Assessing the Problem- Quality, Safety, and Cost Considerations

Assessing the Problem- Quality, Safety, and Cost Considerations

CDC.gov (2022) reports that type 2 diabetes mellitus accounts for more than 90 percent of DM cases. As such, all stakeholders should work in concert to address this healthcare concern. This paper discusses the impact of type 2 DM on patient safety, quality of care, and healthcare costs. It also describes policies and standards that impact DM management and identifies the sources of benchmark data.

Part 1

Impact on the Quality of Care, Patient Safety, and Costs

Type 2 diabetes mellitus (DM) impacts the quality of care. Poor management of the disease is characterized by non-adherence to the treatment plan, lack of patient follow-up and screening, and lack of optimized treatment plans (Chung et al., 2020). This impacts the quality of care by increasing the likelihood of complications. Patients are likely to have complications such as cerebrovascular disease, hyperosmolar hyperglycemic state (HHS), retinitis, and neuropathy (Chung et al., 2020). As such, the interdisciplinary team should collaborate with patients and their families to optimize the quality of care and achieve a better outcome. The interdisciplinary team should be involved in patient education, formulation and implementation of an evidence-based treatment plan, screening, and follow-up (Szafran et al., 2019). Furthermore, the interdisciplinary team should aim to provide holistic care that addresses the preferences of each patient (Szafran et al., 2019). This evidence is consistent with the findings of my clinical practice.

Poorly managed DM impacts patient safety. It impacts the physical and psychosocial aspects of the patient. The physical aspects are related to the complications and mortalities associated with DM. For instance, CDC.gov (2022) reports that approximately 25,000 and 242,000 cases of HHS and hypoglycemia were reported in 2018. Furthermore, about 223,000 cases of diabetic ketoacidosis were reported at the emergency department (CDC.gov, 2022). Twenty-three percent of hypoglycemic patients were hospitalized, whereas about eighty-five percent of patients with hyperglycemic crises were hospitalized in 2018 (CDC.gov, 2022). Further evaluation revealed that DM accounted for over 1.8 million cardiovascular diseases, such as cerebrovascular and ischemic heart disease (CDC.gov, 2022). Furthermore, DM resulted in more than 150,000 amputations in 2018 (CDC.gov, 2022). CDC.gov (2022) reports that in 2021, more than 39 percent of adult diabetic patients had chronic renal disease. Furthermore, more than 11 percent of adult diabetic patients reported vision disability in 2019 (CDC.gov, 2022). More than 280,000 deaths recorded in 2019 were attributed to DM (CDC.gov, 2022). Common psychosocial problems include depression and anxiety.

CDC.gov (2022) reports that the USA spends over $320 billion annually managing DM. In this context, direct costs entail medical expenditure, whereas indirect costs address decreased home and workplace productivity. Direct costs account for more than $230 billion annually, whereas indirect costs account for about $90 billion annually (CDC.gov, 2022). Furthermore, it is estimated that the direct costs of managing each patient are more than $9,600 annually (CDC.gov, 2022). This evidence is consistent with the findings of my clinical practice.

Organizational and Government Policies

The American Nurses Association’s standards impact the quality of care, patient safety, and healthcare costs of managing DM. Its standards of practice address thematic areas such as diagnosing patients, evaluating them, and creating treatment plans (MO.gov, n.d.). In this scenario, the American Nurses Association (ANA) champions the protection of human dignity, holistic care, and continuous education to uphold professional competency. By so doing, the quality of care and patient safety is optimized. ANA’s standard of professional performance also champions evidence-based practice, ethical practices, a collectivistic culture, and open communication (MO.gov, n.d.). This will ensure that the best interventions are used to manage patients with DM. Furthermore, ANA provides specialty practice guidelines that target specific patient populations (MO.gov, n.d.). Guidelines targeting diabetic patients will create a standardized care approach and optimize the quality of care.

Medicare Diabetes Prevention Act of 2015 is another policy that impacts the quality of care, patient safety, and healthcare costs. This law aims to provide healthcare coverage for everyone who qualifies for the diabetes prevention program (DPP) (Congress.gov, n.d.). The DPP is intended for those with type 2 diabetes. This program emphasizes dietary modification, cardiorespiratory and muscle-building exercise, weight management, and offering helpful coping techniques to patients with type 2 DM (Congress.gov, n.d.). As such, the interdisciplinary team involved in patient management should provide holistic care that entails periodic patient monitoring, availing coping mechanisms, and continuous patient education. Patients should access local community resources that optimize their well-being.

McIntyre and Song (2019) report that the Affordable Care Act aims to improve healthcare access. This Act advocates for the expansion of the Medicaid program, innovative healthcare, and affordable insurance (McIntyre & Song, 2019). This Act allows people to access healthcare insurance in the marketplace and through employers. Notably, ACA benefits people with low income levels. This impacts the management of type 2 DM by lowering healthcare costs and increasing access to quality healthcare.

ANA’s standards, the ACA, and the Medicare Diabetes Prevention Act of 2015 impact nurses’ actions and the scope of nursing practice. As earlier stated, ANA’s standards require nurses to research and embrace evidence-based practice (MO.gov, n.d.). Also, nurses should uphold ethical practices in their routines. They should collaborate with other healthcare providers to increase the quality of healthcare services. Furthermore, nurses should maintain professional competency and demonstrate pertinent skills and knowledge when caring for patients with type 2 DM. The ACA requires nurses to provide holistic care to all patients. In addition, it directs nurses to advocate for patients’ access to affordable healthcare services. The Medicare Diabetes Prevention Act of 2015 directs nurses to embrace patient-centeredness and continuous patient education. Nurses should collaborate with other stakeholders from local community resources to ensure that the diabetes prevention program is implemented to its entirety.

Improving Quality of Care and Patient Safety and Lowering Costs

Various strategies can be used to improve the quality of care and patient safety. To begin with, the interdisciplinary team involved in the management of DM should receive periodic training and education. Training and education aim to maintain their professional competency by addressing major aspects involved in the management of DM (Chung et al., 2020). Refresher training will enable the workforce to adopt current evidence-based practices used in the management of DM (Szafran et al., 2019). Training new members will enable them to gain skills and knowledge to optimize the management of DM.

Secondly, the interdisciplinary team should conduct periodic screening and patient education. Screening enables the team to monitor the patient’s response to therapy (Szafran et al., 2019). Optimal response to therapy is demonstrated by tight glycemic control and the absence of diabetic complications (Szafran et al., 2019). Poorly controlled plasma glucose levels and the presence of complications imply non-adherence to the treatment plan or lack of an optimized treatment plan (Szafran et al., 2019). Screening forms the basis of decision-making and impacts the modification of existing treatment plans. On the other hand, patient education enables patients and their families to understand the course of their disease (Szafran et al., 2019). By so doing, they are likely to be actively involved in managing the disease. Patient involvement is beneficial as it is associated with high levels of adherence to the treatment plan. Also, it enables the interdisciplinary team to achieve patient-centeredness and a holistic care approach.

Thirdly, the interdisciplinary team should adopt a standardized approach to managing DM. To accomplish this, they should formulate standard operating procedures and standard treatment guidelines (Koliaki et al., 2020). Standardized processes avert variations in the management of DM. Limited variations enable the team to work harmoniously toward a common goal. Also, standardized processes enable the interdisciplinary team to use evidence-based approaches when managing DM (Koliaki et al., 2020). For instance, the standard guidelines should describe the diagnosis of DM, the first-line and second-line medications for different patient populations, recommended non-pharmacological approaches, and the goals of therapy (Koliaki et al., 2020). Furthermore, the guidelines should provide a framework for patient monitoring. Standardized procedures will ensure that the best interventions that improve patient safety and outcomes are adopted in practice.

Healthcare costs can be reduced by optimizing disease management to reduce hospitalizations and advocating for affordable coverage. To optimize disease management, the interdisciplinary teams should implement EBP care plans, improve treatment plan adherence, and perform regular follow-ups (Koliaki et al., 2020). Healthcare technology, such as telehealth, can be leveraged to improve adherence to the treatment plan and monitor patients remotely (Appuswamy & Desimone, 2020). This will promote tight glycemic control, minimize complications, and minimize hospitalizations, lowering treatment costs. Advocacy for affordable coverage by employers and the state and federal government will enable the majority of the population to afford quality healthcare services.

Sources of Benchmark Data

AHRQ.gov (n.d.) reports that the Agency for Healthcare Research and Quality provides quality and disparities reports that provide key benchmark data on the management of DM in the USA. The report focuses on aspects such as patient safety, patient-centeredness, quality of care, and access to care (AHRQ.gov, n.d.). The disparity report focuses on various ethnicities and social determinants of health (AHRQ.gov, n.d.). It provides the values of national and state benchmarks. This enables healthcare facilities to compare their performance with other top-performing facilities in different states. By so doing, states and healthcare facilities identify underperforming metrics and formulate improvement strategies.

Part 2

I interacted with a seventy-year-old Indian American female. She is a known diabetic patient diagnosed with the disease three decades ago. The patient is brought in by her spouse and daughter. Physical examination reveals a weak pulse, lethargy, confusion, and dry mucous membranes. Her respiratory rate is 28 breaths per minute. Further workup reveals plasma glucose levels of 37.0 mmol/L, bicarbonate levels of 17 mEq/L, and a serum osmolality of 335 mOsm/kg. These are manifestations of a hyperosmolar hyperglycemic state. The patient is started on intravenous fluid resuscitation, and a plan for insulin therapy is initiated.

I spent four hours with the patient and her family. I embraced active listening to promote information sharing and improve our interaction. The patient reported that she is forgetful and misses some of her medication. I educated the family on the importance of their involvement in the treatment process. Furthermore, I educated the family on the strategies for improving medication adherence, such as drug calendars and mobile health. We agreed that the patient’s spouse and daughter would actively participate in the treatment process. The main barrier was limited digital and health literacy. I addressed this by enabling the patient and her family to locate relevant online and community resources. I obtained evidence from online medical databases such as Google Scholar, PubMed, and government websites. I learned that online databases enable users to customize searches.

References

AHRQ.gov. (n.d.). National Healthcare Quality and Disparities Reports (NHQDR). https://datatools.ahrq.gov/nhqdr

Appuswamy, A. V., & Desimone, M. E. (2020). Managing Diabetes in Hard to Reach Populations: A Review of Telehealth Interventions. Current Diabetes Reports, 20(7). https://doi.org/10.1007/s11892-020-01310-2

CDC.gov. (2022). Coexisting Conditions and Complications. https://www.cdc.gov/diabetes/data/statistics-report/coexisting-conditions-complications.html

Chung, W. K., Erion, K., Florez, J. C., Hattersley, A. T., Hivert, M. F., Lee, C. G., McCarthy, M. I., Nolan, J. J., Norris, J. M., Pearson, E. R., Philipson, L., McElvaine, A. T., Cefalu, W. T., Rich, S. S., & Franks, P. W. (2020). Precision Medicine in Diabetes: A Consensus Report from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care, 43(7), 1617–1635. https://doi.org/10.2337/dci20-0022

Congress.gov. (n.d.). H.R.2102 – Medicare Diabetes Prevention Act of 2015. https://www.congress.gov/bill/114th-congress/house-bill/2102

Koliaki, C., Tentolouris, A., Eleftheriadou, I., Melidonis, A., Dimitriadis, G., & Tentolouris, N. (2020). Clinical Management of Diabetes Mellitus in the Era of COVID-19: Practical Issues, Peculiarities and Concerns. Journal of Clinical Medicine, 9(7), 2288. https://doi.org/10.3390/jcm9072288

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Medicine, 16(2), 10–12. https://doi.org/10.1371/journal.pmed.1002752

MO.gov. (n.d.). Standards of Nursing Practice. https://health.mo.gov/living/lpha/phnursing/standards.php.

Szafran, O., Kennett, S. L., Bell, N. R., & Torti, J. M. I. (2019). Interprofessional collaboration in diabetes care: Perceptions of family physicians practicing in or not in a primary health care team. BMC Family Practice, 20(1), 1–10. https://doi.org/10.1186/s12875-019-0932-9

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Assessment 2 Instructions: Assessing the Problem: Quality, Safety, and Cost Considerations

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 two 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 Healthcare Quality Safety & 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 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: 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 two practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.