Assignment: Assessing a Healthcare Program/Policy Evaluation

Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.

Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.

To Prepare:

• Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
• Select an existing healthcare program or policy evaluation or choose one of interest to you.
• Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

• Describe the healthcare program or policy outcomes.
• How was the success of the program or policy measured?
• How many people were reached by the program or policy selected?
• How much of an impact was realized with the program or policy selected?
• At what point in program implementation was the program or policy evaluation conducted?
• What data was used to conduct the program or policy evaluation?
• What specific information on unintended consequences was identified?
• What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
• Did the program or policy meet the original intent and objectives? Why or why not?
• Would you recommend implementing this program or policy in your place of work? Why or why not?
• Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

By Day 7 of Week 10

Submit your completed healthcare program/policy evaluation analysis.

Discussion: The Healthcare Workplace: Using Policy to Improve Patient Safety

According to an article published by the Becker’s Hospital Review (Vaidva, Zimmerman, & Bean, 2018), the top 10 patient safety concerns for 2018 are:

1. Disparate EHRs (electronic health records)
2. Hand hygiene
3. Nurse-patient ratios
4. Drug and medical supply shortages
5. Quality reporting
6. Resurgent diseases.
7. Mergers and acquisitions
8. Physician burnout
9. Antibiotic resistance
10. Opioid epidemic

Each of these concerns has led to poor patient outcomes, including deaths (Vaidva et al., 2018). The good news is that number of hospital-acquired health conditions (e.g., infections, falls, pressure ulcers, adverse drug events, etc.) has decreased by 21%, between 2010 and 2015 (Agency for Healthcare Research and Quality, 2016). Similarly, there has been a decrease in medical, medication, or lab errors or delays, which may indicate that policy efforts to keep patients safe have been successful (Davis, Kristof, Squires, & Schoen, 2014).

In this Discussion, you will consider the impact of policy on patient safety and recommend policies that could address different topic areas.

References
Agency for Healthcare Research and Quality. (2016). National scorecard on rates of hospital-acquired conditions 2010 to 2015: Interim data from national efforts to make health care safer. Retrieved from https://www.ahrq.gov/professionals/quality-patient…

Davis, K., Kristof, S., Squires, D., & Schoen, C. (2014). Mirror, mirror on the wall: How the performance of the U.S. health care system compares internationally. Retrieved from https://www.commonwealthfund.org/sites/default/fil…

Vaidya, A., Zimmerman, B., & Bean. (2018). Top 10 patient safety issues for 2018. Retrieved from https://www.beckershospitalreview.com/10-top-patie…

By Day 4

Post a comprehensive response to the following:

• In your own words, briefly summarize the article. Include 1) the purpose/aim(s) of the study/article, 2) a description of the healthcare setting (e.g., hospital, clinic, urgent care, etc.), 3) the circumstances that created a patient safety issue (e.g., lack of training, working too many hours, understaffed, etc.), and 4) the policy or need for a policy.
• Describe a change in policy or procedure that could help address this patient safety issue.
• Explain what other factors besides policy may have contributed to the safety issue and how these can be addressed.

I need a response to the post below:

This health policy was introduced April 15, 2021 (Congress, 2021). The bill proposes prescription drug companies be required to allow any pharmacies that are in a medically underserved area, rural area, or an area where there is a healthcare shortage to be included as an in-network pharmacy (Congress, 2021). H.R.2608 would also prevent prescription drug plans from to reimburse other pharmacies at a different cost than the ones as spoken above (Congress, 2021).

Evidence provides support in favor of this proposed bill. The main purpose of pharmacists in a rural area is dispensing medications, patient safety, and education (Rural, 2021). Pharmacies in rural areas struggle to due to unfavorable insurance practices, low volume purchasing, limitation on pharmacy workforce, and slim profit margins (Rural, 2021). When a pharmacy is not close by, some patients in rural areas suffer from their medication condition being too severe to travel a long distance, lack of transportation, and/or extreme weather conditions which delays patients in obtaining medications, etc. in a timely manner. The residents in rural areas also lack the access to technological skills, telecommunications, and equipment to obtain mediations from an online pharmacy, etc. Rural populations tend to have more chronic conditions than urban populations. Support for local healthcare facilities, Immunizations and education on non-prescription drugs is also provided by pharmacists. Between 2003-2018, 1218 independent/private pharmacies in rural America closed and 630 were the only pharmacy in the area, according to the Rural Health Policy Report (Rural, 2021). In 2018, 12% of US pharmacists were working in non-metropolitan areas according to the Bureau of Labor and Statistics (Rural, 2021). Rural pharmacists do not get paid as high, work longer hours, and reduced use of vacation/sick time due to lack of replacement. Recruitment and retaining rural pharmacists are difficult.

A study reported 82% of Americans reported using at least one over-the-counter medication, at least one prescription medication, and/or dietary supplement each week (Rural, n.d.). In the same study, 30% reported using more than five of these combined drugs in the same week (Rural, n.d.). Over 1,500,000 people are injured every year due to medications and the incorrect way of taking them. There is a difference between dispensing medications and pharmaceutical care. Pharmaceutical care provides an involved summary of medications, interacts, how to take the medication, if the medication is currently necessary, etc. It is individualized care and management of the patient.

The Centers for Disease Control and Prevention (CDC) report 15% of Americans, roughly 46 million, live in rural America (CDC, 2021). Rural Americans are usually sicker and more likely to die from chronic lower respiratory disease, cancer, stroke, heart disease, and unintentional injury (CDC, 2021). Unintentional deaths are fifty percent higher and alcohol/drug use is significantly higher in rural areas (CDC, 2021).

Rural areas have less resources and less opportunity or access to medical care overall, including pharmacies, medications, and pharmacy management. This bill would offer the patients better accessibility to the medications and pharmacy management which would improve the patient outcome. The need is great and will continue to affect the patients in a negative way if a solution is not found.

Discussion: Quality, Health, and Reduced Spending

Value based purchasing is a payment model that offers financial incentives to healthcare providers and organizations when they meet certain performance measures. This model also penalizes healthcare providers for poor outcomes, medical errors, or increased costs. Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs), and Bundled Payment Care Improvement (BPCI Advanced) are prospective value-based purchasing programs aimed at improving healthcare quality and reducing costs. Hospitals and physicians participate in these programs with the goal of getting the right care to the right patient at the right time.

In this Discussion, you will consider what happens with these systems as they relate to nursing home care. Nursing home administrators are facing a reduction in the demand for skilled nursing rehabilitation (SNF) beds, while physicians in an ACO or a gain-sharer in a BPCI program are looking at discharging patients with home care or outpatient resources to reduce cost. All these programs are affected by re-admission penalties.

Most businesses are constantly looking to reduce cost. In healthcare, often the necessity to reduce cost means a reduction in utilization. Consider how this compares to a retail market where reduced demand reduces cost by consumer choice. How much influence does the consumer have on the change in healthcare economics? Is it the payer (Medicare), the provider (the physician), or the patient?

Consider the following scenarios:

Scenario 1: You are a rehabilitation director in a nursing home. Your administrator has given you the directive that, to participate with a Medicare MCO and become a preferred provider for a hospital BPCI or comprehensive care for joint replacement (CJR) program, you need to reduce the length of stay for the short-term rehab patients from 20 days to 10 days for DRG 470: Total knee replacement. To compound the problem, you see that the usual 400 total knee patients you get annually has been reduced to 160 patients.

Scenario 2: You are the manager of a large orthopedic practice who participates in the BPCI program. Your practice does 400 total knee patients each year. Medicare has set pricing for a Total Knee Replacement patient at $28,415 per patient for a 90-day episode of care. Current practice is that all patients automatically go to a skilled nursing facility (SNF) for 20 days. Based on current research the goal is for 60% of your patients to go home with home care and those going to a SNF to stay for 10 days so the BPCI program will be profitable.

To Prepare:

• Review the Learning Resources for this week.
• Select one of the two scenarios to focus on for this Discussion.
• Reflect on the scenario, and consider redesign measures you might recommend. For example, consider length of stay, reducing readmissions, attracting new business, care redesign, patient satisfaction, and physician engagement.

By Day 4

Post a comprehensive response to the following:

• Describe at least three care redesign strategies you might recommend to the scenario.
• Justify why you selected these three care redesign strategies and explain how you would implement the redesign strategies you recommended.
• Be specific, and provide examples.
• Be sure to support your Discussion with a reference to course materials or a reference within the last three years.

Discussion: Quality and Safety

A patient is prescribed an antibiotic for an illness caused by a virus. The patient is allergic to this antibiotic and has a severe adverse reaction that is life-threatening. If you were a leader or manager in the hospital in which this occurred, would you understand what aspects of quality and safety were at issue here? Would you be able to identify this as a problem of overuse, underuse, or misuse? What would your responsibilities be in this situation?

This is just one example of a scenario related to safety in a healthcare setting. Errors in quality and safety happen every day in healthcare organizations. Quality and safety remain critical issues for healthcare leaders and managers as well as patients and other stakeholders today. Because healthcare leaders and managers hold matters of life and death in their hands, it is imperative that they be vigilant in matters of quality and safety, and understand that quality might be perceived differently depending on who you ask. Therefore, it is important that healthcare leaders consider the perspectives of stakeholders.

To prepare for this discussion:

• Carefully review your Learning Resources. View the two media pieces: Incident in the ER: Part I and Incident in the ER: Part 2. Consider how both healthcare managers handled the incident in both situations. What did the two individuals do wrong? What did they do right to ensure better quality and safety in the future?
• Select one of the two case studies provided to discuss: “Door to Balloon (Percutaneous Coronary Intervention [PCI]) —Case for Chapter 7,” or “On Being Transparent.”
• Seek additional resources to support your Discussion from one of these website resources on healthcare quality:
  • Agency for Healthcare Research and Quality http://www.ahrq.gov/qual/
  • Institute for Healthcare Improvement http://www.ihi.org/ihi
  • The Joint Commission http://www.jointcommission.org/

By Day 4

Post a comprehensive response to the following:

• Describe how issues of quality of care and safety might be viewed from the perspective of each of the following:
  • A patient
  • A healthcare provider
  • A healthcare leader or manager
• Describe the similarities between these perspectives.
• Describe the differences between these perspectives.
• Explain the role of a healthcare leader or manager in addressing quality and safety challenges in the case study you chose. Then, provide a specific example of a strategy that might help ensure future quality and safety by protecting patients from quality and safety errors.