Portion 1
Patients with Heart Failure: Quality Improvement Strategies that Helps Prevent Readmissions
The objective and goal of this paper will be to evaluate a quality improvement plan, and strategies implemented in LMC to reduce readmissions of patients with heart failure. In the United States heart failure is the main reason patients 65 years of age or older are hospitalized (Joynt, & Jha, 2011).
Medicare spent over seventeen billion on these patients due to being hospitalized (Setoguchi, & Stevenson, 2009). Medical treatment of patients has improved since CMS began publishing heart failure readmissions through the Hospital Readmission Reduction Program (HRRP) in 2012 (CMS, 2013). Reduction of readmission rates will reduce costs, and improve quality of care for these patients (Affordable Care Act, 2010). The high readmission rates have caused the government to penalize hospitals if patients are readmitted within the first thirty days after discharge. In a bid to ensure that patient readmission rates are incredibly cut. Hospitals particularly those that offer treatments on heart related complications have been forced to adopt strategies that will in essence reduce readmission rates. In our case, a particular focus on the quality improvement plan and the strategies adopted in the aftermath by LMC will be scrutinized.
LMC’s Mission, Vision, and Values
This quality initiative is in alignment with LMC’s mission, vision, values, and strategic plan, and goals. Mission is: “Our family caring for your family, your quality of life our passion.” Vision of LMC is: “to be a nationally renowned academic medical center always providing compassionate care and service.” Values of LMC are: “ICARE which stands for integrity, compassion, accountability, respect, and excellence.” The mission, vision, values and strategic goals were rewritten last year. The focus of the hospital became one of quality and education. Improving patient care through quality programs such as reducing heart failure patient’s readmission rates by five percent this year became the priority for the entire staff. LMC’s vision, mission, and values statements are important components of the strategic plan. The vision statement focuses on becoming a nationally known teaching facility that focuses on care and service to the patients. The mission targets the purpose of LMC and its existence of caring for patients as if they were family members, and quality care being the priority. The values address behavior and guiding principles for the team members on how to act and achieve the mission and vision. Quality plays a big part of LMC’s overall mission and vision and is the underlying force driving profitability and success of the hospital.
The objective of LMC’s quality program was to treat the right patient in the right setting while lowering health care costs. Continuous improvement, learning, participation, teamwork, and a customer focus was the foundation for the heart failure program. The principles adopted followed the Donabedian model and divided the program into the three components: structure, process, and outcomes. Structure of the heart failure program involved hiring a nurse practitioner, and creating a post-discharge clinic. Process occurred through the nurse practitioner working with staff nurses, cardiologists, and patients to provide better healthcare. Outcomes included the effects of the nurse practitioner improving patient outcomes through the post-discharge clinic. The strategies implemented were centered around: a customer focused organization, leadership involvement of people, process approach, system approach to management, continual improvement, metrics, and facts are collected to improve decision-making processes. A multidisciplinary approach that monitors heart failure patients from admission through thirty days after discharge at LMC is the core of the congestive heart failure quality program. A collaborative approach is necessary, and the entire team has to be committed to continuing to reduce readmission rates of heart failure patients by five percent by the end of the year.
Apparent from the Paradigm above is the fact that an effective program has to undergo a certain process that will in essence make it dynamic or rather positive towards achieving the set objectives. In relation to LMC, it is important to note that profound research was done prior to adopting the strategy mentioned herein. Irrespective of the fact that the data provided by LMC in regards to the subject matter is perceived to be accurate and ingenuous. It is of utmost importance while analyzing not to lean or rather solely focused on the information provided.
Performance Analysis
As a way of acquiring the necessary information, reading the historical evidence of the organization’s performance as it relates to the quality improvement issue will be imperative and of utmost significance. Addtionally interviews and questionnaires will be filled by those who have been in the organization for more than ten years. Considering that they have a clear picture of hospital readmissions in the past at LMC, it will be much easier to merge the current status with the historical past in the organization. Hence establishing in essence the effects of the program in place. By conducting observational studies and incorporating the use of quality indicators that are closely monitored to avoid bias. It will be much easy to assess the current qualitative and quantitative data that will in essence establish the current performance of the organization in regards to the program and the issue at hand (Joint Commission International, 2011).
Apparently, considering that that target of LMC is to in effect reduce the rates of hospital readmissions to an insignificant number as a way of embracing quality defined in their mission and vision statement. It is imperative to establish the fact that there exist gaps between the current performance and this target (La & Couttolenc, 2008). Firstly, the fact that the program requires a regular follow-up of patients upon being discharged from the discharge clinic makes it even more complicated and costly since the hospital will have to make use of its resources as a way of attaining their target of offering quality services to the patients (Schiller, 2014). Another gap that is likely to act a hindrance to the program stem from the fact that there is an increased prevalence of heart disease. That will in essence stir the need to hire more practitioners in an effort to offer quality and adequate services. In general, the program is outstandingly effective though there exist some negligible gaps.
In future, the effectiveness of this program will be evaluated by establishing the extent to which LMC has eliminated the gaps that were mentioned. It will entail the use of inpatient quality indicators, output indicators, qualitative indicators and financial indicators. By the use of these indicators the hospital will in essence determine the hospital quality care using the hospital data collected using the methods mentioned herein (Schulz & Johnson, 2003). Measures will entail the use of Agency for Healthcare Research and Quality (AHRQ). The target of the program was to reduce the rates of readmissions to insignificant levels that in essence will be achieved in the aftermath if LMC strongly adheres to the program and seek appropriate improvements to the same.
Summary
Subsequent to the increased need to reduce the rates of readmissions to hospitals in regards to patients with heart failures. LMC this portion of the paper inherently sought to analyze rather scrutinize the quality improvement plan, and strategies implemented in LMC to reduce readmissions of patients with heart failure. In a bid to establish the efficiency of the program adopted (in this case the post-discharge clinic), interviews and questionnaires were adopted to collect information. In addition, appropriate indicators and measures were adopted to eliminate the gaps established.
References
Joint Commission International., & Joint Commission on Accreditation of Healthcare
Organizations. (2002). Joint Commission International accreditation standards for hospitals. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations.
Joynt, K.E., & Jha, A. K. (2011). Who has higher readmission rates for heart failure, and
why? Implications for efforts to improve care using financial incentives. Care Cardiovasc Qual Outcomes, 15(4), 53-59.
La, F. G. M., & Couttolenc, B. F. (2008). Hospital performance in Brazil: The search for
excellence. Washington, DC: World Bank.
Schiller, M. R., Miller-Kovach, K., & Miller, M. A. (2014). Total quality management for
hospital nutrition services. Gaithersburg, Md: Aspen Publishers.
Schulz, R., & Johnson, A. C. (2003). Management of hospitals and health services:
Strategiissues and performance. Washington, D.C: Beard Book.
Setoguchi, S., & Stevenson, L. W. (2009). Hospitalization in patients with heart failure: Who
and why. Journal of American Coll Cardial, 54(3), 1703-1705.
