Policy Proposal Paper
The healthcare system requires regular benchmarks for continuous quality improvement and identification of underperforming areas, thus addressing them. Underperforming areas are identified using external and internal benchmark evaluations and used to guide quality improvement interventions. The healthcare leaders are responsible for internal changes, as well as influencing the external policymakers and regulators for external changes that influence the benchmark.
Once in a while, healthcare professionals get an opportunity to change the policies at the local, state, or federal levels. They do so by presenting professional, evidence-based proposals on a specific health issue. This paper presents a policy proposal that will enhance diabetic foot exams and HbA1c tests, therefore improving the overall quality of care for diabetes patients.
The Need for Creating Policy and Practice Guidelines
The public diabetes care dashboard metric displays a considerable variation between the number of diabetic foot exams done and the guidelines set by the National Healthcare Quality and Disparities Report. The number of foot exams and HbA1c tests done in the last quarter of 2021 is 62, 11.01%, and 64, 11.37%, respectively, yet the number of new patients in the previous quarter is 563 (Villa Health, n.d). The percentage of diabetic foot exams is significantly low, compared to the recommended 84%. The number of HbA1c tests is also considerably low.
The government recommends at least two annual tests. Mercy Medical Center’s public diabetes dashboard metrics show a huge underperformance that requires interventions to improve it. HbA1c tests are important in diabetes follow-up and management (Price and St. John, 2019). Well-controlled diabetes hardly develops complications. HbA1c tests help healthcare providers determine the effectiveness of treatment interventions and glycemic control and make relevant healthcare decisions.
The test helps healthcare providers predict complications and thus help prevent them. Diabetic foot is a leading cause of amputations, significantly affecting the quality of life and healthcare costs. These underperforming benchmarks mean that healthcare providers cannot detect or prevent complications due to a lack of data on the effectiveness of care or onset of complications.
The potential repercussions for inaction on the issue of diabetic foot exams and HbA1c tests underperformance will contribute to poor diabetes care quality, undesirable health outcomes for diabetes patients, and more cases of diabetes complications posing a burden to the healthcare institution and the individual patient/families. Thus, there is a need for policy and practice guidelines that will help raise the diabetic foot exams and HbA1c tests for better patient follow-up.
Ethical, Evidence-based Practice Guidelines
Evidence-based literature suggests approaches to improve underperformance in low turn-ups, including patient education, health promotion, and prevention. Ensuring all patients have access to detailed patient education and encouraging them and their families to participate will improve their health literacy and, more importantly, teach them the importance of diabetes management compliance and treatment adherence.
Studies show that patient education enhances patients to make informed decisions (Ghisi et al., 2021). It will also increase the health-seeking behavior of the diabetes patients, therefore increasing their turn-up for diabetic foot exams and HbA1c tests. According to Ghisi et al. (2021), strategic education sessions addressing identified patient needs are an effective tool in enhancing patients’ self-care ability and healthcare responsibility. Therefore, extensive patient education will increase the number of diabetic foot exams and HbA1c tests significantly.
Health promotion is the process of enabling people to increase taking charge of their health and improve their health. Health promotion aims at engaging and empowering healthy individuals and communities to choose healthy behaviors and make the necessary changes to ensure a reduction in the risk of developing a health condition.
Health promotion and prevention activities carried out by healthcare professionals in the community enhance patients’ control of their health. Through the activities, the patients will learn about the importance of effective diabetes care on their health outcomes and quality of life. Effective diabetes care includes going for foot exams and taking HbA1c tests as required, thus preventing diabetes complications such as leg amputations.
These strategies will ensure extensive improvement in the number of patients who show up for the diabetes foot exams and HbA1c tests, thus reducing the possibility of occurrence of diabetes complications caused by the same. It will also reduce the healthcare cost burden that comes with diabetes complications to the healthcare system and the individual patient/family.
The policy and practice guidelines propose applying these strategies in the context of Mercy Medical center by ensuring that healthcare providers are retrained on the importance of patient education and health promotion activities to improve the benchmark underperformance. The policy will give more emphasis to the nurses and the interprofessional team, who come into contact with the patients the most.
The policy would also ensure that the strategies are ethical and culturally sensitive in their application by the use of culturally sensitive communication in patient education. Culturally sensitive communication is a major driver of effective patient education (Brooks et al., 2019). Patient education sessions will also give examples that the patients and their families can relate to while taking into consideration the cultural diversity of the patients. Ethical principles such as autonomy would also be applied by allowing patients to attend sessions out of their own volition.
Effects of Environmental Factors on Proposed Policy Guidelines
Various environmental factors considerably impact the proposed policy and practice guidelines. The regulatory conditions that would affect the policy guidelines include patient education literacy as recommended by the Agency for Healthcare Quality and Research (AHQR). The AHQR recommends a set of universal literacy precautions that inform patient education interventions to ensure success and ethical acceptability.
The toolkit ensures healthcare professionals can communicate effectively with patients from all literacy levels (AHQR, n.d). Patient education interventions should have provisions to cater to all patient needs, including the differences in literacy levels. Staff training is also required for effective patient education program delivery. The AHQR train the trainer program will be used to ensure the success of the proposed policy (AHQR, n.d.).
Health Insurance Portability and Accountability Act (HIPAA) is another federal law that will influence the policy. HIPAA regulates the access and dissemination of healthcare data. The act also focuses on sensitive patient information and its use in healthcare institutions (HHS.gov, n.d.). The act ensures that healthcare patient data is protected from unauthorized persons and maintains patient confidentiality. The patient education programs should thus ensure it does not use patients’ data without their consent.
The data used should also not be easily identifiable or easily associated with an institution or a patient. Technical barriers such as passwords and the use of biometrics should also be installed to ensure that only authorized persons have access to the programs’ data (HHS.gov, n.d.). AHRQ and HIPAA will therefore play integral roles in ensuring the success of the proposed policy.
One of the resources that could affect the proposed policy proposal is staffing. Shortage of staff may pose a huge barrier to implementing the policy. Patient education, health promotion, and prevention require the institution to have enough healthcare professionals to cater to all patients effectively. Sometimes patient education is complex and requires individualized care, thus the need for adequate staff. The institution should consider addressing the staff shortage issue to implement policy and practice guidelines successfully.
Stakeholders in the Policy and Practice Guidelines Proposal
Specific stakeholders and stakeholder groups should be involved in the further development and implementation of the proposed policy proposal and practice guidelines. The relevant stakeholders will include diabetic patients, healthcare professionals, hospital leaders, state leaders, and federal leaders. The stakeholders and groups are crucial to ensuring strong, high-quality policy guidelines and the policy’s acceptability and its implementation.
According to Graham and Woodhead (2021), successful implementation and development of healthcare policy and practice guidelines requires detailed stakeholder engagement and shared decision-making. Involving stakeholders at all levels of the implementation would ensure that their needs are identified and taken into consideration.
Shared decision-making also ensures that the policy guidelines include all stakeholders’ inputs, thus increasing acceptability. Therefore, the input of all stakeholders will be required to produce a strong policy with higher chances of implementation.
Healthcare improvement depends on the best interventions from evidence-based literature. Patient education, health promotion, and prevention are powerful tools in influencing personal accountability and increasing patients’ health-seeking behavior and treatment compliance.
Additionally, informed patients can adequately perform self-care, further improving diabetes management. They are also more likely to go for foot exams and HbA1c tests since they understand their importance in their health. A policy and practice guideline proposal is subject to existing regulations, which influence the set interventions.
The AHQR and HIPAA act relay essential regulations that require keen consideration when handling quality improvement projects that involve patient information. Compliance with these regulations ensures the implementation of high-quality, ethically, and legally acceptable interventions. Healthcare professionals should also proactively choose the stakeholders to develop strong, acceptable, and applicable policies and practice guidelines for healthcare improvement.
Agency for Healthcare Quality and Research (AHQR) (n.d.). Patient Engagement and Education. Retrieved 29th July 2022, from https://www.ahrq.gov/health-literacy/patient-education/index.html
Brooks, L. A., Manias, E., & Bloomer, M. J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26(3), 383-391. https://doi.org/10.1016/j.colegn.2018.09.007
Ghisi, G. L. D. M., Seixas, M. B., Pereira, D. S., Cisneros, L. L., Ezequiel, D. G. A., Aultman, C., Sandison, N., Oh, P., & da Silva, L. P. (2021). Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health, 21(1), 1-16. https://doi.org/10.1186/s12889-021-11300-y
Graham, R. N. J., & Woodhead, T. (2021). Leadership for continuous improvement in healthcare during the time of COVID-19. Clinical Radiology, 76(1), 67-72. https://doi.org/10.1016/j.crad.2020.08.008
Health Information Privacy (n.d.). The HIPAA Privacy Rule. US department of health and human services (HHS), Office of Civil Rights (OCR). Retrieved 29th July 2022, from https://www.hhs.gov/hipaa/for-professionals/privacy/index.html
Price, C. P., & St John, A. (2019). The value proposition for point-of-care testing in healthcare: HbA1c for monitoring in diabetes management as an exemplar. Scandinavian Journal of Clinical and Laboratory Investigation, 79(5), 298-304. https://doi.org/10.1080/00365513.2019.1614211
Villa Health. (n.d). Dashboard and Healthcare Benchmark Evaluation. Capella University.