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.

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Dashboard Benchmark Evaluation

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