NURS 8300 Week 5: System Management of Populations

NURS 8300 Week 5 Discussion: Quality Metrics for Chronic Disease Management

Quality Metrics for Chronic Disease Management – Comparing types of Quality Metric for Managing Chronic Diseases that applies to Hospital and Home Settings

A quality metric for managing chronic disease

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Diabetes mellitus was known in antiquity and remains today a worldwide and increasing health problem with a high cost from associated premature coronary artery disease, blindness, renal failure and amputations (Watkins, Amiel, Howell, & Turner, 2003, p. 224). Chronic disease management such as diabetes type II (T2DM), has become the mainstay of primary care physicians (PCP) and inpatient hospitalizations while other emergencies and illnesses are treated at the urgent care facilities. The National Committee for Quality Assurance’s (NCQA’s) Diabetes Physician Recognition Program (DPRP) is designed to recognize PC physicians, who use evidence-based measures and provide excellent care to their patients with diabetes, in conjunction with the American Diabetic Association (ADA) (Beich, Scanlon, & Boyce, 2010, p. 132).

The treatment of patients with T2DM is individualized with the cornerstone therapeutic agent being Metformin and with the main goal of safely achieving a targeted A1C of 6.5% for all patients (Watkins et al., 2003). The National Quality Measures Clearinghouse maintained by the Agency for Healthcare Research and Quality (AHRQ), was searched for measures that addressed diabetes care, and blood glucose and Hgb A1C monitoring was the chosen one (Leas et al., 2009). Diabetes is common in hospitalized people, even among those without a previous history, and is associated with increased in-hospital complications, longer length of stay and mortality (Malcolm et al., 2018, p. 116).  It has been reported to be the fourth most common comorbid condition listed on all hospital discharges. Hospitalized patients’ diabetes management occurs after meals and at bedtime daily without the cost of implements considered, coupled with frequent lab tests while PCPs must consider the cost to patients, so testing may be less daily with periodic hemoglobin A1C monitoring as protocol requires every 90 days. Common to both settings is the daily testing which allows for the application of solutions in the event of hyperglycemic episodes such as diet adjustments, lifestyle changes, and insulin use…

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NURS 8300 Week 5 Discussion: Quality Metrics for Chronic Disease Management

According to the CDC, chronic diseases are the leading cause of death in the United States, with almost 50% of the population suffering from at least one chronic illness. As a result, almost 80% of health care spending is devoted to its management (CDC, 2010). To this end, the National Committee for Quality Assurance (NCQA) developed performance measures. These performance measures allow organizations to compare yearly quality improvement outcomes in the management of chronic diseases. As a nurse engaged in advanced practice, you may find yourself at the forefront of prevention and care management efforts.

To prepare FOR Quality Metrics for Chronic Disease Management:

• Review      the National Committee for Quality Assurance report, presented in the      Learning Resources, and examine current trends and measures associated      with at least two chronic diseases. This information will form the basis      for this Discussion.
• Review      examples of measures that address the management of chronic diseases for      an inpatient setting that might not be relevant in an outpatient setting.      Be sure to explore the companion metrics that influence a patient’s      ability to manage chronic disease.
• Consider      how these metrics facilitate change and improve the management of chronic      disease.
• Examine      the efficiency of current automated trigger systems for managing patient safety.      Ask yourself: How do these automated trigger systems help improve quality      of health care, patient education, and management of chronic illnesses?

By tomorrow 12/27/, write a minimum of 550 words essay in APA format with 2 references from the list below. Include the level one headers as numbered below:

Post a cohesive response that addresses the following:

1) Compare one quality metric for managing chronic disease that applies to your practice setting to a metric that applies in a different practice setting (i.e. hospital nurse compared to home health nurse).

2) Evaluate how these quality metrics facilitate change and improve the management of chronic disease.

3) Take a stance on the efficiency of current automated trigger systems to help manage patient safety. Do you believe these to be proactive or reactive responses when educating patients on disease management?

Read a selection of your colleagues’ responses.

By Day 7 OF Quality Metrics for Chronic Disease Management

Respond to two of your colleagues in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence, or research.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Offer and support an alternative perspective, using readings from the classroom or from your own research in the Walden Library.
• Validate an idea with your own experience and additional research.
• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

Required Readings-Quality Metrics for Chronic Disease Management

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Administration Press.

Chapter 9: “Measuring and Improving Patient Experiences of Care”

Frith, K. H., Anderson, F., & Sewell, J. P. (2010). Assessing and selecting data for a nursing services dashboard. Journal of Nursing Administration, 40(1), 10–16. doi:10.1097/NNA.0b013e3181c47d45

This article highlights the benefits of nurses using dashboards to help with staffing issues. It considers the sharing of data that dashboard can facilitate from the perspectives of nurses, units, hospitals, and patients.

Grossmeier, J., Terry, P. E., Cipriotti, A., & Burtaine, J. E. (2010). Best practices in evaluating worksite health promotion programs. American Journal of Health Promotion, 24(3), TAHP 1–9.

In this article, the authors discuss how to measure success when analyzing worksite health promotion (WHP). They then cover how to organize these measurements, assess WHP programs, and determine factors related to best-practice evaluation frameworks.

Stanley, R., Lillis, K. A., Zuspan, S. J., Lichenstein, R., Ruddy, R. M., Gerardi, M. J., & Dean, J. M. (2010). Development and implementation of a performance measure tool in an academic pediatric research network. Contemporary Clinical Trials, 31(5), 429–437.

The details of this article focus on a multi-center research network that initiated an evaluation method using balanced scorecards. The first three years of the measurement tool’s implementation are covered, and the achievements and challenges are discussed.

Required Media FOR Quality Metrics for Chronic Disease Management

Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: Benchmarking outcomes. Baltimore: Author.

Note: The approximate length of this media piece is 10 minutes.

In this program, Barbara Epke and Carrie Brady discuss methods that health care organizations use to gather data for measuring outcomes, and explain how data are used to measure key indicators of quality and safety.

NURS 8300 Assignment 1: Measuring Quality

Continue to work on this Assignment, assigned in Week 3 and due by Day 7 of this week.

By Day 7

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK5Assgn+last name+first initial.(extension)” as the name.
• Click the Week 5 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 5 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

NURS 8300 Week 5 Assignment 2: Major Assessment 6

This Assignment requires completion of 13 IHI Open School modules and the completion of the Certificate of Completion Basic level. There are 13 modules which you must complete over the course of these 11 weeks. While they are learner paced, it is to your advantage to complete the modules in the week assigned as the content of the course is related to the modules.

To earn the 30 points associated with this application, you must complete all 13 modules and earn the certificate of completion. Partial credit is not permitted.

Week 5 IHI Open School Modules

• QI 104: The Life Cycle of a Quality Improvement Project
• QI 105: The Human Side of Quality Improvement

There is nothing to submit this week.

Please save the certificate you receive upon completion. You will be required to upload this to gradebook in evidence of your completion.

NURS 8300 Organizational Systems Leadership for Quality Improvement

Week 5 Assignment 1:  Measuring Quality Guidelines and Grading Rubric (Assigned in Week 3, due at the end of Week 5). In an 8 to 10 page paper, describe 3 rate based measurements of quality.  Your paper must be fully annotated, written in scholarly voice, and compliant with APA 6^th edition style.

Select three rate based measurements of quality that you will use as the primary basis for this paper.

These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care.  For the purposes of this assignment, an analysis of staffing levels is not permitted.  You can find useful information on quality indicators that are of interest to you on these websites and resources.  You may choose only one of the three measures to be some form of patient satisfaction measure.

http://www.qualityindicators.ahrq.gov/

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures.html

http://www.medicare.gov/hospitalcompare/search.html?AspxAutoDetectCookieSupport=1

http://www.cdc.gov/HAI/surveillance/index.html

http://www.ihi.org/resources/Pages/IHIWhitePapers/AGuidetoMeasuringTripleAim.aspx

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html

http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/index.html?redirect=/cahps/

http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HOS/index.html?redirect=/hos/

Deconstruct each measure to include descriptions of the following:

• The definition of the measure
• The numerical description of how the measurement is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.
• Explain how the data for this measure are collected
• Describe how the measurement is compared externally to other like settings; differentiate between the actual rate and a percentile ranking.
• Explain whether the measure is risk adjusted or not.  If so, explain briefly how this is accomplished.
• Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace.
• Describe the importance of each measure to a chosen clinical organization and setting.
• Using these websites and resources you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic or private office; a total population of patient types is also acceptable, but please be specific as to the setting.  That is, if you are interested in patients with chronic illness across the continuum of care, you might hone in a particular healthplan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings. Academic organizations are not permitted. For all other settings, consult the instructor for guidance.  You do not need actual data from a given organization to complete this assignment.
• Relate each measure to patient safety, to the cost of poor quality, and to the overall cost of healthcare.