Assessing the Problem- Quality, Safety, and Cost Considerations
The population health problem of focus is heart disease among the Black American population. I have worked closely with patients and community members from Black American populations during my practicum. In this paper, I will assess the impact of heart disease among Black Americans on the quality of care, patient safety, and costs to the system and individuals. The paper will also discuss how state board nursing standards and governmental policies affect heart disease and how it impacts care quality, safety, and care costs on the system and the individual. Finally, I will propose strategies to improve care quality and patient safety and manage the costs of heart disease management.
Impact of Heart Disease among Black Americans on Quality of Care, Patient Safety, and Costs to the System and Individual
Heart disease is a healthcare issue of concern in the United States today. There are higher prevalence and mortality rates among the Black American population related to heart disease than in other racial groups (American Heart Association, 2022). During my practicum, I have noticed that heart disease significantly impacts the quality of the care patients receive and that heart disease compromises patient safety. I have also noticed high care costs for people with heart disease. For instance, a patient I was assigned to during my practicum had been diagnosed and admitted with coronary artery disease. Later, the patient was diagnosed with prediabetes and clinical depression. He needed to be attended to by different care professionals to manage his health conditions. This led to the patient spending more to meet the care costs needed to manage the comorbid conditions. Additionally, there was a case where a patient had taken the wrong medications, citing “confusion over having to take so many medications.” Besides this, I also noted that the billings sent to Medicaid and Medicare for covered patients were slightly higher than those without heart disease.
The available evidence is consistent with my observations of how heart disease affects the quality of care and safety of the patient. Heart disease impacts the quality of care, the safety of patients, and the costs of care as it is a factor for patients developing other diseases. Depression and cardiovascular are common comorbid in patients diagnosed with type 2 diabetes (Inoue et al., 2020). Additionally, research shows an increased risk of cardiac mortality in people with comorbid depression and diabetes (Farooqi et al., 2019). Having heart disease and other comorbidities can negatively impact the quality and safety of the care patients receive. Comorbidity in heart disease requires using multiple medications for both heart disease and other diseases, which is a risk for medication administration errors that impact the quality and safety of the patient. Besides these, the medications for managing and treating heart disease and other comorbid diseases have side effects and can lead to adverse outcomes that threaten patient safety, which can further influence adherence to the prescribed medications (Easthall et al., 2019).
Research evidence also supports the observations related to the increase in care costs in heart disease patients with comorbid diseases such as depression and diabetes. The cost of treating two or more diseases is higher than treating one. From a general disease perspective, a research study in New Zealand showed that having more than one non-communicable disease increased the burden of disease and contributed to higher health system costs (Blakely et al., 2019). Another study by Nichols et al. (2020)focused on comparing expenditures for managing chronic kidney disease (CKD) in patients with and without comorbid diabetes, cardiovascular disease, and heart failure. Nichols et al. (2020) found that comorbidities increased the costs of care for CKD by 31 percent, as well as the rate of hospitalizations and costs associated with hospitalizations by 61 percent as compared to people without comorbidities (Nichols et al., 2020).
Influence of State Board Nursing Practice Standards and Governmental Policies on the Impact of Heart Disease on the Quality of Care, Patient Safety, and Costs to the System and Individual
Each state’s nursing board in the U.S. has its own nursing practice standards guided by the Nursing Practice Act (NPA). NPA was developed to define and act as a standard regulation for the scope of practice for nurses across all states. Revisions are made to the NPA to expand the practice authority for nurses based on health care system demands as well as on the basis of the competence of the nurses. For instance, various boards of nursing in a majority of states have been revising the NPA within their states to suspend the existing practice restrictions and allow full practice authority for nurse practitioners (NPs) in the wake of the COVID-19 health emergency (American Association of Nurse Practitioners, 2022). There has been a relationship between patients with cardiovascular disease and an increased mortality risk, hence the demand for care services (Bansal, 2020). According to Moore et al. (2020), the revisions to the NPA allowing for full NP practice authority expand the scope of practice for NPs, hence helping meet the growing demands for NP service while improving access to quality health care services. Further, the practice standards ensure that NPs, with their expanded scope of practice, follow the boards’ directives on patient care to ensure patients have access to quality and safe healthcare services.
Expanding the scope of practice for NPs has been proven to impact patient safety, quality of care, and care costs. The revision of the NPA and granting NPs full practice authority eliminates the requirements for physician supervision with benefits on the available practice hours for both the physicians and the NPs, with a proven effect on decreasing the costs of care (Moore et al., 2020). Evidence on the use of full-practice NPs within various healthcare settings showed that NPs improve the accessibility and utilization of care services in which the full practice NPs improve care quality outcomes, the safety of care, and cost-effectiveness within care settings more than physicians (Geller & Swan, 2021).
The standards and policies of the board of nursing in my state will guide my actions in addressing care quality, patient safety, and costs to the system and individuals in several ways. For instance, I will adhere to and practice as per the board’s permitted scope of practice to ensure that I do not engage in practices beyond my knowledge. My actions and decisions on patient care will also be guided by the existing standards and policies on caring for patients with heart disease. Additionally, the state’s policies on the nursing scope of practice allow for its expansion with further development of my nursing competencies. As a BSN-prepared nurse, I will have increased my competence level and my ability to provide quality primary care services safely. Therefore, the state policies allow for an expanded scope of practice for me and help improve the number of qualified primary care providers to adequately meet the demands of the population with positive impacts on care quality, the safety of patients, and costs of care as evidence by Geller and Swan (2021).
Proposed Strategies to Improve the Quality of Care, Enhance Patient Safety, and Reduce Costs to the System and Individual
The application of telehealth technology in care delivery is a proposed strategy that can improve the quality of care, enhance patient safety, and reduce care costs to the system and the individual. Telehealth allows for the remote delivery of care services as well as the monitoring and management of patients remotely. Heart disease patients have an increased demand for care services, which increases the costs of care to both the patient and the system in several ways. For instance, the need to provide collaborative interdisciplinary care to a heart disease patient can lead to a shortage of care providers within a particular care setting. This can increase costs and risk patient safety in terms of traveling expenses, reimbursements for a large care team, the time taken to respond to complications and emergencies, and the lack of continuous changes in patient’s health. However, the use of telehealth eliminates the need to travel, supports remote care delivery and interdisciplinary collaboration to deliver care, and supports the continuity of care and disease management in outpatient settings (Khera et al., 2020). Available resources for benchmark data on care quality, patient safety, and costs to the system and individuals related to heart disease include targeted surveys, administrative and medical records, claims data, surveillance data, disease registries, standardized patient assessments, and peer-reviewed literature.
Conclusion
Heart disease is a leading threat to public health due to its prevalence, high mortality rates, and impact on the quality of care and quality of life for patients. It also increases the costs of care at the individual and system levels. Nursing standards and policies guide nurse practices in the management of heart diseases. Therefore, it is important for nursing boards and government policies to make necessary practice revisions that improve the availability of healthcare professionals to support access to care services and improve the costs, safety, and quality of care. Additionally, the application of technologies such as telehealth in patient monitoring and rehabilitation can improve the quality of care, enhance patient safety, and reduce care costs.
References
American Association of Nurse Practitioners. (2022). COVID-19 State Emergency Response: Temporarily Suspended and Waived Practice Agreement Requirements. https://www.aanp.org/advocacy/state/covid-19-state-emergency-response-temporarily-suspended-and-waived-practice-agreement-requirements
American Heart Association. (2022). 2022 Heart Disease & Stroke Statistical Update Fact Sheet Black Race & Cardiovascular Diseases. https://professional.heart.org/-/media/PHD-Files-2/Science-News/2/2022-Heart-and-Stroke-Stat-Update/2022-Stat-Update-factsheet-Black-Race-and-CVD.pdf
Bansal, M. (2020). Cardiovascular disease and COVID-19. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(3), 247–250. https://doi.org/10.1016/J.DSX.2020.03.013
Blakely, T., Kvizhinadze, G., Atkinson, J., Dieleman, J., & Clarke, P. (2019). Health system costs for individual and comorbid noncommunicable diseases: An analysis of publicly funded health events from New Zealand. PLOS Medicine, 16(1), e1002716. https://doi.org/10.1371/JOURNAL.PMED.1002716
Easthall, C., Taylor, N., & Bhattacharya, D. (2019). Barriers to medication adherence in patients prescribed medicines for the prevention of cardiovascular disease: a conceptual framework. International Journal of Pharmacy Practice, 27(3), 223–231. https://doi.org/10.1111/IJPP.12491
Farooqi, A., Khunti, K., Abner, S., Gillies, C., Morriss, R., & Seidu, S. (2019). Comorbid depression and risk of cardiac events and cardiac mortality in people with diabetes: A systematic review and meta-analysis. Diabetes Research and Clinical Practice, 156, 107816. https://doi.org/10.1016/J.DIABRES.2019.107816
Geller, D. E., & Swan, B. A. (2021). Recent evidence of nurse practitioner outcomes in a variety of care settings. Journal of the American Association of Nurse Practitioners, 33(10), 771–775. https://doi.org/10.1097/JXX.0000000000000451
Inoue, K., Beekley, J., Goto, A., Jeon, C. Y., & Ritz, B. R. (2020). Depression and cardiovascular disease events among patients with type 2 diabetes: A systematic review and meta-analysis with bias analysis. Journal of Diabetes and Its Complications, 34(12), 107710. https://doi.org/10.1016/J.JDIACOMP.2020.107710
Khera, A., Baum, S. J., Gluckman, T. J., Gulati, M., Martin, S. S., Michos, E. D., Navar, A. M., Taub, P. R., Toth, P. P., Virani, S. S., Wong, N. D., & Shapiro, M. D. (2020). Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic: A scientific statement from the American Society for Preventive Cardiology. American Journal of Preventive Cardiology, 1, 100009. https://doi.org/10.1016/J.AJPC.2020.100009
Moore, C., Kabbe, A., Gibson, T. S., & Letvak, S. (2020). The Pursuit of Nurse Practitioner Practice Legislation: A Case Study. Policy, Politics, & Nursing Practice, 21(4), 222–232. https://doi.org/10.1177/1527154420957259
Nichols, G. A., Ustyugova, A., Déruaz-Luyet, A., O’Keeffe-Rosetti, M., & Brodovicz, K. G. (2020). Health care costs by type of expenditure across eGFR stages among patients with and without diabetes, cardiovascular disease, and heart failure. Journal of the American Society of Nephrology, 31(7), 1594–1601. https://doi.org/10.1681/ASN.2019121308/-/
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Question 
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 the subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or groups in the Capella Academic Portal Volunteer Experience Form. Report on your experiences during your first two practicum hours.
Assessing the Problem- Quality Safety and Cost Considerations
Introduction
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. Healthcare 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.
Preparation
In this assessment, you’ll assess the effect of the health problem you’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 on 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: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.
Instructions
Complete this assessment in two parts.
Part 1
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 groups in the Capella Academic Portal Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 2 [PDF] provided for this assessment to guide your work and interpersonal interactions.
Part 2
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.
Who 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 patient’s, family’s, or group’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?
Capella Academic Portal
Update the total number of hours on the NURS-FPX4900 Volunteer Experience Form in the Capella Academic Portal.
The BSN Capstone Course (NURS-FPX4900 ) requires the completion and documentation of nine (9) practicum hours. All hours must be recorded in the Capella Academic Portal. Please review the BSN Practicum Campus page for more information and instructions on how to log your hours.
Requirements
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 problem’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 individuals.
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 groups in the Capella Academic Portal Volunteer Experience Form.
Paraphrasing and summarization are used to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Additional Requirements
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.
Competencies Measured
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 individuals. Document the practicum hours spent with these individuals or groups in the Capella Academic Portal 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 problem’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.
Paraphrasing and summarization are used to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Practicum Focus Sheet
Assessment 2
Note: Expect to spend at least 2 hours with the patient, family, or group you’ll be working with
during this portion of your practicum, exploring issues of patient safety, quality, and costs
associated with the health problem you’ve defined. This includes time spent in consultation with
subject matter or industry experts. You’ll report on the results of this work as part of your next
assessment.
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:
• Has the patient, family or group experienced any serious safety events because of the
problem?
• How many times have they gone to the emergency department (ED)?
• How many times have they been hospitalized?
• What is the frequency of ED visits or hospitalizations?
• How many medications are needed to manage the problem?
• Does insurance pay for these medications?
• Have the medications caused any side effects?
• How often are doctors’ visits or other therapies needed?
• Does insurance pay for these visits or treatments?