Assessing The Problem: Quality Safety And Cost Considerations

Assessing the Problem: Quality Safety and Cost Considerations

Chronic illnesses place a significant burden on both patients and the healthcare system as a whole. The burden is caused by the significant morbidity, mortality, and high costs associated with long-term disease management. Hypertension, which affects approximately 1.38 billion people worldwide (31.1% of the global adult population), has a significant impact on patient quality, safety, and cost (Mills et al., 2020).

It is critical for healthcare organizations and government agencies to measure and document the quality of organizational services and report on the status of patient safety. Through this initiative, an organization can determine strategies to improve healthcare quality, increase patient safety, and lower healthcare costs.

The objective of this paper is to explain how the population problem (hypertension in adult patients) affects the quality of care, patient safety, and the cost of healthcare, to explain how state board nursing practice standards and/or organizational or governmental policies affect the quality, safety, and cost of care, and finally to propose strategies to improve the quality, safety, and cost of care services in the defined population health problem.

How Population Problem Impacts the Quality of Care, Patient Safety, and Costs to the System and the Individual

Impact on the Quality of Care and Patient Safety

The primary goal of healthcare delivery is to provide services that increase the likelihood of individuals achieving desired health outcomes. The World Health Organization (2022) defines the quality of care as the extent to which health services for individuals and populations result in the desired health outcomes. Thus, the quality of care is attributed to evidence-based professional knowledge, which is critical to achieving universal health coverage.

Structure, process, and outcomes are three elements that have been widely described as elements of quality of care. While the structure refers to the organization’s resources (infrastructure, tools, and technology), the process refers to the transformation of inputs from the health care system into outcomes (WHO, 2022). Health status, mortality rate, morbidity, disability-adjusted years, and patient satisfaction are examples of outcomes. So, how does hypertension affect the quality of care?

The prevalence of chronic illnesses is expected to rise due to an aging population and poor lifestyle choices such as an unhealthy diet, a sedentary lifestyle, alcohol, and smoking (Franceschi et al., 2018). As a result, as the number of hypertensive patients increases in a healthcare workforce with a physician and nurse shortage, care is jeopardized. Furthermore, the large number of patients leads to a scarcity of available medical supplies, such as antihypertensive medications.

Due to the high number of hypertensive patients, process-the interaction between the patient and the provider is also significantly impacted. A low provider-patient ration increases the provider’s workload, lowers morale, and reduces job performance, resulting in poor quality and safety of care (Karagiannidis et al., 2019). The outcome may also aid in determining how to assess the quality of care.

However, it is not an effective method of measuring quality because patients can recover even if poor quality care is provided, or patients can fail to recover even if the best quality of care is provided (WHO, 2022). Regarding hypertension, the WHO (2021) estimates that 1.28 billion adults aged 30-79 have the condition globally. About 46% of adults with hypertension are unaware they have it, 42% have it diagnosed and treated, and one in every five (21%) has it under control (WHO, 2021).

This low control rate does not imply that healthcare has failed to detect and treat hypertensive patients aggressively; however, this may be the case, which is why outcomes are not better indicators of quality of care. While these factors have an impact on the quality of care, patient safety is simultaneously affected.

Impact on the Cost of Healthcare on the Population and the Healthcare System

According to previous projections, hypertension is the costliest of all cardiovascular diseases. Using a nationally representative database, the Medical Expenditure Panel Survey, to calculate the estimated annual healthcare expenditure for hypertensive patients and to measure trends in expenditure longitudinally over 12 years (2003-2014), Kirkland et al. (2018) found that the unadjusted mean annual medical expenditure attributable to patients with hypertension was $9089.

Individuals with hypertension had $1920 more annual adjusted incremental expenditure, 2.5 times the inpatient cost, nearly double the outpatient cost, and nearly triple the prescription medication expenditure when compared to those without hypertension (Kirkland et al., 2018).

Furthermore, it is estimated that the adjusted annual incremental cost for the hypertensive patient adult population is $131 billion per year higher than for non-hypertensive patients in the United States (Kirkland et al., 2018). The high costs associated with hypertension necessitate a concerted effort toward disease prevention and management. In my practice, we lose track of some hypertensive patients during treatment, which could be attributed to a lack of funds for regular clinic visits and antihypertensive medications; thus, the evidence drawn from the literature is consistent with what I see in practice.

How State Board Nursing Practice Standards and/or Organizational or Governmental Policies affect the Problem’s Impact on the Quality of Care, Patient Safety, and Costs to the System and Individuals

State Board Nursing Practice Standards and Impact on Care Quality, Safety, and Cost

The standards of nursing practice apply to all registered nurses (RNs) in all practice settings, and they provide guidance to help RNs self-assess as part of their continuing competence, as well as guide practice decision-making. The first nursing practice standard is accountability and responsibility (Nurses Association of New Brunswick, 2020). The RN is accountable to the patients and is responsible for practicing safely, competently, compassionately, and ethically.

An RN must accept responsibility for their actions, inactions, decisions, and behavior. When an RN accepts full responsibility and accountability for patients, the quality and safety of care improve. The second practice standard is knowledge-based practice, which requires RNs to practice with evidence-informed knowledge, skill, and judgment (Nurses Association of New Brunswick, 2020). T

his standard of practice includes indicators such as critical inquiry, point of care effectiveness, competence, reasonable judgment, and the use of new knowledge and technology. The use of the most recent research findings to inform practice is intended to improve the quality and safety of patient care. Furthermore, nurse strategies for using technology to care for chronically ill patients, such as patient telemonitoring, have been shown to be cost-effective.

The third standard of nursing practice is client-centered care. Client-centered care is provided based on the needs and preferences of the patients (Nurses Association of New Brunswick, 2020). The RN is responsible for being present and behaving professionally, communicating with the patient respectfully, protecting patients’ privacy and confidentiality, supporting clients and self-management of their health, and respecting patient diversity and cultural differences.

While using technology to provide care to patients, RNs protect patients’ health information from unauthorized access, which increases the safety of patient care. Moreover, as the RN communicates and provides health education, patients’ self-management skills improve, resulting in a higher quality of life. Concerning the fourth standard-professional relationship and leadership-RNs are required to use resources for effective and efficient care, to communicate effectively and respectfully with team members, to advocate for public policies, and to advocate for a quality professional practice environment (Nurses Association of New Brunswick, 2020).

When used in conjunction with other resources to guide nursing practice, the four standards improve the quality and safety of care while also closing loopholes for patient extortion in healthcare.

Effects of Local, State, and Federal Policies or Legislation on Nursing Scope of Practice within the Context of Care Quality, Patient Safety, and Costs

Every year, states and municipalities enact new laws and regulations that have an impact on the quality, safety, and cost of healthcare. Nurses may find it difficult to keep up with new local, state, and federal laws that may affect patient care. In the state of Illinois, 255 new laws were set to go into effect on January 1, 2020. 35 of the 255 laws were identified as being related to health and having implications for the health of residents, caregivers, and patients (Phillips, 2020).

One of the health acts passed by the Illinois General Assembly in 2018 was the Health Care Workplace Violence Prevention Act, which would protect healthcare workers from violent encounters (Phillips, 2020). In the current situation where healthcare professionals are overburdened by the number of patients, misunderstandings may arise, resulting in violence. However, such legislation ensures that care providers coexist peacefully and advocates for better ways to resolve workplace disagreements, resulting in improved care quality and safety.

Strategies to Improve the Quality of Care, Enhance Patient Safety, and Reduce Costs to the System and Individual

Globally, healthcare systems develop strategies to achieve the most valuable outcomes of care (quality, safety, and cost-effectiveness), one of which is policy. Policies concerning access to care, such as private and public medical insurance, are required to provide patients with easy and affordable access to health services.

One example is the Affordable Care Act, which was drafted and enacted during the Obama administration and resulted in approximately 35 million people enrolling in coverage (Assistant Secretary for Public Affairs, 2022). Policies may also require periodic hospital accreditation, putting pressure on hospital administration and leadership to improve quality.

Technology is increasingly being used to deliver care to adult hypertensive patients. Because of the increased need to provide care without patient-provider physical interaction, the Covid19 pandemic has increased technology use. As a result, telemedicine, defined as the use of information and communication technologies (ICT) to exchange medical data (vital and non-vital parameters) between patients and providers for disease management, has brightened the healthcare landscape.

A pool of recent studies on the effectiveness of telemedical approaches to care has found that the intervention has tremendous benefits for patients, care providers, and the healthcare system. For example, in the case of hypertensive patients, the intervention establishes and maintains a long-term relationship, which results in better patient outcomes (Omboni et al., 2020).

Furthermore, telemedical intervention improves cooperation and information sharing among the care team, resulting in organizational effectiveness. In addition to allowing hypertension patients to access diagnostic services without having to travel long distances, telemedical services are unquestionably prompt for quality of care and patient safety. While the initial implementation costs may be high due to the purchase of infrastructure, skilled personnel, and training, studies show that the long-term program is cost-effective.

Conclusion

Quality, safety, and cost-effectiveness of healthcare services are all highly desired outcomes. Every healthcare system worldwide strives to implement strategies to improve patient quality and safety of care while also lowering healthcare costs. Hypertension, the most common preventable risk of cardiovascular events and all-cause mortality worldwide, has an impact on the quality, safety, and cost of healthcare services.

With the aging population and increased participation in poor lifestyle choices such as alcohol and unhealthy foods, smoking cigarettes, and rising physical inactivity, people are at an increased risk of hypertension. As a result of a large number of patients and scarcity of care providers, the quality and safety of care are jeopardized. Therefore, institutions must develop strategies to reduce the risk, such as by developing policies or opting for technology use, which has increased in the Covid19 era.

References

Assistant Secretary for Public Affairs (ASPA). (2022, April 29). New reports show record 35 million people enrolled in coverage related to the Affordable Care Act, with historic 21 million people enrolled in medicaid expansion coverage. US Department of Health and Human Services. https://www.hhs.gov/about/news/2022/04/29/new-reports-show-record-35-million-people-enrolled-in-coverage-related-to-the-affordable-care-act.html

Franceschi, C., Garagnani, P., Morsiani, C., Conte, M., Santoro, A., Grignolio, A., Monti, D., Capri, M., & Salvioli, S. (2018). The continuum of aging and age-related diseases: Common mechanisms but different rates. Frontiers in Medicine, 5. https://doi.org/10.3389/fmed.2018.00061

Karagiannidis, C., Kluge, S., Riessen, R., Krakau, M., Bein, T., & Janssens, U. (2019). Auswirkungen des Pflegepersonalmangels auf die intensivmedizinische Versorgungskapazität in Deutschland. Medizinische Klinik, Intensivmedizin und Notfallmedizin, 114(4), 327–333. https://doi.org/10.1007/s00063-018-0457-3

Kirkland, E. B., Heincelman, M., Bishu, K. G., Schumann, S. O., Schreiner, A., Axon, R. N., Mauldin, P. D., & Moran, W. P. (2018). Trends in healthcare expenditures among US adults with hypertension: National estimates, 2003-2014. Journal of the American Heart Association, 7(11). https://doi.org/10.1161/JAHA.118.008731

Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews. Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2

Nurses Association of New Brunswick. (2020). Nursing Standards. Nanb.Nb.Ca. http://www.nanb.nb.ca/practice/standards

Omboni, S., McManus, R. J., Bosworth, H. B., Chappell, L. C., Green, B. B., Kario, K., Logan, A. G., Magid, D. J., Mckinstry, B., Margolis, K. L., Parati, G., & Wakefield, B. J. (2020). Evidence and recommendations on the use of telemedicine for the management of arterial hypertension: An international expert position paper: An international expert position paper. Hypertension, 76(5), 1368–1383. https://doi.org/10.1161/HYPERTENSIONAHA.120.15873

Phillips, J. (2020, April 25). Local legislation impacts nursing and those we serve. Minority Nurse. https://minoritynurse.com/local-legislation-impacts-nursing-and-those-we-serve/

World Health Organization. (2021). Hypertension. Who.int. https://www.who.int/news-room/fact-sheets/detail/hypertension

World Health Organization. (2022). WHOQOL – measuring Quality of life. Who.int. https://www.who.int/tools/whoqol

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 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 Capella Academic Portal Volunteer Experience Form. Report on your experiences during your first two practicum hours.
- 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 individual and document the practicum hours spent with these individuals or group 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.
  - Use paraphrasing and summarization to represent ideas from external sources.
  - Apply APA style and formatting to scholarly writing.
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. Health care 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 group 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.
- Whom 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 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 individual.
  - 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 group in the Capella Academic Portal Volunteer Experience Form.
- Use paraphrasing and summarization 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: