Assessing the Problem – Quality, Safety, and Cost Considerations
Alzheimer’s disease (AD) impacts healthcare costs, patient safety, and the quality of care. The significance of the disease is attributed to the fact that it is incurable. When AD is poorly managed, it can progress from mild to severe form and result in mortalities. As such, nurses and other healthcare providers should work harmoniously to manage this disease. This paper discusses the safety, cost, and quality aspects of Alzheimer’s disease.
Part One
Impact on the Quality of Care, Patient Safety, and Costs
Alzheimer’s disease impacts the quality of care by predisposing patients to various complications. Patients with severe AD are likely to experience challenges in accomplishing activities of daily living. The severe form of the disease increases the likelihood of aspiration pneumonia, which increases mortality rates among these patients (Schachter & Davis, 2022). The moderate form of the disease predisposes patients to mental health problems such as anxiety, depression, and paranoia (Schachter & Davis, 2022). As such, nurses and the interdisciplinary team should strive to provide quality patient-centered care to patients with AD. Patient-centered care is relevant because it recognizes the unique requirements of each individual based on the severity of the disease (ALZ.org, n.d.). Accordingly, patient-centeredness will enable the interdisciplinary team to develop evidence-based care plans that foster optimal outcomes for patients with AD. Examples of key interdisciplinary team members include nurses, physicians, and pharmacists. This evidence is harmonious with the findings that I observe in my clinical practice.
Further, Alzheimer’s disease compromises patient safety. To begin with, it affects their physical well-being. For example, Mok et al. (2020) report that patients with severe Alzheimer’s disease have mobility problems due to extrapyramidal dysfunction. Mobility problems increase the likelihood of falls and injury. In addition, immobilization predisposes the patient to pressure ulcers and aspiration pneumonia which increase morbidity and mortality rates among these patients (Mok et al., 2020). As earlier stated, patients’ ability to execute their daily activities is hampered by limited mobility. In this context, patients become fully dependent on their families or caregivers. It is worth noting that early-onset AD has a poor prognosis compared to late-onset AD. Also, poorly managed AD has a poor prognosis and increases the risk of complications and mortalities. The significance of AD is evidenced by the findings that it is the fifth leading cause of mortality in people over the age of 65 in the USA (CDC.gov, 2020). AD impacts the patients’ mental health by increasing the risk of anxiety, delusions, depression, and paranoia
Moreover, according to CDC.gov (2020), at least 5.8 million persons in the USA have Alzheimer’s disease. The prevalence of AD is expected to triple by 2060. As such, the disease has a significant impact on healthcare costs. These costs can be categorized into direct and indirect costs. CDC.gov (2020) reports that in 2010, the annual cost of managing AD ranged from $159 billion to $215 billion. According to ALZ.org (n.d.), the annual cost of managing Alzheimer’s disease was approximately $320 billion in 2022. The annual cost is expected to exceed $500 billion by 2040 (CDC.gov, 2020). The projected increase in healthcare costs is attributed to the anticipated increase in the prevalence of the disease.
Organizational and Government Policies
The standards of practice established by the American Nurses Association (ANA) influence the quality of care. The ANA’s standards cover three themes: to begin with, ANA explores professional standards. MO.gov (n.d.) reports that professional standards direct how nurses should examine and diagnose patients, create and implement care plans, and monitor patients. The quality of care and patient outcomes are improved by providing accurate diagnoses, patient treatment, and patient monitoring. Improved patient outcomes lower the cost of healthcare by minimizing hospitalizations. Secondly, MO.gov (n.d.) reports that ANA provides performance standards. These standards define the role of nurses in care coordination, patient care, and providing quality care. By adhering to these standards, nurses achieve holistic care and patient-centeredness. Thirdly, ANA discusses practice guidelines. The guidelines offer a systematic approach to patient care. The guidelines are methods backed by scientific evidence that harmonize the provision of healthcare to a specific population. As such, the application of ANA’s standards to the management of AD will improve the quality of care and optimize patient outcomes.
The Affordable Care Act (ACA) is an example of a policy that will impact healthcare costs and the quality of care provided for patients with AD. The act intends to provide access to affordable care, extend the Medicaid scheme, and promote healthcare innovation. Patel et al. (2020) indicate that ACA provided coverage to at least twenty million people in the USA. In addition, by banning discrimination against those with multiple underlying medical conditions, the ACA increased access to healthcare treatments. By championing employer-provided coverage and availing coverage at the marketplace, the ACA significantly contributed to the reduction of healthcare costs. As such, the ACA impacts patients with long-term illnesses, such as Alzheimer’s disease.
Further, the National Alzheimer’s Project Act (NAPA) is another policy that seeks to reduce treatment costs and optimize the quality of care for AD patients (HHS.gov, n.d.). To that end, the NAPA advocates for the effective distribution of resources to improve the management of AD. NAPA has six goals regarding the management of AD. The first goal is to optimize the prevention and management of AD by 2025 (HHS.gov, n.d.). The second goal is to improve the efficacy and quality of care for AD patients. The third goal is to increase support programs for families and individuals with AD and other dementias (HHS.gov, n.d.). The fourth goal is to increase public awareness about AD. The fifth goal is to enhance data monitoring for AD. The sixth goal is to expedite initiatives that foster healthy aging to decrease AD risk factors (HHS.gov, n.d.).
ANA standards of practice, the Affordable Care Act, and the NAPA influence the scope of nursing practice. According to ANA’s standards of practice, nurses must research and adopt evidence-based practice in their routine (MO.gov, n.d.). Furthermore, nurses should demonstrate effective teamwork skills and partner with the interdisciplinary team to optimize care delivery. In addition, nurses must complete regular training exercises and demonstrate adequate professional competency. According to the ACA, nurses should ensure all patients have adequate access to quality and affordable healthcare. They can accomplish this via policy formulation to ensure more people can access health coverage. According to the NAPA, nurses should commit to the effective management and prevention of AD. They should collaborate with patients and their families to improve the management of the disease. Additionally, they should educate the public and optimize AD data collection, reporting, processing, and dissemination.
Improving Quality of Care and Patient Safety and Lowering Costs
Various strategies should be adopted to increase the quality of care and patient safety. To begin, Galvin et al. (2021) report that nurses and other members of the interdisciplinary team should be trained in the management of Alzheimer’s disease. Training improves the quality of care by ensuring that the interdisciplinary team is equipped with pertinent knowledge and skills for managing AD (Galvin et al., 2021). Notably, training should be provided to recruits. Refresher training will allow the existing workforce to remain competent in the management of AD. Training will allow the interdisciplinary team to familiarize themselves with periodic updates on AD management. By so doing, the quality of care is improved.
Secondly, the formulation of standardized processes will improve the quality of care and patient safety. Standardized procedures are relevant because they act as a reference point and create harmony in the delivery of healthcare services. They minimize the likelihood of medical errors emanating from the treatment process. Also, they ensure that all patients receive evidence-based care based on the severity of their AD. Galvin et al. (2021) report that standardized procedures address processes such as screening, patient education, and the formulation of care plans. For instance, standardized yearly assessments of individuals with Alzheimer’s disease provide an opportunity for monitoring response to therapy (Galvin et al., 2021). Findings from these assessments form the basis for modifying care plans to optimize the management of AD and improve patient safety.
Thirdly, the quality of care and patient safety can be optimized via performance evaluation. Performance evaluation allows leaders to evaluate the quality of services offered by the interdisciplinary team. This is guided by the roles and responsibilities allocated to the members of the interdisciplinary team and the specific performance metrics. Performance evaluation enables healthcare practitioners to detect variables that are underperforming and those that impede the delivery of quality care (Galvin et al., 2021). This provides an opportunity for re-setting goals to improve the quality of care and patient safety.
Different initiatives can be implemented to minimize the costs of managing AD. Firstly, patients, families, and public education will optimize disease control because this population will be equipped with pertinent information about AD (Mok et al., 2020). By achieving better control of AD, healthcare costs will be lowered significantly. This is attributed to a reduction in emergency department visits, hospitalizations, and AD-associated complications (Mok et al., 2020). Secondly, healthcare costs can be minimized by improving clinical workflows. This involves leveraging technology to enhance the delivery of healthcare services. For example, clinical decision support systems can be used to develop evidence-based care plans. Also, mobile technology, such as reminders and alarms, can be used to reduce medical errors. Subsequently, this will improve patient outcomes, reduce complications and hospitalizations and lower healthcare costs. Thirdly, cost-effective non-pharmacological approaches can be used to manage AD. Mok et al. (2020) report that patients with mild to moderate AD benefit from techniques such as cognitive stimulation therapy. The use of non-pharmacological approaches alone or in combination with pharmacotherapy will optimize disease control, minimize hospitalizations, and minimize healthcare costs.
Sources of Benchmark Data
The Alzheimer’s Association provides benchmark data on Alzheimer’s disease in the USA. This is accomplished via yearly reports on different themes of Alzheimer’s disease. Examples of themes included in the annual report include the prevalence of AD, mortality and morbidity patterns, costs associated with AD, management of AD, and the social impact of AD (Alzheimer’s Association, n.d.). In addition, the Alzheimer’s Association releases updates on Alzheimer’s disease awareness. These reports allow stakeholders involved in AD prevention and management to make informed decisions and implement appropriate strategies. In addition, the reports allow healthcare institutions to compare their performance with other facilities and to determine the need for change based on the performance of their metrics.
Part Two
I interacted with my aunt, a sixty-nine-year-old African-American female diagnosed with AD three years ago. She is in the company of my uncle, her spouse. Examination reveals perceptual-motor difficulties, muscle twitches, and diminished impulse control, as evidenced by the indiscriminate use of vulgar language. Her attention span has deteriorated over the past year. Also, she has been experiencing difficulty recognizing close family members over the past six months. According to her spouse, the patient has been restless and wanders at night over the past month. Further history reveals that she is not adherent to her medications.
I spent three hours with the patient and her spouse. This enabled me to understand her disease process. I learned that the patient did not take her medication as prescribed. According to the patient and her spouse, non-adherences were related to their forgetfulness. They admitted that they had been educated on the importance of adhering to the treatment plan during their previous visit to the facility. At the end of our interaction, we agreed to leverage mobile technology to improve the patient’s adherence to her treatment plan. Furthermore, we agreed that the patient’s daughter would be actively involved in the treatment process. The main barrier during this interaction was limited health and digital literacy. I addressed this by embracing therapeutic communication and providing resources to the patient and her family. In this scenario, the resources were online databases and available local community resources.
To obtain information, I used online databases such as PubMed to locate peer-reviewed articles. In addition, I searched for information from reputable organizational and educational websites. I checked the journal article’s currency, correctness, and purpose to determine its credibility and relevance. I learned that AD is the fifth leading cause of death among people aged 65 years and above in the United States.
References
ALZ.org. (n.d.). Quality of Care. https://www.alz.org/professionals/public-health/public-health-topics/quality-of-care#:~:text=Alzheimer’s%20places%20a%20huge%20burden,share%20of%20costly%20residential%20care.
Alzheimer’s Association. (n.d.). Alzheimer’s Disease & Dementia Help. https://www.alz.org/
CDC.gov. (2020). Alzheimer’s Disease and Related Dementias. https://www.cdc.gov/aging/aginginfo/alzheimers.htm#:~:text=Alzheimer’s%20disease%20is%20the%20most,thought%2C%20memory%2C%20and%20language.
Galvin, J. E., Aisen, P., Langbaum, J. B., Rodriguez, E., Sabbagh, M., Stefanacci, R., Stern, R. A., Vassey, E. A., de Wilde, A., West, N., & Rubino, I. (2021). Early Stages of Alzheimer’s Disease: Evolving the Care Team for Optimal Patient Management. Frontiers in Neurology, 11(January), 1–8. https://doi.org/10.3389/fneur.2020.592302
HHS.gov. (n.d.). NAPA – National Alzheimer’s Project Act. https://aspe.hhs.gov/collaborations-committees-advisory-groups/napa
MO.gov. (n.d.). Standards of Nursing Practice. https://health.mo.gov/living/lpha/phnursing/standards.php.
Mok, V. C. T., Pendlebury, S., Wong, A., Alladi, S., Au, L., Bath, P. M., Biessels, G. J., Chen, C., Cordonnier, C., Dichgans, M., Dominguez, J., Gorelick, P. B., Kim, S. Y., Kwok, T., Greenberg, S. M., Jia, J., Kalaria, R., Kivipelto, M., Naegandran, K., … Scheltens, P. (2020). Tackling challenges in care of Alzheimer’s disease and other dementias amid the COVID-19 pandemic, now and in the future. Alzheimer’s and Dementia, 16(11), 1571–1581. https://doi.org/10.1002/alz.12143
Patel, M. R., TerHaar, L., Smith, A., Tariq, M., Worthington, K., Hinton, J., & Lichtenstein, R. (2020). Knowledge of Health Insurance Terms and the Affordable Care Act in Racially and Ethnically Diverse Urban Communities. Journal of Immigrant and Minority Health, 22(3), 456–466. https://doi.org/10.1007/s10903-019-00924-3
Schachter, A. S., & Davis, K. L. (2022). Alzheimer’s disease. Dialogues in clinical neuroscience, 2:2, 91-100. https://doi.org/10.31887/DCNS.2000.2.2/asschachter
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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 individuals.
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