Data Analysis and Quality Improvement Initiative Proposal for St. Anthony Medical Center

Data Analysis and Quality Improvement Initiative Proposal for St. Anthony Medical Center

Introduction

Quality improvement in health care is a continuous process.  The performance of the healthcare service systems in terms of the quality of care delivered is directly linked to the health outcomes of patients (Hancock et al., 2020). For this, healthcare service providers continuously seek new approaches to improve the quality of care to meet the ever-changing health needs of targeted populations. The quality of care is influenced by a number of elements within a delivery system or a facility. It can be influenced by health care and facility policies, procedures, the motivation of the staff, available staff skills, the environment of provision of care, and the costs of providing care, among others. Despite the conditions of these factors of care quality, the ultimate goal of providing care is to improve the quality of life and satisfaction of the recipients of the care. Therefore, quality improvement (QI) of quality of care includes carrying out systematic analyses of the quality of care against all true indicators of successful care delivery and applying continuous efforts to achieve notable and measurable improvement in health care services against set indicators for a target population. Quality improvement in healthcare has positive impacts on patient health outcomes and quality of life and influences healthcare organizations’ financial and social performance (Knudsen et al., 2019).

Evidence-based quality improvement in targeted care facilities comparatively utilizes internal and external quality benchmark data to develop reports available to all stakeholders to stimulate efforts towards improving health care quality. Both conceptual and technical challenges exist in all facilities offering long-term care, especially in-home hospice programs. In order to improve the quality of care in such settings, quality assurance analysts need to utilize available data and information to identify key targets for QI. For the success of all QI initiatives, specific areas of improvement using clinical data and provider reports need to be identified and combined with the efforts of inter-professional teams and stakeholders, including physicians, nurses, regulators, patients, and facility staff. As a quality assurance analyst, I will analyze hospice and home health adverse event data for St. Anthony Medical Center (SAMC), part of the Vila Health organization, and interview a few stakeholders in the SAMC’s in-home hospice program in order to identify areas qualifying for QI and the related issues.

St. Anthony Medical Center Mission and Quality Assurance

The quality of care and safety of patients, staff, and other visitors in a long-term facility should always be the focus of facility management. St. Anthony Medical Center is a part of the Vila Health organization that provides in-home hospice programs. According to the hospice’s director of services, Roger Goldenberg, their mission is to provide end-of-life care that focuses on providing comfortable care and alleviating suffering for people in their final stage in life. Therefore, the hospice’s goal is to treat the symptoms rather than wait for an illness to develop and treat the disease. The facility utilizes a holistic approach to care. The care provided in the hospice is thus designed to meet the physical, emotional, psychological, and spiritual needs of the patients. The difference between the St. Anthony Medical Center and other units of the Vila Health organization is that it provides all-around care involving the consideration of the patients and their families as the recipients of care.

The facility has a comprehensive approach to safety and quality of care for the residents. As reported by the quality assurance director, David Brooks, as a facility that offers care to individuals with a higher risk of falls it has processes and procedures in place that provide movement support to such patients and an adverse event reporting system. It has all the necessary processes and utilities to maintain high levels of facility sanitation, management of medical wastes, storage of medicines and other medical equipment, and comprehensive processes for pain and need of inpatient unit (IPU) admissions. The facility has trained nurses and caregivers who ensure that the facility residents and families achieve the desired levels of comfort to face the end of life as comfortably as possible. Despite these processes and procedures, in response to the current landscape of healthcare service delivery in the long-term care and end-of-life care domains, healthcare facilities require continuous assessments and efforts. Accordingly, these assessments ensure high-quality care services are delivered and improve the financial performance of the facilities. Therefore, it is necessary to analyze the existing systems of care delivery to further improve the quality and safety of care delivered and position the SAMC for success and constant growth.

Analysis and Contextualization of Hospice Adverse Events Data

The analysis of existing hospice data reports within LTC and end-of-care facilities is critical in identifying areas of concern and making decisions on the initiatives to improve the quality of health care for facility residents. The identification of a specific area of quality improvement and the proposal for the initiative to improve the quality of care in SAMC is developed from the analysis and contextualization of SAMC’s hospice adverse event data reported in the years 2014 and 2015.

An analysis of the reported data focuses on the length of stay (LOS), pain management, inpatient unit (IPU) admissions, and relief of symptoms. The analysis also includes interview data collected from people in charge and responsible for the SAMC’s in-home hospice program operations. The quality of care for quality improvement can be assessed by classifying the domains of care into the structure, process, and outcome category measures (Santana et al., 2018). The assessment of the adverse events data to identify issues and areas of concern in the clinical performance, quality of care delivered in the hospice, and safety measures put in place at SAMC is guided by structural, process, and outcome metrics.

Hospice Adverse Event Data (2014)
	Jan	Feb	Mar	Apr	May	June	July	Aug	Sept	Oct	Nov	Dec	Total
LOS less than 7 days	5	3	11	0	2	9	0	5	2	0	4	9	50
IPU admission	5	6	7	2	1	4	3	9	3	2	1	4	47
Pain level 7-10 more than 24 hours	0	2	1	3	0	1	1	0	0	2	1	2	13
Inadequate symptom relief more than 24 hours	0	1	1	0	2	0	2	1	2	1	2	1	13
													123

Table 1: Hospice Adverse Event Data for 2014

Hospice Adverse Event Data (2015)
	Jan	Feb	Mar	Apr	May	June	July	Aug	Sept	Oct	Nov	Dec	Total
LOS less than 7 days	10	2	5	6	2	9	8	1	0	0	2	1	46
IPU admission	1	0	1	2	3	2	5	6	1	0	4	2	27
Pain level 7-10 more than 24 hours	2	1	0	0	1	2	3	4	2	1	0	1	17
Inadequate symptom relief more than 24 hours	1	2	1	0	0	2	4	3	6	2	1	0	22
													112

Table 2: Hospice Adverse Event Data for 2015

Unit – Year	LOS Less than 7 Days	IPU Admission	Pain Level 7-10 More than 24 Hours	Inadequate Symptom Relief More than 24 Hours
Hospice 2014	50	47	13	13
Hospice 2015	46	27	17	22

Table 3: Hospice and Home Health Adverse Event Data 2014-2015

Table 1 and Table 2 above present the hospice and home adverse events data for the year 2014 and the year 2015, respectively. LOS levels in 2014 were reported at 50 and 46 in 2015, indicating a drop in LOS. IPU admissions were at 47 in 2014 and recorded at 27 in 2015. This indicates a significant drop in IPU admissions, a sign of good facility performance and a positive health outcome. However, the recorded levels of pain lasting for more than 24 hours increased from 13 in 2014 to 17 in 2015. Further, the cases of inadequate symptom relief rose from 13 in 2014 to 22 in 2015. Pain levels of 7-10 lasting more than 24 hours and inadequate symptom relief lasting more than 24 hours indicate an area of concern as a professional quality assurance analyst. It indicates an issue with the SAMC’s pain control and management procedures.

Besides the adverse events data, interview data from various players in the hospice has also been considered and analyzed. The hospice director of services claims the facility is focused on providing comfortable end-of-life care and alleviating suffering for their patients with an interdisciplinary team aggressive in symptom management. At the same time, the CFO notes that the facility is adequately staffed and resourced with current technologies to support communication and patient records management, including electronic health records systems that are accessible and updatable remotely. The quality assurance director’s responses indicate that the facility has all the processes, procedures, and equipment to ensure the safety of residents and support the provision of quality care to residents and their families. Essentially, this means that the SAMC hospice qualifies for a facility that is able to provide quality care against the structural and process metrics of quality care. However, the rising numbers in pain level records and inadequate symptom relief in more than 24 hours indicate an issue with the current approach to pain control. Accordingly, this means that the facility does not fully satisfy the expectations of the outcomes metrics. For the facility to meet the outcome measures, it needs to have positive patient-reported health outcomes and experiences, including Health-Related Quality of Life, rapid management and alleviation of symptoms and normal functionality and reduced financial burden due to reduced length of hospital stay (Santana et al., 2018). Using the quality indicators of quality care regarding outcome metrics, including length of stay (LOS), duration of pain level 7-10, and adequacy of symptoms relief, I conclude that the pain management procedures and approaches to pain control in SAMC are suboptimal and require improvement to meet the expected patient outcomes.

Inadequate pain relief can have substantial consequences on patients’ health outcomes, leading further to unnecessary suffering (Yadlapati et al., 2021). Furthermore, Niknejad et al. (2018) noted that pain management is directly related to cognitive outcomes in elderly patients. This means inadequate pain management risks cognitive decline, depression, and reduced ability of the residents to perform their daily activities. Cognitive impairment is a risk factor for depression in elderly patients and vice versa (Perini et al., 2019). This means by inadequately controlling pain and symptoms, SAMC risks the development of other multidimensional symptoms in their patients, adding to the length of stay and increasing the burden of health on the patients and families.

As a result, this risks the reputation of SAMC and its performance. Inadequate symptom relief also increases the IPU admission rates, misbalancing the care loads among the available hospice nurses. Therefore, a quality improvement initiative is justified. The hospice’s chief nursing officer, in her interview responses, noted that the inadequacies in symptom relief could be related to the fact that patients get referred to the facility too late in their end-of-life stage. Subsequently, this places the issues and areas of concern within an external context. Considering that the facility meets the structural and process domains of quality care, the timing of reference to the facility is a barrier to the ability of the hospice to provide adequate relief symptom management. Therefore, the QI initiative needs to consider both internal and external factors that influence the inadequacies affecting the quality of care in SAMC.

Proposed Quality Improvement Initiative

This proposed QI initiative is developed with a focus on the outcomes domain of quality care. It aims to improve the ability and efficiency of SAMC to adequately relieve symptoms in the facility residents. It considers the dependency of the outcome domain on the structural and process domains. The inadequate symptom relief in SAMC results from a late reference of patients to specialist care due to the individuals’ self-diagnosis of the severity of their condition, avoidance of related costs and expenditures of IPU admissions, and the overall socioeconomic perceptions of elderly care and end-of-life care. Consequently, this presents a complex system that will require a change in the facility’s process domain to develop a system that can identify individuals in need of care as early as possible, even before they are referred to the medical center, and promote early reference. Therefore, for SAMC to achieve the desired care outcomes, it needs to go beyond the current metrics of quality care, structural, process, and outcome domains to consider a complexity-based quality measurement framework.

The QI initiative considers the complexity of symptoms across populations, the complexity of ecological systems, and other cumulative complexities that may influence the referral of patients to the in-home hospice program. The quality improvement initiative will focus on developing a multi-sector system that creates social awareness of end-of-life care across communities, the SAMC center’s services, and the need for early reference. The approach to QI will also seek to identify patterns of need for end-of-life care within communities based on multidisciplinary health reports to initiate a referral process. This means that the QI initiative is an early identification and intervention plan. The evidence behind the early intervention approach is based on the empirical evidence that early contact and intervention of symptoms results in desirable health and recovery outcomes even during the end-of-life stage in all domains of well-being (Hoerger et al., 2018). The QI initiative borrows a lot of its design from the principles of person-centered care (Barnett, 2018). The initiative and the QI process will seek to remain within the Academy of Hospice and Palliative Medicine (AAHPM) guidelines and the Hospice and Palliative Nurses Association (HPNA).

Quality Improvement Initiative Modelling

The QI initiative is a model based on the Quality Health Outcomes Model (QHOM). The Quality Health Outcomes Model will enable the SAMC facility to evaluate the value of care, its organizational structure, and its processes. It will also include the technical aspects of care and components of care surrounding the patient that influence the quality of health outcomes. It considers the primary constructs of health, including the system, the client, interventions, and outcomes. As a model of improving the quality of care, QHOM enables healthcare providers to conceptualize and measure quality and safety components of healthcare interventions at the individual, family, community, and population levels (Boyle & Baernholdt, 2021). The QHOM will guide the QI initiative as the model highlights the aspects of a complex system that influences the uptake of interventions, references, and health outcomes.

Inter-Professional Perspectives and Communication Strategies to Support Care Quality Improvement

The improvement of quality of care requires multidisciplinary, inter-professional, and stakeholder perspectives and inputs. Inter-professional collaboration in health care is defined by the ability and capability of every health care professional with the team to effectively embrace complementary roles and work cooperatively (Donnelly et al., 2021). Each professional entity has its unique perspective on a particular issue in all inter-professional collaborations. Therefore, different responsibilities must be shared and profession-specific decisions made in order to formulate the best plan to achieve a healthcare goal or solve the current and future healthcare issues. The successful implementation of the proposed QI initiative will require a seamless alignment of all professional and stakeholder inputs. As in all inter-professional and multi-stakeholder teams, the biggest challenge lies in nurturing collaborative relationships that allow for open information sharing and ready support for different professional teams. Trust, respect, communication, and the lack of appreciation of a different profession are the inherent barriers to establishing an effective interprofessional and stakeholder team (Donnelly et al., 2021). However, such obstacles can be intervened by adopting an effective communication strategy to link the inter-professional and stakeholder teams to improve health care.

Effective inter-professional communication allows individuals from varied professional backgrounds to successfully understand and appreciate input from other professions and understand their own professional identity and role with a healthcare team. Effective communication between the inter-professional teams and other stakeholders will promote team collaboration and create a synergy that will support the efficient progress of the initiative to deliver safe and high-quality patient care. The improvement of a specific area within the health care system or facility requires constant communication between teams, members, and stakeholders. It requires comparative reporting, simulations of the initiatives, and reporting milestones to motivate the teams to keep up with their efforts. Such reporting may require constant meetings and conferences to communicate. This can negatively impact the team members’ work-life balance and overall quality of life. Therefore, to overcome these impacts and the challenge to communication and reporting, I propose using multidisciplinary audio and video conferencing with recordable sessions and a report-sharing platform where all team members can review and share comments on progress during their free time.

Conclusion

Quality of care is always the focus of all healthcare service providers. Improved stakeholder engagement in the definition of symptoms will result in early action towards the end-of-life care process with better health outcomes for patients. It will also create a bigger market for the hospice due to improved awareness. Through the use of community health reports from multidisciplinary inputs and inter-professional health models, the initiative can make better use of predictive population health analytics to target patients and provide early and timely interventions to patients in need. Subsequently, this will improve the quality of the health outcomes by reducing the number of inadequate symptom relief cases. It will also reduce LOS and IPU admissions significantly, reducing hospice nurses’ workload. A reduced workload further helps nurses better their practice and create a balance between their personal lives and work life. The initiative to improve care quality in SAMC will result in happier staff members with the residents receiving the best care. Therefore, improving the quality of care will improve patient and stakeholder satisfaction and constant growth for SAMC.

References

Barnett, N. (2018). Person-centered over patient-centered care: not just semantics. Clin Pharm, 10(4).

Boyle, D. K., & Baernholdt, M. (2021). Overview of the Quality Health Outcomes Model. In Nurses Contributions to Quality Health Outcomes (pp. 3-17). Springer, Cham.

Donnelly, S., Ó Coimín, D., O’Donnell, D., Ní Shé, É., Davies, C., Christophers, L., … & Kroll, T. (2021). Assisted decision-making and interprofessional collaboration in the care of older people: a qualitative study exploring perceptions of barriers and facilitators in the acute hospital setting. Journal of Interprofessional Care, 35(6), 852-862.

Hancock, S. L., Ryan, O. F., Marion, V., Kramer, S., Kelly, P., Breen, S., & Cadilhac, D. A. (2020). Feedback of patient-reported outcomes to healthcare professionals for comparing health service performance: a scoping review. BMJ Open, 10(11), e038190.

Hoerger, M., Greer, J. A., Jackson, V. A., Park, E. R., Pirl, W. F., El-Jawahri, A., … & Temel, J. S. (2018). Defining the elements of early palliative care that are associated with patient-reported outcomes and the delivery of end-of-life care. Journal of Clinical Oncology, 36(11), 1096.

Knudsen, S. V., Laursen, H. V. B., Johnsen, S. P., Bartels, P. D., Ehlers, L. H., & Mainz, J. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC health services research, 19(1), 1-10.

Niknejad, B., Bolier, R., Henderson, C. R., Delgado, D., Kozlov, E., Löckenhoff, C. E., & Reid, M. C. (2018). Association between psychological interventions and chronic pain outcomes in older adults: a systematic review and meta-analysis. JAMA Internal Medicine, 178(6), 830-839.

Perini, G., Ramusino, M. C., Sinforiani, E., Bernini, S., Petrachi, R., & Costa, A. (2019). Cognitive impairment in depression: recent advances and novel treatments. Neuropsychiatric disease and treatment, 15, 1249.

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person-centered care: A conceptual framework. Health Expectations, 21(2), 429-440.

Yadlapati, R., Masihi, M., Gyawali, C. P., Carlson, D. A., Kahrilas, P. J., Nix, B. D., … & Pandolfino, J. E. (2021). Ambulatory reflux monitoring guides proton pump inhibitor discontinuation in patients with gastroesophageal reflux symptoms: a clinical trial. Gastroenterology, 160(1), 174-182.

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Prepare an 8-10 page data analysis and quality improvement initiative proposal based on a health issue of interest. Include internal and external benchmark data, evidence-based recommendations to improve healthcare quality and safety, and communication strategies to gain buy-in from all interprofessional team members responsible for implementing the initiative.

Attached are two sample papers and the instructions.