Assessing the Problem: Quality, Safety, and Cost Considerations

Safety to the patients is one of the dimensions of quality in healthcare. Safety encompasses freedom from risks to physical and nonphysical harm. Injuries can arise from medical and medication errors as well as the natural history of the disease. Failure to prevent these injuries or detect the, early can lead to a high cost of care to the patient and the health system. This capstone project was about Amie, a 3-year-old patient who was diagnosed with cystic fibrosis and was to start treatment. This health problem has various associated effects on patient safety, cost of care, and quality of healthcare. The purpose of this proper is to describe the effects of Amie’s health problem on care quality, safety, and care cost and describe the impact of the state board of nursing regulations and government policies on the health problem.

Effects of Cystic Fibrosis on Care Quality

Cystic fibrosis is a lifelong genetic disease with no cure. However, its symptomatic management can improve the quality of life of the patients. This is rare among the general population but is more common in the Caucasian population as compared with other ethnic groups. US Cystic Fibrosis Foundation (CFF) in the 1970s identified a multidisciplinary approach to the management of cystic fibrosis that saw the establishment of cystic fibrosis centers in the united states. According to Pougheon Bertrand et al. (2018), PHARE-M which is a quality improvement program model for populations with cystic fibrosis has been adopted by the health system in France and other countries to improve the quality of care for CF. However, this complex model still requires additional avenues for quality improvement despite the evidence of its effectiveness in enhancing coordinated care for patients with CF in cystic fibrosis centers. Health information systems and the generalization of the guidelines are some of the areas that are to be explored for maximum quality outcomes with the multidisciplinary team (MDT) outcomes in care for patients with CF. factors such as adaptive environments favor the success of population-based interventions in the care of CF patients. The ultimate goal in these situations is to improve the quality of care provided to CF patients.

The quality of life of patients with CF, regardless of the mode of management, is also determined by the mental health variables. Significant physical and social challenges are also experienced by CF patients. Accordion to Cronly et al. (2019), depression and anxiety are major mental health variables that are associated with the quality of life of patients with CF. as the CF patients from childhood to adolescence and adulthood, mental health issues set in. delay in the development of these patients due to frequent gastrointestinal and respiratory complications impede the expected growth and development rates. Their emotional functioning, and body image, among other domains of health, are also affected by this disease. this will later affect the quality of care these patients receive. Other confounding factors such as the ability to participate in the activities of daily living (ADL), education, and social engagements affect the quality of the care for these patients. Therefore, the multidisciplinary team should take into consideration these factors to offer holistic care that is of high quality. In my daily practice, these factors also affect the quality of care offered to other patients with chronic diseases and those diseases requiring lifetime care.

Effects of the Health Problem on the Patient Safety

Patient safety ensures that they are free from physical as well as emotional harm. Patient safety was suggested to be a standard element of quality of care by the Committee on Data Standards for Patient Safety. Safe care is defined as one that is free from unintentional injuries that usually occur to errors of commission or omission. Adverse events and near misses in the care for patients with CF constitute the major patient safety threats. Organ failure is the main cause of mortality for patients with CF. Medications that act as a chaperone for the cystic fibrosis transmembrane conductance regulator such as ivacaftor and lumacaftor only improve the clinical symptoms of this disease but do not cause significant adverse drug events. These medications are prescribed based on the weight of the child on a twice-daily dosing frequency. According to Yu & Sharma (2021), this disease advances despite these treatments. Disease progression is characterized by pulmonary and gastrointestinal complications. The stasis of secretions in these systems predisposes the patients to the development of infections. The medications work to slow this progression and improve the clinical symptoms.

Effects of the Health Problem on Cost

Recurrent admission and the chronic nature of the disease make the costs of treatment to be higher. The multidisciplinary approach aims at reducing these readmissions and provides a multisystemic approach to this health problem. Individual patients, their families, and unites state healthcare system incur significant costs in the treatment and care for CF. A study by Grosse et al. (2018) through the centers for disease control and prevention (CDC) estimated that the average costs of care for individual CF patients doubled between 2011 and 2016. The average cost for an individual patient incurred by the United States health system was about 67,000 US dollars per patient per year. This figure increased to about 131,000 per patient per year in 2016. Expenditure on pharmaceuticals has also been increasing in the health system and individuals owing to the recent development in the treatment and science of CF

According to Orenstein & Abood (2018), various factors wield a big influence on the costs of CF care to the patients, their families, and the US health system. These factors include but are not limited to costs of diagnosis of the disease and clinical investigations to identify the cause of compilations, insurance costs, technical costs surrounding clinic visits, medications, and nutrition (Orenstein & Abood, 2018). With new drugs come increased costs because of their perceived superior efficacies. Technical issues surrounding the frequent clinic visits include but are not limited to meals, transportation, physician fees, housing, and daycare costs for siblings (Orenstein & Abood, 2018). Overall expenditure on hospitalizations may range from 0 to about 120,000 US dollars per year. Insurance costs are also incurred by the individuals and the health system. Subsidized public insurance, private insurance, co-paying, and lifetime plans are some of the modes of health payments that determine the costs of expenditure.

Effect of Nursing Practice Standards, Policies, and Regulations

The role of nurses in the management of CF is very essential. The multidisciplinary teams that care for these patients require the coordination, communication, collaboration, and advocacy roles of nurses. However, these roles have limits that are regulated by the state boards of nursing, national associations of nursing policies, and federal government policies. the state board regulations include regulation of scope and licensure of nurses. In some states, the scopes are restricted or reduced. Under these circumstances, nurses can only assess, and diagnoses nurses but not treat CF medically. Therefore, their roles in the MDT are also reduced.

Federal policies and legislation such as acts of parliament also play roles in the management of CF. Legislations and acts of parliament that regulate insurance also affect the health problem. The Affordable Care Act, for example, impacts the care for CF. this legislation has helped patients with CF access and afford care. Before this policy was enacted by President Obama’s regime, individuals with chronic diseases such as CF would be denied insurance coverage by insurance companies for their illness. The ACA barred insurance companies from denying patients with chronic diseases insurance covers and this has improved access and lowered costs from the patients’ perspectives.

The US health system also plays important role in influencing the care for CF patients. Policies such as HIPAA and HITECH that regulate the use of technology and patient data, also influence the care coordination for care for patients with CF. A review study by Orenstein & Abood (2018) explored the influencers of costs of care for CF patients. Insurance costs such as Medicaid, Medicare, and ACA were given significant mentions. All these factors reflect the effectiveness of the health systems in dealing with this disease at the population and individual levels. These regulations will determine my scope of practice in the state where I will practice. Abiding by the principles of meaningful use and applying my practice principles within my scope will ensure that my care is legally, ethically, and socially acceptable.

Patient Safety and Quality Improvement and Cost Reduction Strategies

The current paradigm in health care revolves around evidence-based practice and health information technology use. Improving quality will require improvement in more than one domain of quality of care. Domains of quality in health care include safety, effectiveness, efficiency, timeliness, patient-centeredness, and equity. Two strategies that would improve the quality of care for CF patients will include the adoption of technology and the use of the evidence-based practice. With no identifiable cure for this disease adherence to available treatments strategies is key. Calthorpe et al. (2020) identified time, treatment burden, competing demands of life, and the general life of the patient as the main determinants of adherence to the treatment in patients with CF.

The use of technology such as mobile technology, web-based technologies, and digital health will involve patients in their health and improve coordination through enhanced inclusive communication. This will improve patient-centered care and enable patient education remotely to improve adherence. Technology use will also improve care efficiency and thus quality improvement. Planning and coordination for patient care will also be timely. Evidence-based practice will provide the MDT with current and proven methods to improve care for patients with CF. According to Dury et al. (2021), most adults have daily unmet needs in their care. These needs can also be met through community resources

Conclusion

Amie’s health problem impacts the cost of care for her family and the health system. Annual expenditure on the treatment of CF has been increasing in recent years owing to the advancement of treatment methods. There is no cure for this lifelong condition and the quality of the life is determined by the absence pr presence of complications. Best strategies should incorporate technology and evidence-based practice to improve the quality, safety, and cost of care. State boards of nursing regulations such as the scope of practice and licensure are important in care coordination and role definition in multidisciplinary teams.

References

Calthorpe, R. J., Smith, S. J., Rowbotham, N. J., Leighton, P. A., Davies, G., Daniels, T., Gathercole, K., Allen, L., Elliott, Z. C., & Smyth, A. R. (2020). What effective ways of motivation, support, and technologies help people with cystic fibrosis improve and sustain treatment adherence? BMJ Open Respiratory Research7(1), e000601. https://doi.org/10.1136/bmjresp-2020-000601

Cronly, J. A., Duff, A. J., Riekert, K. A., Fitzgerald, A. P., Perry, I. J., Lehane, E. A., Horgan, A., Howe, B. A., Ni Chroinin, M., & Savage, E. (2019). Health-related quality of life in adolescents and adults with cystic fibrosis: Physical and mental health predictors. Respiratory Care64(4), 406–415. https://doi.org/10.4187/respcare.06356

Dury, S., Perotin, J.-M., Ravoninjatovo, B., Llerena, C., Ancel, J., Mulette, P., Griffon, M., Carré, S., Perrin, A., Lebargy, F., Deslée, G., & Launois, C. (2021). Identifying specific needs in adult cystic fibrosis patients: a pilot study using a custom questionnaire. BMC Pulmonary Medicine21(1), 270. https://doi.org/10.1186/s12890-021-01613-4

Grosse, S. D., Do, T. Q. N., Vu, M., Feng, L. B., Berry, J. G., & Sawicki, G. S. (2018). Healthcare expenditures for privately insured US patients with cystic fibrosis, 2010-2016. Pediatric Pulmonology53(12), 1611–1618. https://doi.org/10.1002/ppul.24178

Orenstein, D. M., & Abood, R. N. (2018). Cost(s) of caring for patients with cystic fibrosis. Current Opinion in Pediatrics30(3), 393–398. https://doi.org/10.1097/mop.0000000000000625

Pougheon Bertrand, D., Nowak, E., Dehillotte, C., Lemmonier, L., & Rault, G. (2018). Quality of care in cystic fibrosis: assessment protocol of the French QIP PHARE-M. Orphanet Journal of Rare Diseases13(Suppl 1), 10. https://doi.org/10.1186/s13023-017-0749-3

Yu, E., & Sharma, S. (2021). Cystic Fibrosis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493206/

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