Assessing the Problem: Quality, Safety, and Cost Considerations
The health cost is one of the key aspects defining the quality of care and safety of the patients. This is so because the high cost of health care services impacts negatively on the operations of the health care delivery systems. It also leads to non-adherence of the patient with the laid down medication plan due to costs involved. It also raises the odds of negative health consequences as well as the risk to the patient. According to studies by Center of Disease Control and Prevention (CDC), among the U.S. population overall, 29.7 million people or 8.9% of the U.S. population had diagnosed diabetes (CDC, 2024).
In this assessment, we will have an overview of health care costs associated with the management of diabetes in Mr. Mathew and devise a healthcare plan for the management of diabetes in terms of cost in health care, patient safety and care as a nursing student. Other aspects discussed include governmental policies, their effectiveness, impact on the nursing and the origin of benchmark data.
Background of the Problem
During my practicum I was able to interact with Mr. Mathew for two hours. Mr. Mathew is 45 years of age, male, Caucasian, who has been diagnosed with diabetes for the last twenty years. The interview helped me get an idea of the status of healthcare, patient safety, and cost of health for diabetes in the United States.
From the interaction, I identified that Mr. Mathew has had two major episodes of hyperglycemic hyperosmolar State (HHS), caused by diabetes, leading to severe dehydration and increased osmolarity of blood in the last four months for which his family sought help from the emergency care of the nearby health facility. He was admitted the two occasions until he was
stable. He was given fluid and electrolyte replacements, along with insulin therapy. Some of the side effects of insulin are hypoglycemia or low blood sugar level manifested as dizziness, sweating, confusion and others. Other side effects include weight gain and redness and swelling of injection site. The insurance covers visits to the emergency room. The payment for the visit to general physician is covered once a month. Whereas Mr. Mathew needs frequent consultation depending on his condition. While the medications are reimbursed in the insurance, the medical devices are not included in this insurance plan of him. The medical emergencies affected Mr. Mathew’s health in various ways physically and mentally. He takes quite some time to get back to his normal life as the conditions have negative impact on his health.
Problem Impacts: Quality, Safety and Costs
Diabetes is a chronic disease that affects the quality of life and safety of patients and the cost of the healthcare system all over the world. It can also be one of the leading causes of morbidity and mortality in the patient if not well addressed. The detail of its effects on quality of care, patient safety and healthcare costs is laid down below.
Impact on Quality Care
The quality of care directly affects the patient’s life in different aspects of his or her life. For instance, like in the case of Mr. Mathew, diabetes developed due to lack of adequate medical care, family history and work and life stress. It restricts the movement of the patient and therefore reduces the life span’s quality. It has a negative effect on the health of a person. The chronic condition of diabetes results in anxiety, depression, and mood swings because the condition is progressive and debilitating (Liu et al., 2020). This means that in addition to the medical impact, the patient has to suffer from emotional pain as well, which worsens the patient’s mental health and the overall health of the entire life.
Likewise, it is also a source of stress for the care givers and adds an additional responsibility. It also affects the quality of care given to the patients. Diabetes should be treated based on a complex and coordinated model of care delivery. This involves the cooperation of physicians, diabetes specialists, endocrinologists, nurses, dietician, social care workers for the enhancement of quality of care, patient education, rehabilitation and therapeutic management plan (Powers et al., 2020).
Impact on Patient Safety
Diabetes is a chronic condition that has an adverse impact on the patient’s health due to impact on patient safety. Diabetic patients are at risk of cardiovascular diseases, nephropathy, neuropathy, retinopathy and limb amputation, that causes hospitalization, morbidity, and mortality according to Foussard et al. (2020). Analyzing the cases presented by Mr. Mathew during the interview, it is possible to identify that patient safety was not adequate.
The medications used in the management of diabetes, primarily insulin can cause hypoglycemia, dizziness, sweating and confusion etc. repeated injection administration may cause skin reactions. Other complications of diabetes affect a patient’s cognitive function, which in turn reduces the quality of life of the patient (Świątoniowska-Lonc et al., 2021). The most important issues are the medications compliance, regular checkups, and lifestyle modification which are expected to improve the patient safety and avoid the deterioration of the disease.
Impact on Costs
Diabetes is among the top diseases that exert a great pressure on the health care delivery costs. As per data by National Institute of Health (NIH), the cost imposed by diabetes management on the US healthcare system is around 412.9 billion USD annually (Parker et al., 2023). This includes costs for regular check-ups, admissions and prescription, which leads to
high direct health care costs. The other indirect costs are the losses in productivity that result from the disability that is caused by the condition.
Diabetic patients also require some medical equipment such glucose monitoring devices and wearable devices. Comorbidities that are common in most patients with diabetes may increase the hospital visits (Mithal et al., 2021). In short, diabetes is a major cost driver for the patient, health care systems and society. Thus, it is important to maximize the control of diabetes and undertake preventive measures in order to minimize cost.
Regarding the health insurance, it covered the cost of the medicine for Mr. Mathew and pays partially for the hospitalization and did not cover the medical devices at all. This has turned into a rather expensive trial for the financial stream of Mr. Mathew.
State Board of Nursing Practice Standards and State Policies
There are many State and Federal laws that exist in order to help in the provision of frameworks in the treatment of diabetes in the population. These policies can be formulated and implemented effectively in the case of patients such as Mr. Mathew for managing diabetes efficiently. American Nursing Association (ANA) has a significant role in this issue. It assists nurses in their efforts to gain information and improve the nursing practice. It underpins the care of diabetes and promotes professionalism and collaboration in order to provide optimal care. Also, the ANA advocates for the study on nursing in diabetes in order to improve the understanding and management of the patients (American Nurses Association, 2019).
Health Information Technology (Health IT) Standards assures the sharing of information between the different healthcare organizations in the enhancement of the care coordination plan for enhancement of public health. The statistical data in electronic form helps in deciding to introduce change or in developing an interventional plan (Miandoab et al., 2023).
In the same manner, Mobile Health (mHealth) Policies encourage the use of the latest use of technology by the patients. This can be in form of devices such as glucose monitoring devices whether a one off or a continuous one or software and mobile applications. They are helpful instruments to give an idea about the disease state. They are also very helpful for the patient who resides in the remote area or cannot come to the healthcare facility due to some health barriers or some other issues (Ali Sherazi et al., 2022).
The state also develops the polices and plans regarding the diabetes based on the data collected from the healthcare facilities and the healthcare institutions. Among which the most significant ones include the National Diabetes Prevention Program (NDPP). CDC’s NDPP is a partnership program of CDC and the federal health agencies. It is to either prevent diabetes or to diagnose it at its initial stage to control the occurrence of this disease. This is for the population that may be predisposed to diabetes or due to the environment, diet and gene factors. It complements behavior change by including exercise and healthy diet into one’s schedule (Ritchie et al., 2020).
Electronic Health Record (EHR) Incentive Programs is a policy in which an attempt is made to develop an electronic record of the information of the patient and his or her health status. They are useful in the reproduction of information in form of data or statistics whenever needed for interventional or policy purposes. The meaningful use of EHR is incentivized and the healthcare professionals are incentivized for the same by the Centers for Medicare & Medicaid Services (CMS) (CMS, 2023).
Impact on Nursing Scope of Practices
ANA has supported the shift in the use of health information technology in the nursing practice which has increased the responsibility of a nurse in capturing and processing patient data
with an aim of improving the quality of care. With the help of EHR, the manner in which the nurses document and access the information of their patients has been altered in a way that has improved the co-ordination and provision of health care services (Zarora et al., 2022). Mobile Health (mHealth) technologies have empowered the nurses to conduct patient monitoring from other regions; hence broadening their role in chronic disease management and patient education. Nurses have been more involved in preventive measures and management of chronic diseases, and use of technology in assessing patient’s status and also in educating him/her through the National Diabetes Prevention Program (NDPP). Collectively, these policies and technologies have enhanced the nursing practice scope, thus requiring new skill sets in health IT and patient care from the nursing staff. CMS has been instrumental in defining the nursing scope of practice by promoting value based care and Health IT (Wang et al., 2020). Some of the CMS programs are payment reforms that focus on outcomes and not services; the role of nurses is critical in care coordination, patient and caregiver support, and chronic diseases.
Strategies to Improve Quality of Care, Safety and Reduce Costs
Diabetes is among the chronic diseases that need quality care to be given to clients; using evidence based practice interventions like lifestyle modification and medication compliance are some of the ways that can assist in enhancing quality care to the patients. Some evidence suggests that all the above strategies may help diabetic patients have better control of their condition and hence reduce cardiovascular disease. Moreover, interdisciplinary cooperation and continuity of care could also mean that all-round care is given to the patients, which includes not only the physical but also psychosocial domain.
In order to give the patients such as Mr. Mathew the best care, the care team involves primary care givers, diabetes specialists, endocrinologists, nutritionists and other health care
professionals in order to offer a comprehensive care plan. This may include diet, exercise, pharmacological management and the application of measures that can improve blood glucose level management and also improve the healthy well-being of the human being (Gillani et al., 2020).
Improving Quality of Care and Safety
As a nursing student, it is my role to increase the quality of care delivered to patient with diabetes using an integrative approach. Making sure the right medicines are given to the patients and the ones compatible with their treatment plans and using medical devices in the monitoring of blood glucose is important. The emphasis is made on increasing the quality of life of the patient by eliminating the stress factor because stress is a major cause of diabetes. Further, diet and physical activity modification is also necessary to ensure that the glucose levels remain low (Cannata et al., 2020).
Diet counselling and exercise training of diabetic patients can enhance the tolerance of the patient as well as the quality of life of the patient. It also involves the knowledge of self-management measures such as the symptom monitoring. The counselling and support groups are helpful to tackle the psychological part of the disease which ensure that the care plan is beneficial to the patient (Winkley et al., 2020) By the adoption of these strategies, the healthcare providers will be in a better place to enhance the quality of care they offer as well as the results of the diabetic patients. The use of these strategies for the improvement of medical condition of the patient including Mr. Mathew can go a long way in improving the health of the patients.
Impact on Cost Reduction
As nursing student, it is my duty to ensure that the management of diabetes is affordable to the patient and the health facility. This is achievable using a multi-dimensional approach. It
will help in making sure that the patients such as Mr. Mathew gets quality and affordable treatment to treat his conditions. The healthcare plan which calls for better insurance plan that involves provision of medical devices may at first appear to be costly, but it has some overall health costs benefits in the long run.
Also, there is an opportunity to enhance the overall medication management that involves the affordable medications, and where possible generics. Thus, the burden of diabetes is going to be decreased in the population which will have positive effects on the health economy (Mohan et al., 2019). The home based care programs and telemedicine can also help in increasing the likelihood of patients receiving care and reduce the need to seek costly admissions. Particularly on self-management education of patients, they can gain the ability to manage their conditions hence reducing high health care consumption.
Furthermore, it can be noted that the multiple care strategies enhance a good coordination of the care of the patients. The quality care given to the patients include timely and appropriate care, less complications and hence expensive interventions. Thus, with the knowledge of the above described care elements, these methods can be used to increase the cost efficiency of diabetic care while providing the required quality (Siegel et al., 2020).
Evidence Supporting the Cited Impact
A lot of research studies are available in the literature that provides evidence to the effectiveness of nursing care in the patient care, safety and cost of the health care system. Some are given below.
A study conducted by Subramanian et al. (2020) showed that nursing intervention in care of the patient contributed to the reduction of blood glucose of the experimental group compared
Likewise, through the research conducted by Lin et al. (2021) the importance of the management of the diabetic patients, especially those who are having retinopathy and neuropathy management through the assistance of the nurses was noted. In terms of costs of care, Aberer et al. (2021) conducted a study as to the evaluation of cost of care of the diabetes patients, who are being supervised by the nursing staff through the use of telemedicine. A very high level of cost reduction was realized in the study as highlighted in the results section. In the same way, Powers et al. (2020) explored the effectiveness of nursing care in disease management by electronic healthcare system and found out that there was a reduction of costs related, for the health systems and the patient.
Sources of Benchmark Data
To assess the quality, patient safety and costs, relevant benchmark data include hospital quality reports, surveys, and healthcare costs databases. From a statistical data given by Agency for Healthcare Research and Quality (2024) among the total hospitalizations in US, around 8 million were directly due to type 1 or type 2 diabetes. According to National Institute of Health (National Institute of Diabetes and Digestive and Kidney Diseases, 2024), 38.4 million or 11.6% of the US population suffered from diabetes in 2021. According to the data provided by Health Resources and Services Administration (2021) One of seven patients in US has diabetes, while around nearly one in three of those has uncontrolled diabetes. According to (CDC, 2024a), around 29.7 or around 8% population of US have been diagnosed with diabetes.
During my nursing practicum, I interviewed with Mr. Mathew for two hours. We discussed the quality of health care, cost and safety measures to address diabetes were of crucial importance. During the assessment we considered the effectiveness of the use of medications and monitoring devices to increase their utility and relevance to the patient while maintaining the cost of the patient in mind. The importance of communication with the multidisciplinary care coordination team was also discussed in relation to patient management. Altogether, the knowledge acquired during this practicum was rather beneficial for assessing the patient and the possibility to reveal the course of diabetes for Mr. Mathew.
Conclusion
Diabetes is a chronic disease that impacts the large population of the American community, and hence requires a multi-disciplinary approach to its management. The information and evidence based studies can be used as an insight in the improvement of patient status and decreasing the economic burden of diabetes and its complications. The strategies for the medication management, behavioral and lifestyle therapies and the low-cost care can greatly improve the quality of life of the diabetic patients. The knowledge from the authorities is the norm and serve as benchmarks which the healthcare providers can use to enhance their practices in diabetes. Thus, due to the application of these strategies and through the comparison with the benchmark data, the healthcare systems can improve the quality of diabetes management at low costs for the patients such as Mr. Mathew, who have been suffering from the outcomes of the disease for many years.
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