Dashboard Benchmark Evaluation

This report presents an evaluation of the data contained in the Mercy Center’s Public Health Dashboard – Diabetes dashboard. The evaluation identifies the shortcomings of the organization and gives a proposal of the improvement needed.

Evaluation of Dashboard Metrics

The evaluation of the Mercy Center’s Public Health Dashboard – Diabetes revealed metrics of concern regarding diabetes management in the organization. The dashboard reveals that there has been a decline in the number of tests done to monitor the levels of HgbA1c in patients over the last three quarters of 2019 (Villa Health, n.d.). In 2018, the tests conducted in the four quarters were 1, 11, 23, and 87, respectively. In the first quarter of 2019, 123 tests were conducted (Villa Health, n.d.). Thereafter, they declined to 32, 13, and 6 tests in the second, third and fourth quarters, respectively.

The other underperformance in the metrics is observed in foot examinations. In 2018, the number of quarterly foot examinations was 2, 5, 27, and 48, respectively (Villa Health, n.d.). This reflects an increase in the exams over the first year. However, in 2019, a decline in the number of foot exams was noted in the second, third, and fourth quarters. The tests reported were 73, 62, 7, and 3, respectively, in the quarters of 2019.

The other metrics that raise concern are the number of eye exams and the data on new cases of diabetes. There are fluctuations in the number of eye exams over the two years. The number of eye exams over the eight quarters of the two years is 4, 16, 7, 33, 41, 28, 16, and 27 (Villa Health, n.d.). The fluctuations raise concerns even though the values in the last two quarters of 2019 are higher than a foot and HgbA1c exams. Data on the new cases of diabetes mellitus does not provide a comparison with the previous quarters of the two years (Villa Health, n.d.). This limits the possibility of creating a comparison and determining the impact of the data.

In the State of Minnesota, data exists on the number of tests conducted on diabetics aged 40 years and above. In 2018, about 78.5 percent of diabetics had eye exams, 80.9 percent had foot exams, and 75.7 had measurements of their HgbA1c levels (Report, 2020). In 2019, the numbers increased to 78.7, 81.9, and 75.8 for eye, foot, and measurements of HgbA1c levels, respectively. National data on diabetics aged 40 years and above revealed the percentage of the population who conducted the tests. In 2018, 75, 62, and 67 percent of the population received HgbA1c, eye, and foot exams, respectively (Report, 2020). In 2019, the percentages reported were 75.2, 62.8, and 68 for HgbA1c, eye, and foot exams, respectively.

The Mercy Center’s Public Health Dashboard – Diabetes only provides data on the number of diabetics in the last quarter of 2019. The data in the last quarter form the basis of comparison with the State and Federal governments. Based on this data, the percentage of the population who have received the tests is 6 percent, 0.7 percent, and 1.5 percent for eye exams, foot exams, and HgbA1c, respectively (Villa Health, n.d.). Therefore, the number of eye exams, foot exams, and HgbA1c tests performed at Mercy Medical Center were below those set by the State and Federal governments.

The few tests have a negative implication on the well-being of diabetic patients. Diabetic complications such as retinopathy and foot ulcers are most likely to occur and go unnoticed. This is associated with a poor prognosis of the disease. The number of foot and eye exams on diabetic patients should be increased. This will facilitate the early detection of diabetic complications. Early detection enables prompt initiation of treatment. The values from the measurements of Hgb1Ac help to monitor the progress of treatment in diabetics. High values indicate poor blood sugar control.

Additional information that could improve the evaluation is data on the number of diabetics in 2018 and 2019. The Mercy Center’s Public Health Dashboard – Diabetes provides data for the last quarter of 2019. It doesn’t contain data for 2018 and the first three quarters of 2019.  This limits the comparison with the State and Federal governments, whose data reflects all quarters of the two years, 2018 and 2019.

Analysis of Challenges in Achieving Acceptable Performance.

The main challenges facing the organization are the lack of a policy that requires mandatory follow-up of diabetic patients and an inadequate number of healthcare providers. The health care facility should have a policy on the care of diabetic patients. An example of an effective policy would be mandatory follow-ups of all diabetic patients enrolled in the facility. The policy should also focus on fulfilling the benchmarks set by the State and Federal governments. The policy should direct all healthcare workers to monitor all diabetic patients closely. Monitoring entails performing regular eye exams, foot exams, measurements of Hgb1Ac, and other screening procedures (Pickens et al., 2018). The number of tests and screenings performed should correspond with the number of patients in the facility. The lack of such a policy leads to underperformance in conducting screening and tests. Furthermore, the lack of a policy that requires the fulfillment of state and federal benchmarks contributes to underperformance. Healthcare workers in such settings are not motivated because they don’t work towards a common goal. Therefore, underperformance in the metrics is recorded.

The problem of an inadequate number of healthcare providers can also contribute to underperformance. Healthcare providers such as nurses, physicians, and pharmacists are actively involved in patient monitoring. Healthcare providers in understaffed facilities are overwhelmed by the number of patients (Gardner et al., 2019). This creates burnout and reduces their productivity. This can contribute to the decrease in the number of foot exams, measurements of Hgb1Ac, and fluctuations in the eye exams observed in the health care facility. In contrast, a facility that is adequately staffed has a high ratio of healthcare providers to patients. The healthcare providers in these facilities make regular patient follow-ups. The performance of such facilities is better compared with those that are understaffed.

Specific Target for Improvement

Based on the data from Mercy Center’s Public Health Dashboard – Diabetes. The number of foot exams and measurements of Hgb1Ac has declined over the last three quarters of 2019. Fluctuations were noted in the number of eye exams. A comparison with the data from the State and Federal governments reveals an underperformance in all three metrics. Therefore, a strategy that leads to an improvement in the number of foot exams, Hgb1Ac measurements, and eye exams is the desired action that should be taken.

Underperformance in the number of foot exams increases the risk of development and a poor prognosis of diabetic foot complications. Diabetic foot is a microvasculature complication (Netten et al., 2020). It can lead to the development of ulcers and increase the number of amputations. Foot exams help to identify complications in their early stages. Early identification by conducting more regular exams enables the initiation of treatment and foot care (Netten et al., 2020). Therefore, the number of foot exams should be increased and be performed consistently to avert diabetic foot complications.

Eye exams are important for all diabetic patients. They enable the identification of diabetic retinopathy, a microvascular complication. The complication is characterized by blurred vision, floaters, and complete blindness (Zie et al., 2020). Conducting regular exams for all diabetic patients enables the identification of these complications and the initiation of treatment. This can help to improve the prognosis of the disease.

Hgb1Ac (glycated hemoglobin) helps to monitor the progress of diabetes treatment. High levels of Hgb1Ac indicate poor control of blood sugar, hence an increased risk of developing diabetic complications. The normal levels should be between 4 and 5.6 percent  (Ceriello, 2020). Therefore, all diabetic patients should have their Hgb1Ac levels regularly monitored to determine their response to treatment and prevent the likelihood of developing macrovascular and microvascular complications.

Ethical and Sustainable Recommended Action

To address the underperformance, two interventions should be used. A policy that guides the routine operations of healthcare providers should be established. The second strategy is patient education on the importance of regular eye exams, foot exams, and measurements of Hgb1Ac. The policy should enforce mandatory follow-ups of all diabetic patients enrolled in the facility. It should also focus on fulfilling the benchmarks set by the State and Federal governments. Patients should be educated on the importance of visiting the facility regularly for routine screening and checkups.

Stakeholders include all healthcare providers and the administration of the hospital. The hospital administration should be involved in policy formulation. Healthcare providers should understand that there is underperformance in the metrics and there is a need for change. Thereafter, healthcare providers should uphold the policy and ensure patient care delivery is efficient. The other stakeholders are patients. Patients are key stakeholders because they work in concert with healthcare providers to ensure that all tests are performed as scheduled.

Healthcare providers should incorporate healthcare ethics when fulfilling the policy. They should uphold non-maleficence, beneficence, justice, and respect for autonomy. Justice will ensure that the screening and tests are done equally regardless of the patient’s background and beliefs (Gillon, 2015). Upholding the policy fulfills the provisions of non-maleficence and beneficence because it is aimed at improving the well-being of the patient and averting any harm (complications). Patient autonomy should also be respected.

The recommendations fail to address the problem of an inadequate number of healthcare providers. However, the formulation of a policy and patient education will make the existing staff work passionately to increase the performance of the metrics. This will lead to an increase in the number of foot exams, Hgb1Ac tests, and eye exams.

References

Vila Health. (n.d.). Dashboard and Health Care Benchmark Evaluation.

Ceriello, A. (2020). Glucose Variability and Diabetic Complications: Is it Time to Treat? Diabetes Care, 43(6), 1169–1171. https://doi.org/10.2337/dci20-0012

Gardner, R. L., Cooper, E., Haskell, J., Harris, D. A., Poplau, S., Kroth, P. J., & Linzer, M. (2019). Physician Stress and Burnout: The Impact of Health Information Technology. Journal of the American Medical Informatics Association, 26(2), 106–114. https://doi.org/10.1093/jamia/ocy145

Gillon, R. (2015). Defending the Four Principles Approach as a Good Basis for Good Medical Practice and, Therefore, for Good Medical Ethics. Journal of Medical Ethics, 41(1), 111–116. https://doi.org/10.1136/medethics-2014-102282

Pickens, C., Pierannunzi, C., Garvin, W., & Town, M. (2018). Morbidity and Mortality Weekly Report Surveillance for Certain Health Behaviors and Conditions Among States and Selected Local Areas-Behavioral Risk Factor Surveillance System, United States, 2015. Morbidity and Mortality Weekly Report, 67(9).

Report, N. D. S. (2020). National Diabetes Statistics Report. National Diabetes Statistics Report, 2.

Netten, J. J., Bus, S. A., Apelqvist, J., Lipsky, B. A., Hinchliffe, R. J., Game, F., Rayman, G., Lazzarini, P. A., Forsythe, R. O., Peters, E. J. G., Senneville, É., Vas, P., Monteiro-Soares, M., & Schaper, N. C. (2020). Definitions and Criteria for Diabetic Foot Disease. Diabetes/Metabolism Research and Reviews, 36(S1), 1–6. https://doi.org/10.1002/dmrr.3268

Zie, G., Kerr, Z. Y., & Moore, J. B. (2020). Universal Healthcare in the United States of America?: A Healthy Debate. 1–7.

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

PART 1 of 4
**************************************
Please see the following attachments:
1. Assignment 1 – Instructions
2. Grading Rubric
3. Example Paper

Please use the Distinguished boxes in the Grading Rubric to guide content for paper.

Hello,

Please see the attached Dashboard file for Villa Health that can be used for metrics if desired.

Thank you!

Communication Strategies & HIPPA

Question 1

When it comes to interacting with patients and other members of the healthcare team, nurses at my healthcare institution are increasingly turning to a broad variety of devices and communication techniques. Smartphones, barcode readers, and tablets are a few instances of the communication technology that is available today (Martin et al., 2019). Those who use the aforementioned devices have a number of different alternatives accessible to them for communicating, some of which include sending an email, sending a text message, or making a phone call. When it comes to gaining access to medical records and receiving information on patient treatment, they are all very important players. On occasion, nursing therapies might be recorded with their help employing them.

The use of online technologies and clinical practice standards provides registered nurses with access to healthcare information. Through the use of integrated smart medical systems, they are also able to electronically place lab test orders, access patient data, and get lab test results. Electronic communication is seen as being effective, safe, and efficient within the framework of the medical field (Nussbaum et al., 2018). EHealth, which mostly refers to activities that are conducted over the web or the internet, is largely considered a tool that saves time by the majority of medical personnel, including registered nurses. The more effectively patients are able to communicate via technological means, the more content the patients may become.

Question 2

Confidentiality, integrity, and confidentiality of the patient are important for a variety of reasons. As a result of the healthcare facility’s HIPAA policy, sensitive patient information has always been protected. The policy considers privacy as an essential component of human well-being and something that is objectively valued. HIPAA regulations compel healthcare organizations to safeguard the patient data that is gathered in the clinical setting (Neame et al., 2020).

Therefore, the healthcare facility is expected to maintain the security of all patient information at all times. For example, physicians are prohibited by HIPAA’s confidentiality guidelines from releasing patient information that is revealed during treatment. The policy also prohibits the healthcare facility from releasing data that is either inadvertent or prohibited. Confidentiality policies often consider it a breach of privacy.

The organization’s HIPAA policy emphasizes security in addition to confidentiality restrictions. It obstructs unauthorized access to information from the outset. General data alteration and disclosure policies restrict outsiders from accessing or modifying any data. Instead, the policy encourages the use of automated data processing (Bui et al., 2020). In addition, the policy restricts the patient’s privacy by prohibiting the willful refusal of services. Third parties are barred from accessing some patient-based services. The healthcare system’s security and confidentiality are jeopardized if unauthorized outsiders gain entry.

In accordance with the organization’s HIPAA policy, the individual’s privacy and autonomy are protected. When it comes to the most sensitive patient information, such as a client’s psychological health and treatment, the organization’s policy often includes extensive health information recommendations to clinicians. Step-by-step instructions are frequently beneficial in giving appropriate parties access to or use of the patient’s personal information. In addition, the policy explains to users how to take legal action if they get illicit material. Measures to protect the privacy and confidentiality of the patient are critical in ensuring the patient’s safety against security breaches.

References

Bui, Q. A., Lee, W. B., Lee, J. S., Wu, H. L., & Liu, J. Y. (2020). Biometric-based key management for satisfying patients’ control over health information in the HIPAA regulations. KSII Transactions on Internet and Information Systems (TIIS), 14(1), 437- 454.

Martin, G., Ghafur, S., Cingolani, I., Symons, J., King, D., Arora, S., & Darzi, A. (2019). The effects and preventability of 2627 patient safety incidents related to health information technology failures: a retrospective analysis of 10 years of incident reporting in England and Wales. The Lancet Digital Health, 1(3), e127-e135.

Neame, M. T., Sefton, G., Roberts, M., Harkness, D., Sinha, I. P., & Hawcutt, D. B. (2020). Evaluating health information technologies: A systematic review of framework recommendations. International Journal of Medical Informatics, 142, 104247.

Nussbaum, S. R., Carter, M. J., Fife, C. E., DaVanzo, J., Haught, R., Nusgart, M., & Cartwright, (2018). An economic evaluation of the impact, cost, and medicare policy implications of chronic nonhealing wounds. Value in Health, 21(1), 27-32.

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

What electronic communication strategies are used at your organization to communicate with patients?

Based on your organization’s HIPAA policy, how is patient privacy and confidentiality protected?

A PICOT Question

A PICOT question has five components. It identifies a specific patient population, the intervention used in managing the people, and a comparison to a population that does not receive the intervention. It evaluates the outcome and the time needed to implement the intervention. The PICOT question for my capstone change project: Among patients receiving surgical nursing care, does a low nurse-patient ratio improve recovery rates compared to a high nurse-patient ratio (due to nursing shortage) over five months? A literature review is integral to any research to evaluate how the currently available research supports the question at hand.

A Comparison of Research Questions

Abhicharttibutra et al. (2017) propose three qualitative research questions. How did the Production and Development of Educational Management in Nursing (PIPDEMN) get onto the government agenda? What were the development processes of the PIPDEMN? How was the PIPDEMN implemented? The three research questions seek to identify and describe the process of policymaking used by the Thai government to increase nursing capacity and education quality. This helps to identify the key stakeholders involved in policy formulation. When nurses are affected, the problem of nursing shortage is likely to be addressed and lead to the improvement of the quality of services provided.

Buerhaus et al. (2017) propose a hypothesis on the challenges nurses face in the USA. Registered nurses will face four main problems in the next 20 years (Buerhaus et al., 2017). The problems include an ageing task force, the uncertainty of health care reform, the shortage and uneven distribution of physicians, and an increased number of retirees. This has led to a decrease in the quality of services delivered by nurses. The research question proposed by Drennan & Ross (2019): What is known about current nurse workforces and shortages, and what can be done to forestall such shortages? The question seeks to address the problem of nursing shortage that has been reported.

Haryanto (2019) proposes a hypothesis that states that nursing shortage is a global challenge. The challenge has led to burnout, stress, and a reduction in the productivity of the workforce. According to Zhang et al. (2018), the demand for registered nurses will exceed the supply from 2016 to 2030. This hypothesis reveals that the nursing shortage problem will worsen in the future. This suggests that the issue of decreased service delivery quality is likely to be compounded. Weaver et al. (2018) hypothesised that the nursing shortage creates a burden of care for families whose children receive palliative care. The nursing shortage has a time, economic and psychological impact on the families of children receiving palliative care.

According to Scheffler & Arnold (2019), the demand for doctors and nurses will increase by 2030, compounding the nursing shortage problem. Mar? et al. (2019) formulate a research question to determine the causes of nursing shortage and the impact of the existing policies. This can help address the problem by ensuring the best approaches are adopted.

A Comparison of Sample Populations

The study by Abhicharttibutra et al. (2017) focuses on the informants who were initially involved in the policymaking process of PIPDEMN. Buerhaus et al. (2017) target the nursing workforce in the USA, whereas Drennan & Ross (2019) review published documents from international organizations. The sample for the study conducted by Haryanto (2019) is published papers such as the fact sheet of the American Association of College of Nursing.

Mar? et al. (2019) analyze national listings and strategic documents for nursing policy in Poland. Scheffler & Arnold (2019) target 32 countries in the Organization for Economic Cooperation and Development. Weaver et al. (2018) target families of children receiving inpatient pediatric palliative care consultation during admission. Zhang et al. (2018) performed a linear regression analysis of national listings of demand and supply of nurses in the 50 states of the USA.

A Comparison of the Limitations of the Study

Drennan & Ross (2019) note that international policies fail to consider nurses’ demographic profiles, career paths, and remuneration. Haryanto (2019) and Drennan & Ross (2019) reported a similar limitation: limited access to data. The end is attributed to insufficient published documents from national and international organizations. Time constraints were written by Abhicharttibutra et al. (2017). Time constraints hindered access to all critical informants targeted by the study. Weaver et al. (2018) reported a small sample and noted that the impact of nursing shortage may differ across the USA. Zhang et al. (2018) note that the study excluded the possibility of foreign nurses entering the country. This can lead to an underestimation of the supply of registered nurses.

Conclusion and Recommendations

The nursing shortage is a global problem that should be addressed promptly. A review of the research literature identified research questions that seek to implement policies that address the issue. The primary study limitations placed during the literature review are time constraints, ends in the sample size, limited access to data, and failure to consider the remuneration and demographics of nurses.

Several recommendations have been proposed. Nurses should be actively involved in policy formulation to address the nursing shortage. Scholarships and incentives should be provided to qualified nursing applicants. The number of training nursing training institutions should be increased to accommodate all qualified applicants. A data-informed, country-specific model of the routes of supply and demand should be used to address the nursing shortage. It requires evidence-informed policy and resource allocation at national, sub-national, and organisational levels. Hospital patient care unit managers and human resource officers should be involved in identifying the causes of the main problems of the workforce and informing both the federal and state governments.

References

Abhicharttibutra, K., Kunaviktikul, W., Turale, S., Wichaikhum, O. A., & Srisuphan, W. (2017). Analysis of a Government Policy to Address Nursing Shortage and Nursing Education Quality. International Nursing Review, 64(1), 22–32. https://doi.org/10.1111/inr.12257

Buerhaus, P. I., Skinner, L. E., Auerbach, D. I., & Staiger, D. O. (2017). Four Challenges Facing the Nursing Workforce in the United States. Journal of Nursing Regulation, 8(2), 40–46. https://doi.org/10.1016/S2155-8256(17)30097-2

Drennan, V. M., & Ross, F. (2019). Global Nurse Shortages – The Facts, the Impact, and Action for Change. British Medical Bulletin, 130(1), 25–37. https://doi.org/10.1093/bmb/ldz014

Haryanto, M. (2019). Nursing Shortage: Myth or Fact? Orthopaedic Nursing, 38(1), 1–2. https://doi.org/10.1097/NOR.0000000000000535

Mar?, M., Bartosiewicz, A., Burzy?ska, J., Chmiel, Z., & Januszewicz, P. (2019). A Nursing Shortage – A Prospect of Global and Local Policies. International Nursing Review, 66(1), 9–16. https://doi.org/10.1111/inr.12473

Scheffler, R. M., & Arnold, D. R. (2019). Projecting Shortages and Surpluses of Doctors and Nurses in the OECD: What Looms Ahead. Health Economics, Policy, and Law, 14(2), 274–290. https://doi.org/10.1017/S174413311700055X

Weaver, M. S., Wichman, B., Bach, S., Schroeder, D., Vail, C., Wichman, C., & MacFadyen, A. (2018). Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care. Journal of Hospice and Palliative Nursing, 20(3), 260–265. https://doi.org/10.1097/NJH.0000000000000436

Zhang, X., Tai, D., Pforsich, H., & Lin, V. W. (2018). United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit. American Journal of Medical Quality, 33(3), 229–236. https://doi.org/10.1177/1062860617738328

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

I have attached my PICOT question paper and the Literature Eval table paper to help. Let me know if you need anything else. Also, are you familiar with this assignment? Thanks again.

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables students to map out and move into the project’s active planning and development stages.

A literature review analyzes how current research supports the PICOT and identifies what is known and not in the evidence. Students will use the information from the earlier PICOT Question Paper and Literature Evaluation

Table assignments to develop a 750-1,000 word review that includes the following sections:

• Title page
• Introduction section
• A comparison of research questions
• A comparison of sample populations
• A comparison of the limitations of the study
• A conclusion section incorporating recommendations for further research

Prepare this assignment according to the guidelines in the APA Style Guide in the Student Success Center. An abstract is not required.

Accountable Care Organizations

One of the most revolutionary healthcare delivery is accountable care organizations. Responsible care organizations (ACOs) are healthcare providers such as nurses, physicians, and hospitals who voluntarily improve care coordination (CMS.gov, 2021). The healthcare providers establish agreements with payers. ACOs must meet quality performance standards and reduce healthcare spending by a certain limit set by Medicare to qualify for reimbursements for their cost-saving healthcare services (CMS.gov, 2021). The enactment of the Affordable Care Act (ACA) in 2010 by former President Obama laid the foundation for developing ACOs (Moy et al., 2021). ACOs have been beneficial in achieving quality improvement objectives and reducing healthcare services’ costs by focusing on population health management.

The best benefits that patients gain from ACOs are low healthcare costs and improved quality of healthcare savings. Healthcare acts like ACA focus on reducing healthcare spending (Moy et al., 2021). ACOs have since focused on reducing the cost of healthcare services. Hospitals and physicians are implementing systems and protocols that ensure efficiency and have lowered healthcare costs. Providers under ACOs are implementing disease prevention strategies and reducing or eliminating unnecessary medical procedures and interventions to get a share of the savings reimbursements from Medicare. In ACOs, there are reduced emergency department visits and hospital admissions. ACO also improves population health management and patient outcomes by developing innovative methods such as disease prevention and wellness promotion, reducing the likelihood of contracting diseases and leading to a healthier population (Wilson et al., 2020). Patients benefit greatly since they have improved healthcare outcomes, get quality medical services, have a broader engagement with healthcare professionals, and reduce out-of-pocket spending.

References

CMS.gov. (2021, March 4). Accountable care organizations (ACOs). Centers for Medicare & Medicaid Services | CMS. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO

Moy, H. P., Giardino, A. P., & Varacallo, M. (2021, February 14). Accountable care organization. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK448136/

Wilson, M., Guta, A., Waddell, K., Lavis, J., Reid, R., & Evans, C. (2020). The impacts of accountable care organizations on patient experience, health outcomes, and costs: A rapid review. Journal of Health Services Research & Policy, 25(2), 130-138. https://doi.org/10.1177/1355819620913141

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

Describe one innovative healthcare delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes.