthcare Issue Analysis Assignment: Analysis of a Pertinent Healthcare Issue
The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.
Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.
In this modules Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organizations leadership that addresses the issue/stressor you selected.
To Prepare:
Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.
Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.
The Assignment (3-4 Pages):
Analysis of a Pertinent Healthcare Issue
Develop a 3- to 4-page paper, written to your organizations leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:
Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.
ATTENTION
The paper you develop in Module 1 will be revisited and revised in Module 2. Review the Assignment instructions for Module 2 to prepare for your revised paper.
RUBIC
DEVELOP A 3- TO 4-PAGE PAPER, WRITTEN TO YOUR ORGANIZATION’S LEADERSHIP TEAM, ADDRESSING THE SELECTED NATIONAL HEALTHCARE ISSUE/STRESSOR AND HOW IT IS IMPACTING YOUR WORK SETTING. BE SURE TO ADDRESS THE FOLLOWING:
DESCRIBE THE NATIONAL HEALTHCARE ISSUE/STRESSOR YOU SELECTED AND ITS IMPACT ON YOUR ORGANIZATION. USE ORGANIZATIONAL DATA TO QUANTIFY THE IMPACT (IF NECESSARY, SEEK ASSISTANCE FROM LEADERSHIP OR APPROPRIATE STAKEHOLDERS IN YOUR ORGANIZATION).
SUMMARIZE THE STRATEGIES USED TO ADDRESS THE ORGANIZATIONAL IMPACT OF NATIONAL HEALTHCARE ISSUES/STRESSORS PRESENTED IN THE SCHOLARLY RESOURCES YOU SELECTED AND EXPLAIN HOW THEY MAY IMPACT YOUR ORGANIZATION BOTH POSITIVELY AND NEGATIVELY. BE SPECIFIC AND PROVIDE EXAMPLES.
WRITTEN EXPRESSION AND FORMATTING – PARAGRAPH DEVELOPMENT AND ORGANIZATION:
PARAGRAPHS MAKE CLEAR POINTS THAT SUPPORT WELL-DEVELOPED IDEAS, FLOW LOGICALLY, AND DEMONSTRATE CONTINUITY OF IDEAS. SENTENCES ARE CAREFULLY FOCUSEDNEITHER LONG AND RAMBLING NOR SHORT AND LACKING SUBSTANCE. A CLEAR AND COMPREHENSIVE PURPOSE STATEMENT AND INTRODUCTION IS PROVIDED WHICH DELINEATES ALL REQUIRED CRITERIA.
WRITTEN EXPRESSION AND FORMATTING – ENGLISH WRITING STANDARDS:
CORRECT GRAMMAR, MECHANICS, AND PROPER PUNCTUATION
WRITTEN EXPRESSION AND FORMATTING – THE PAPER FOLLOWS CORRECT APA FORMAT FOR TITLE PAGE, HEADINGS, FONT, SPACING, MARGINS, INDENTATIONS, PAGE NUMBERS, PARENTHETICAL/IN-TEXT CITATIONS, AND REFERENCE LIST. MY POST
At the hospital I work at, a large emphasis has been placed on preventing readmissions. I
chose readmissions as a topic to discuss because I have been personally involved with
this focus at my hospital through two different positions Ive held as a case manager
and an educator.
On October 1, 2012, the Centers for Medicare and Medicaid Services (CMS)
initiated the Hospital Readmission Reduction Program (HRRP), which decreases
payments to hospitals that have excess readmissions. When the program first began, the
three health conditions included in the HRRP were acute myocardial infarction (AMI),
heart failure (HF), and pneumonia (PNA). In 2015, three additional health conditions
were added, which include chronic obstructive pulmonary disorder (COPD), coronary
artery bypass surgery (CABG) and elective primary total hip arthroplasty (THA) and/or
total knee arthroplasty (TKA).
The HRRP could mean significant financial losses for hospitals and an increase in
Medicare spending. According to MedPac (2018), in 2018, 81 percent of hospitals
received decreased payments because of the HRRP, with the penalty amount totaling
$556 million. Mcllvennan, Eapen, and Allen (2015) report that in years prior to initiation
of the HRRP, approximately 12% of discharges could have been avoidable and that
preventing just 10% of those readmissions could save Medicare $1
billion. Understanding the reasons behind readmission is necessary and interventions
should be targeted towards those factors. Hospitals have focused largely on what
interventions assist in decreasing readmission rates, such as close hospital discharge
follow-up, medication reconciliation, partnering with other hospitals, and performing
phone calls after discharge (Mcllvennan, Eapen & Allen, 2015).
This healthcare issue ties into another topic of healthcare payment models. As
noted by the Centers for Medicare and Medicaid Services (n.d.), the HRRP is linked to
the national goal of improving healthcare through the quality of hospital
care. Historically, healthcare providers have been reimbursed under a fee-for-service
model, which essentially means reimbursement for every test, visit, and
procedure. However, there has been a shift in reimbursement for healthcare services,
tying payment to patient outcomes instead (Marshall & Broome, 2017, p. 88. In the
hospital where 1 work, a stronger emphasis is being placed on what can be done to
improve patient outcome. Specific patient outcomes have been reported to staff in the
inpatient setting for quite some time, but I have also noted an increasing awareness in the
ambulatory setting as well. There have also been committees started that address specific
outcome measurements, such as team evaluating diabetes and AMI outcomes.
There have been many changes already implemented and some in the works to
decrease readmission rates within the hospital I work at. When I worked as a case
manager, there was a large emphasis placed on preventing readmissions. Many floors
involved the physicians and physical therapists and others involved with the care of the
patient during rounding so there was clear communication amongst team
members. Without this communication, certain things could have gotten missed, such as
prior-authorization for new medications, or referrals to home therapy. Clearly, if these
things were missed, it would increase the risk of readmission. During this time, the role
of the care navigator was also being developed and within the past five years, the number
of employees on this team has nearly tripled. When the care navigators first started, they
were responsible to perform follow-up phone calls to patients within two days of
discharge. Many of them were responsible for multiple practices, whereas now there is
one to two care navigators per practice depending on the volume of patients. The postdischarge calls focus on patient understanding of the discharge instructions, education no
new or changed medications, and identifying and resolving any issues with the discharge
itself such as a missed prescription or inability to obtain a prescription due to cost. The
care navigator is also responsible for assuring the patient has follow-up within a defined
timeframe dependent on diagnosis. Recently, disease-specific care navigators have been
added specifically for the THAs, TKAs, and AMIs. These care navigators must
make so many phone calls within thirty days after discharge.
My current role as an inpatient certified diabetes educator started nearly four
years ago, with the focus on reducing hemoglobin A1C and reducing all-cause
readmission rates. There are six of us on the team, and we see individuals at high-risk for
re-admissions, such as those with hemoglobin A1C greater than 9%, those hospitalized
with a diabetes-related complication, and individuals with psychosocial barriers. We are
responsible to make two follow up phone calls within thirty days of discharge. This
position has opened my eyes to how many issues can occur within a discharge, such as
being prescribed medications that are not covered under the patients insurance, missed
prescriptions, or even wrong information.
Finally, a team that is currently being developed by the hospital is a
multidisciplinary approach towards individuals who have already shown high
readmission rates. I am not sure what is all involved with this team yet, but I think this is
something that there is a high need for. There are many patients that are continually
readmitted for various reasons, and I am hopeful that this team will be able to identify
issues and help these individuals get what they need to prevent coming back to the
hospital.
References
Centers for Medicare and Medicaid Services. (n.d.). Hospital Readmissions
Reduction Program (HRRP). Retrieved August 25
fromhttps://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/Readmissions-Reduction-Program.html
Marshall, E., & Broome, M. (2017). Transformational Leadership in Nursing:
From Expert Clinician to Influential Leader (2nd ed.). New York, NY: Springer.
McIlvennan, C. K., Eapen, Z. J., & Allen, L. A. (2015). Hospital Readmissions
Reduction Program. Circulation, 131(20), 17961803.
https://doi:10.1161/CIRCULATIONAHA.114.010270
MedPac. (2018). Mandated report: The Effects of the Hospital Readmissions
Reduction Program. Retrieved from http://www.medpac.gov/docs/defaultsource/reports/jun18_ch1_medpacreport_sec.pdf?sfvrsn=0
Reply
Adesola, thanks for this beautiful topic.
Issue of readmission of patients within 30 days of discharge is a big
concern in the facilities these days. Most times nobody knows whom to blame
when it comes to frequent readmission of patients to the hospital. While nurses
and other health care professionals have lots of responsibilities in the reduction
of readmission, patients and insurance organizations are observed to contribute
to the frequent readmission among the patients. Possible causes of readmissions
may include lack of discharge educations, lack of follow-up by the patients and of
course, the inability of patients to afford them discharge home medications of
providers fee. However, readmissions are also a costly price to pay for a system
that doesn’t have resources to spare; Medicare alone reports spending $17.8
billion a year on patients whose return trips to the hospital could have been
avoided (Ness & Kramer, 2013) Patient education, discharge planning, a followup telephone call, patient-centered discharge instructions, and discharge
coaches or nurses who interacted with the patient before and after discharge are
very important interventions (Kripalani et al, 2014)
Dealing with readmission problem
In my facility, before patients are discharged, treatment meetings are
conducted where patients conditions are discussed to determine their readiness
to be discharged. The treatment meetings are made of a team of doctors, nurses,
social workers, case managers, pharmacists and occupational therapists Their
discharge destinations are determined, social issues, housing issues are
confirmed as well as follow-up. In most cases, their medications are discussed to
determine the ability of their insurance companies or Medicare to cover them.
Sometimes doctors are encouraged to switch medications for patients according
to their prizes to accommodate their financial ability. Also in some cases,
patients’ ability is put into consideration and this determines their discharge
destinations and follow-up appointments. Some patients may warrant the need
for a guardian to be appointed by the court or social worker to be appointed to
help the patient.
To reduce patients readmission rate, the hospital provided a place called
discharge lounge where discharge patients go to discuss their discharge
education before they leave the hospital. The nurses in that lounge only conduct
discharges alone for the day. This gives them the opportunity to adequately
educate the patient to good understanding without distractions. In most cases,
patients claim they were not told what to do or where to go for their follow-up.
Education on the need for medication continuation is important and where to get
the medication.
Kripalani, S., Theobald, C. N., Anctil, B., & Vasilevskis, E. E. (2014). Reducing
hospital readmission rates: current strategies and future directions. Annual
review of medicine, 65, 471485. doi:10.1146/annurev-med-022613090415. Retrieved August 29, 2019, from
https://www.ncbi.nlm.nih.gov/pmc /articles/PMC4104507/
Ness D, & Kramer W (August 16, 2013) Reducing Hospital Readmissions: Its
About Improving Patient Care. Retrieved August 29, 2019, from
https://www.healthaffairs.org/do/10.1377/hblog20130816.033808/full/
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