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).

Assessing the Problem: Quality Safety and Cost Considerations

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.


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.

Assessing the Problem: Quality Safety and Cost Considerations References

Assessing the Problem: Quality Safety and Cost Considerations Example 2

Hypertension is a threat to people’s quality of life, safety, and well-being. The Centers for Disease Control and Prevention [CDC] (2021) explains hypertension as blood pressure that is higher than systolic and diastolic blood pressure thresholds. In this sense, guidelines for diagnosing high blood pressure recommend 120/80 mm Hg as the normal systolic and diastolic blood pressure, enabling healthcare professionals to identify at-risk populations and diagnose hypertension based on figures above this cut-off value.

As a chronic condition, high blood pressure is the primary risk factor for various cardiovascular diseases, including heart disease, ischemic stroke, and peripheral arterial disease (Carey et al., 2018). Globally, about 1.28 billion adults aged 30-79 years have hypertension, yet approximately 46% of the affected people are unaware of the condition or effective treatment options (World Health Organization, 2021).

People’s unawareness of hypertension exacerbates more advanced and life-threatening conditions, such as heart disease and stroke. Based on the association between high blood pressure and more burdensome chronic conditions, it is valid to argue that elevated blood pressure affects the quality of care, patient safety, and healthcare costs.

Impacts of Hypertension on the Quality of Care

Quality of care is a multifaceted concept that underpins healthcare professionals’ roles and standards of practice. The World Health Organization (2020) defines the quality of care as “the degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with evidence-based professional knowledge.”

In this sense, the desired outcomes of nursing practice and healthcare services include restoring people’s health, promoting recovery, alleviating suffering and pain, and safeguarding patient safety. When defining the quality-of-care phenomenon, it is vital to consider its multiple dimensions proposed by the Institute of Medicine (IOM). These dimensions are safety, people/patient-centeredness, timeliness, equity, efficiency, and effectiveness (World Health Organization, 2020).

For example, healthcare professionals should provide care that respects and responds to individual preferences, values, and needs, while avoiding harm, addressing the underlying disparities, and incorporating the best evidence to support practices and inform clinical decisions.

Although providing quality care is an overarching goal of healthcare organizations and professionals, it is a daunting endeavor due to the prevailing internal and external environments. For instance, a high prevalence of chronic diseases is one of the significant challenges facing healthcare systems amidst the need to provide quality service. Hypertension is equally burdensome to healthcare professionals and facilities since its prevalence and effects affect the overall quality of care.

High blood pressure increases the individual propensity to more burdensome chronic conditions, including stroke and heart disease. Oparil et al. (2018) argue that hypertension is a preventable risk factor for cardiovascular diseases (CVDs) and the leading contributor to all-cause death and disability-adjusted life years (DALYs).

The association between high blood pressure and other chronic diseases prompts healthcare professionals to understand the individual’s genetic, social, economic, environmental, and cultural issues that contribute to people’s propensity to high blood pressure.

As a result, unmet needs for at-risk populations and people with hypertension affect the quality of care by requiring care providers to focus on primary, secondary, and tertiary prevention approaches. Finally, people with high blood pressure require individualized care interventions and regular follow-ups to enhance the effectiveness and impacts of pharmacological and non-pharmacologic strategies. These demands affect the perspectives of quality care.

Impacts of Hypertension on Patient Safety

Patient safety is a crucial dimension of quality care since it entails preventing, averting, and confronting issues or events that can jeopardize or threaten a patient’s health and wellness. According to Varkey (2021), healthcare professionals are responsible for preventing harm and benefiting the patient.

On the other hand, Lawati et al. (2018) adopt the World Health Organization’s definition of patient safety as the determination to avert harm and the prevention of adverse events, including medication errors. A high prevalence of hypertension and associated morbidities compromise of patient safety by contributing to premature deaths, disability-adjusted life years, poor quality of life, and prolonged hospitalization. Once healthcare professionals diagnose patients with hypertension, they focus on secondary and tertiary prevention strategies, including medications and modifying risk factors to prevent the condition’s progression.

Impacts of Hypertension on Cost to the System and the Individual

Hypertension inflicts massive economic burdens on healthcare systems and Individuals, including upsurged costs of improving symptoms and alleviating complications associated with elevated blood pressure. The Centers for Disease Control and Prevention (2022) presents hypertension as a costly public health problem that costs the US healthcare system approximately $131 to $198 billion annually.

The economic burden of hypertension includes the loss of productivity due to premature death, the costs of healthcare services, and medications for treating elevated blood pressure (Centers for Disease Control and Prevention, 2021). Equally, individuals with hypertension bear the cost burden of the condition, especially if they are underinsured or uninsured. In this sense, they face increased out-of-pocket expenses for paying for frequent consultations, medications, and other healthcare services.

How State Board of Nursing Practice Standards and Organizational or Governmental Policies Affect Hypertension’s Impact on the Quality of Care, Patient Safety, and Costs to the System and individual

Primary, secondary, and tertiary prevention strategies for hypertension are consistent and dependent on practice standards, organizational policies, and governmental policies. Firstly, practice standards guide healthcare professionals by establishing professional and ethical responsibilities.

For example, the American Nurses Association (ANA) Code of Ethics contains nine provisions that focus on various thematic areas, including demonstrating compassion and respect for inherent dignity, commitment to work with patients, families, and communities, the advocacy role of nurses, improving environmental conditions to support quality healthcare, incorporating research and scholarly inquiry into clinical practices, and the need to collaborate with other professionals and integrate the principles of social justice (Haddad & Geiger, 2022). These practice standards can guide my actions for improving patient safety, care quality, and reducing care costs.

Secondly, our organization has a functional policy of early hypertension screening and community health promotion through educational programs. According to Schmidt et al. (2020), early hypertension detection enables healthcare professionals to identify high-risk groups, promoting timely treatment and management of risk factors for high blood.

Also, timely screening can contain health-related costs associated with hospitalization and reduces the risk of premature death (Schmidt et al., 2020). Equally, community-based educational programs promote health literacy, improve individual awareness of self-management interventions, and enhance adherence to treatment options. This policy is consistent with the need to implement primary, secondary, and tertiary prevention strategies.

Finally, the Affordable Care Act (ACA) of 2010 through the Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) influences healthcare professionals’ practices and approaches for preventing, managing, and treating hypertension.

According to Witman et al. (2018), the MIPCD supports smoking cessation programs, quit attempts, and cessation counseling. These interventions focus on intercepting the causal factors for hypertension, including cigarette smoking and other forms of tobacco product use. As a result, they result in reduced mortality rates and improved community health.

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

Early hypertension detection, providing opportunities for physical exercise, supporting smoking cessation programs, and educating people about healthy diets are ideal strategies for preventing and controlling high blood pressure (World Health Organization, 2021).

Equally, these approaches prevent the disease’s progression, reduce care costs associated with life-threatening cardiovascular conditions and safeguard patient safety. Although these interventions are universally accepted standards for tackling hypertension, it is essential to implement tailored measures that improve care quality.

For instance, incorporating telehealth technology in hypertension prevention, treatment, and management can be an ideal strategy for alleviating health inequalities and barriers to care accessibility. Wang et al. (2021) argue that incorporating telemedicine in the management of hypertension results in multiple benefits, including timely detection of elevated blood pressure, virtual consultations, improved communication between healthcare professionals and patients, and telemonitoring.

Further, this technology can effectively address the problem of geographical barriers to care access and utilization. Therefore, it is a profound tool for improving care quality, safeguarding patient safety, and reducing the costs associated with in-office visits. When implementing the proposed interventions, the organization should establish performance metrics and utilize data to track progress and identify areas of improvement. The available and relevant sources of benchmark data include the hospital dashboard, patient medical reports, patient feedback, and surveys.


High blood pressure is a primary risk factor for more burdensome cardiovascular conditions, such as heart disease and stroke. These complications are the leading causes of premature deaths, increased care costs, prolonged hospitalization, and compromised quality of life. These adverse effects impact the quality of care, safety, and costs of the system.

Nursing practice standards, organizational, and governmental policies support developing collaborative care plans, respecting patients’ values and preferences, and operating in interdisciplinary teams to address hypertension. It is possible to capitalize on policy inputs by incorporating telehealth technology in the management of hypertension and educating people about the disease’s risk factors and self-management approaches.

Assessing the Problem: Quality Safety and Cost Considerations References

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.

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