NURS FPX 4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Considerations

Sample Answer for NURS FPX 4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Considerations Included After 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 subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form. Report on your experiences during your first two practicum hours.

Preparation

In this assessment, you will 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: Remember that you can submit all, or a portion of, your draft assessment to Smarthinking for feedback, before you submit the final version. If you plan on using this free service, be mindful of the turnaround time of 24-48 hours for receiving feedback.

A Sample Answer For the Assignment: NURS FPX 4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Considerations

Title: NURS FPX 4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Considerations

Part 1

The selected population problem is diabetes, one of the most common and costly conditions, and it has many comorbidities. Diabetes complications can have a devastating effect on a person’s quality of life, resulting in severe pain and even death. Additionally, it places a major strain on the health and finances of individuals and families all around the country. Diabetes is a serious health and financial burden for many people in the United States, where it has proven to be fatal. In addition, it kills more people each year than any other chronic illness, including cancer and heart disease. Renal destruction is the most common, followed by obesity, heart attack, and blindness due to its co-morbid effects (Centers for Disease Control and Prevention (CDC), 2021). Thus, diabetes can impact the quality of care offered, patients’ safety, and the costs incurred by the patients and their families. As such, the purpose of this paper is to explore diabetes in terms of its impacts, how governmental policies can affect diabetes, and strategies to improve the quality of care.

Quality of Care

According to Mohamed et al. (2018), high blood sugar levels form the primary cause of diabetes, making it costly and debilitating. When the pancreas does not make enough insulin, or the body cannot use the insulin produced adequately, Mohamed et al. (2018) assert diabetes becomes unmanageable. Diabetes is one of the four non-communicable diseases, followed by heart disease, cancer, and respiratory problems. For them, the number of people with diabetes has increased substantially from 108 million in the 1980s to more than 400 million in 2014. Based on 2017 estimates, they further report that mortality from diabetes occurs after 8 seconds. Undetected diabetes is a major issue for public health because it can have serious and expensive health consequences. For example, patients with diabetes who have not yet been diagnosed might experience difficulties. Families, communities, and other stakeholders may also face increased costs. To prevent the progression of this disease, they advise expanding screening and diagnosis efforts.

Selvin et al. (2021) report that while the risk factor has improved considerably over the past two decades, gaps between current treatment recommendations and the quality of care received by diabetes patients in the U.S. remain substantial. In addition, among people with diabetes, the incidence of calibrated glycosylated hemoglobin (A1c) has increased sharply from the 1990s through 2010. They also assert that racial disparities remain a singular concern, with substantial differences in the A1c pervasiveness among racial and ethnic groups. They also argue that the national data shows gaps in care associated with neuropathy and retinopathy in individuals with diabetes. For them, it means that most diabetic patients do not meet standards of care recommendations. For instance, they say that in 2005-2010, more than 28% of adults with adults had not received any diagnosis.

According to Kutz et al. (2018), people with diabetes need access to systematic and continuous care by a team of care professionals. Their study found that irrespective of the national focus and recommended best practices in the United States, diabetic care, A1c, and blood pressure for people with diabetes remained highly varied and way below the

Healthcare Effectiveness Data and Information Set (HEDIS) 75th percentile mark. They also found that from 2015 to 2016, 22% of those with diabetes had blood pressure and A1c levels managed, with only 23 percent having their annual diabetic care bundle done. Diabetes is the 7th leading cause of death in the United States (Kutz et al., 2018). As for the CDC (2021), more than 30 million people in the United States have diabetes. Besides, the risk factors for this disease comprise physical inactivity, high blood sugars, obesity, overweight, and high blood pressure. According to Kutz et al. (2018), bundling diabetic care is fundamental, such as assessing A1c and blood pressure levels, ensuring nephropathy care, and foot evaluation. They also report that conformity with diabetic care bundles and proposed interventions remains vital in reducing costs and risks associated with diabetes complications.

As for Simão et al. (2017), diabetes control entails different aspects beyond drugs and other treatment therapies to provide high-quality care. They found significant deficiencies in primary health care units (PHCUs) besides a high level of unsatisfactory diabetes care outcomes. Further, they did not find any association between structure, process, and care outcomes. They also recommended that it is critical that elements of care include coordination, availability, and comprehensiveness. Because diabetes is becoming more pervasive and affecting the more adult population, there is a need to understand the clinical characteristics of patients and organizational aspects of the healthcare system to enhance the treatment and decision-making process in care for diabetic patients.

Improving Quality of Care

Enhancing the quality-of-care patients with diabetes receive is crucial to their disease management. Addressing diabetes effectively includes designing successful interventions. Diabetes is a complicated disease whose approaches and interventions require the engagement of healthcare leaders and change managers. Engaging all stakeholders allows the delivery of efficient, secure, and superior care to diabetic patients. Healthcare leaders must always initiate and drive change to spur the expected care outcomes among people. Doing so will also lead to increased safety and security among patients.

The role of healthcare leaders is to design and lead effective care model processes while involving different teams to promote the highest care standards. In delivering care, Babiker et al. (2014) established that competent teamwork was instrumental in successfully delivering positive results, such as influencing patient safety. They also reported the need for effective leadership through teams to reduce disease complexities and comorbidities. Dunning and Manias (2008) found that healthcare leaders, such as managers, are critical change leaders who implement required changes and interventions for managing diabetes. In addition, they found that these leaders also communicated changes and trained their teams on different aspects, such as adopting proposed changes.

They equally helped implement suggested multidimensional behavioral interventions, such as integrated insulin therapies. They recommended communication and collaboration in improving the quality of care provided to diabetic patients. Besides, patient-tailored care is an evidence-based methodology that is highly effective in increasing patient approval, promoting high-quality care, and giving safe care to different patients (White-Trevino & Dearmon, 2018). According to White-Trevino and Dearmon (2018), evidence suggests that patient-tailored care enhances the quality of care and lowers costs associated with disease treatment by including patients in the plan of care. In addition, they recommend adopting this method is essential because it promotes patient safety while ensuring standardized care. They further note that when patients are engaged in their care, they are most likely to comply with disease management.

Cost Considerations and Improving Costs

According to Tuso (2014), most Americans have prediabetes and diabetes. He estimated that about 34% of adult Americans have prediabetes. He also found that 79 million adults in the United States had prediabetes, whose prevalence was three times that of diabetes. For them, the estimated cost of diagnosed diabetes in 2012 stood at 245 billion dollars, including 176 billion dollars in direct medical costs and 69 billion dollars in indirect costs. They found that the highest elements of direct medical costs included hospital inpatient care and drug prescription. They further reported that those with diabetes incurred average medical costs of about 13,700 dollars annually.

According to CDC (2022), diabetes is the most expensive disease in the United States. It reports that one dollar out of every four dollars in the United States health care costs is used to address diabetes. It further reports that the country spends 237 billion dollars on direct medical costs and 90 billion dollars on reduced productivity. It estimates that 61% of diabetes expenses are for individuals 65 years and older, paid through Medicaid. In addition, there are about 41-64% of lifetime medical expenses for an individual with diabetes.

Improving diabetes treatment and management costs must begin by enhancing the disease’s prevention, detection, evaluation, and management. The government and healthcare stakeholders should design principles that lower the costs that patients with diabetes incur in the United States. Also, early interventions can assist in preventing issues, decreasing damage, and cutting costs associated with diabetes treatment.

Governmental Policies and The Problem’s Impact on Quality of Care, Patient Safety and Costs

Government policies, especially health-related policies, usually impact disease care in terms of costs, patient safety, and quality of care. One of the policies that have had an impact on the quality of care, patient safety, and costs in relation to diabetes is the Affordable Care Act. Enacted in the year 2010, this policy had the main aim of expanding healthcare access and reducing disparities. For example, the Affordable Care Act has expanded health insurance for individuals with low income (Casagrande et al., 2018). The law has accomplished the expansion in two ways; the expansion of Medicaid and subsidizing private health insurance through the insurance exchanges.

There has also been an enhanced subsidy for individuals with incomes of up to 250% of the federal poverty limit. The implication is that the patients living with diabetes, even from ethnic minorities and economically disadvantaged backgrounds, have improved access to diabetes care. In addition, they are also able to get access to care at subsidized costs hence spending less on the management of the disease (Casagrande et al., 2018). With the coming of ACA, providers cannot block anyone from enrolment due to pre-existing conditions such as diabetes which improves care access and the quality of care among these patients. In addition, the patients can also get the drugs used in managing diabetes at lower costs.

Part 2

To assess the above-identified problem, I spoke with D.J, a 48-year-old female diagnosed with diabetes a decade ago. I learned that she had struggled a lot with education about diabetes, which has resulted in increased stress about lifestyle changes. Since she lost her job five years ago, I also learned that she had faced significant financial stressors. She now lives in America’s rural cities with very limited means. I approached her with the middle-range nursing theory as an efficient approach to ensuring her disease control. In the first phase, I evaluated her readiness to initiate lifestyle changes. She said, ‘I feel as though I am starting all over again because, over the past years, I have been doing everything completely wrong.’ When asked if she would be willing to a new lifestyle plan to manage her condition, she said, ‘I can do anything that can make my condition easier because I want to live long and accomplish several things in life.’

 When discussing her experience with diagnosis and treatment, she noted that she feels like another patient, and she has often seen the doctor write her script. From my interaction with this D.J, I established that she experienced many barriers which prevented proper disease management over the years. Some of these challenges included lack of education and awareness about the disease, poor communication, financial strains, and lack of partnership from healthcare professionals.

When discussing leadership strategies to enhance her outcome, she maintained that if she finds more guidance on what to do, she is willing to work with anyone to meet her goal. She felt that she would have done much better if she had received support. During my interaction with D.J, I adopted a patient-tailored care approach while discussing her needs and what she felt necessary to succeed. For her, a team-based approach was necessary because it could provide the required guidelines for her condition. Based on our discussion, it is apparent that D.J understood the significance of disease management. Thus, our interaction coagulated the need for a solution to the diabetes problem in the United States.

Conclusion

Diabetes is among the major conditions that impact patients negatively due to associated commodities and the cost of care. Its negative impacts have attracted substantial attention in recent times, with various stakeholders undertaking efforts to lower its impacts. Therefore the introduction of policies such as the Affordable Care Act has been vital in the management of the condition. Successful management of the condition requires a proactive and collaborative approach to ensure that the patients experience quality and safe care at manageable and reasonable costs.

References

Casagrande, S. S., McEwen, L. N., & Herman, W. H. (2018). Changes in health insurance coverage under the Affordable Care Act: a national sample of US adults with diabetes, 2009 and 2016. Diabetes Care41(5), 956-962. https://doi.org/10.2337/dc17-2524

Centers for disease control and prevention (CDC). (2021). Diabetes: national diabetes statistics report. Retrieved From https://www.cdc.gov/diabetes/data/statistics-report/index.html

Centers for disease control and prevention (CDC). (2022). Cost-effective of diabetes interventions. Retrieved Fromhttps://www.cdc.gov/chrointerventionsrograms-impact/pop/diabetes.htm#:~:text=Diabetes %20is%20the%20most%20expensive%20chronic%20condition%20in%20our %20nation.&text=%241%20out%20of%20every%20%244,caring%20for%20people %20with%20diabetes.&text=%24237%20billion%E2%80%A1(c)%20is,(c)%20on %20reduced%20productivity.

Kutz, T. L., Roszhart, J. M., Hale, M., Dolan, V., Suchomski, G., & Jaeger, C. (2018). Improving comprehensive care for patients with diabetes. BMJ Open Quality, 7(4), e000101. http://dx.doi.org/10.1136/bmjoq-2017-000101

Mohamed, S. F., Mwangi, M., Mutua, M. K., Kibachio, J., Hussein, A., Ndegwa, Z., … & Kyobutungi, C. (2018). Prevalence and factors associated with prediabetes and diabetes mellitus in Kenya: results from a national survey. BMC public health18(3), 1-11. https://doi.org/10.1186/s12889-018-6053-x

Simão, C. C. A. L., Costa, M. B., Colugnati, F. A. B., de Paula, E. A., Vanelli, C. P., & de Paula, R. B. (2017). Quality of care of patients with diabetes in primary health services in Southeast Brazil. Journal of Environmental and Public Health, 2017. https://doi.org/10.1155/2017/1709807

Selvin, E., Narayan, K. V., & Huang, E. S. (2021). Quality of care in people with diabetes. https://europepmc.org/article/NBK/nbk568015

Tuso, P. (2014). Prediabetes and lifestyle modification: time to prevent a preventable disease. The Permanente Journal, 18(3), 88. https://doi.org/10.7812%2FTPP%2F14-002

White-Trevino, K., & Dearmon, V. (2018). Transitioning nurse handoff to the bedside: Engaging staff and patients. Nursing Administration Quarterly, 42(3), 261-268. Doi: 10.1097/NAQ.0000000000000298