Capella 4900 Assessment 2

Capella 4900 Assessment 2 Assessing the Problem Quality Safety and Cost Considerations

Name

Capella University

NURS-FPX 4900 Capstone project for Nursing

Prof. Name

Date

Assessing the Problem: Quality, Safety, and Cost Considerations

Hypertension significantly impacts healthcare quality and patient safety and incurs costs to patients and organizations by increasing the risk of complications (Wierzejska et al., 2020). This part of the capstone project analyzes the impact of the patient problem, i.e., hypertension, on these three aspects of healthcare. During two practicum hours, I explored care quality, patient safety, and healthcare costs associated with disease management for Claudia Lara and her family. 

Hypertension’s Influence on Care Quality, Patient Safety, and Costs

According to the literature, around 30.7% of adults in the United States are diagnosed with high blood pressure or HTN (He et al., 2023). In Claudia’s case, HTN has a significant impact on the quality of care provisions, patient safety, and healthcare expenses for the patient and the health system. 

Impact on Care Quality

Hypertension significantly impacts the quality of care by necessitating multifaceted, intensive, and frequent medical interventions due to the disease’s chronic nature. When uncontrolled, this medical condition can lead to severe complications impacting the delivery of quality services (Mancia et al., 2023). For Claudia, her poor medication adherence and unhealthy lifestyle contribute to uncontrolled blood pressure, leading to hypertensive emergencies that require urgent hospital visits. Moreover, her financial constraints lead to limited access to medical resources, ultimately influencing her care excellence and quality of life. In my nursing practice, I see that healthcare providers ensure consistent follow-up and patient education to improve care quality and prevent complications, aligning with evidence-based practices (EBP) (Mancia et al., 2023).

Impact on Patient Safety

Hypertension and its associated complications are essential risk factors for patient safety. Poorly managed hypertension can lead to life-threatening conditions, thus requiring adequate adherence to treatment regimens (Hamrahian et al., 2022). In Claudia’s case, she is at high risk of patient safety due to her medication non-adherence, stemming from a lack of financial resources. Additionally, her pool lifestyle habits make her vulnerable to uncontrolled blood pressure, leading to sudden health crises. This evidence aligns with my clinical observations, where nurses often encounter patients suffering from preventable complications due to inadequate hypertension control. Thus, ongoing follow-ups, medication adherence, and constant reinforcement are considered essential to mitigate these health risks and maintain patient safety. 

Impact on Care Costs

The American Heart Association (AHA) reports that the annual national costs for hypertension are $47.3 billion and $3.9 billion in direct and indirect expenses, respectively (Park et al., 2020). This indicates that HTN imposes substantial costs on both the healthcare system and the individual. Hospitalizations for hypertensive emergencies, as experienced by Claudia, result in high medical expenses, including emergency care and potential long-term treatment for complications. Moreover, her loss of job exacerbates the inability to afford medications, creating a cycle of poor health and increased expenses. However, regular screening, early interventions, and effective management of the disease are proven to deliver cost-effective benefits for patients as well as the healthcare system (Mancia et al., 2023). In my nursing practice, I have observed nurses and other providers advocating for affordable care options and preventive measures to reduce these costs and improve patient outcomes.

Nursing Practice Standards and Healthcare Policies 

Nursing practice standards from the American Nurses Association (ANA) and healthcare policies like the Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act (HIPAA) substantially influence the impact of HTN on care quality, patient safety, and cost. The ANA’s nursing practice standards emphasize EBP, patient-focused care, and ongoing quality enhancement (Ernstmeyer & Christman, 2021). These standards impact the quality of care by ensuring nurses are well-trained in current best practices for managing chronic health conditions like hypertension. For Claudia, adhering to ANA standards means providing thorough patient education on medication adherence and lifestyle changes, regularly monitoring her blood pressure, and collaborating with interdisciplinary teams to address her health needs comprehensively.

Similarly, the provisions of the ACA policy aim to reduce healthcare costs and enhance healthcare accessibility. Moreover, the ACA’s emphasis on care coordination and chronic disease management programs helps reduce hospital readmissions and emergency visits, lowering healthcare costs (Jiang et al., 2023). It includes provisions for preventive services without additional costs, which can benefit Claudia by providing access to regular blood pressure screenings and counseling on lifestyle changes. This approach can help manage Claudia’s hypertension more effectively, reducing the economic burden on both patients and the healthcare system.

Lastly, HIPAA policy safeguards patient privacy and confidentiality, which are crucial for maintaining trust and safety in healthcare settings (Edemekong et al., 2024). The act focuses on confidentiality and enhances patient safety by preventing unauthorized access to sensitive information, reducing the risk to patient safety. By safeguarding Claudia’s medical information, HIPAA policies create a secure environment where she can freely discuss her health concerns, including her hypertension management struggles. Nurses must adhere to HIPAA regulations by protecting patient data and using secure communication methods. 

Policy Impacts on Nursing Scope of Practice and Guiding Intervention 

These standards and policies expand the nursing scope of practice by promoting a holistic approach to patient care. The ANA standards will guide my actions by emphasizing the use of evidence-based practices and comprehensive patient education to improve care quality for Claudia (ANA, 2020). This will guarantee her understanding of the importance of medication adherence and that lifestyle changes will be a priority. Secondly, the ACA’s focus on preventive care will direct nurses to leverage available community resources to mitigate financial burdens on Claudia (Jiang et al., 2023). Finally, HIPAA policies will ensure I maintain strict confidentiality, fostering a secure environment for her to discuss her health issues openly. These standards and policies encourage a proactive, comprehensive approach to nursing, enabling me to address the immediate health concerns of Claudia and the broader determinants of health that affect her overall well-being and healthcare costs.

Strategies to Improve Care Quality, Safety, and Costs 

Several strategies can improve the quality of care, maintain patient safety, and minimize healthcare costs for Claudia in managing her hypertensive disorder and associated risk factors. Patient education is crucial. Implementing comprehensive patient education programs can significantly improve the quality of care for Claudia. According to the literature, patient education for cardiovascular disease patients has reduced hospital readmission rate by 36% and has mitigated the risk of mortality by 35% (Marques et al., 2022). By providing detailed information on hypertension management, including the significance of medication compliance, dietary changes, and regular physical activity, Claudia can better understand her condition and actively participate in her care. This education will enhance her self-management skills and reduce the likelihood of hypertensive emergencies.

Secondly, implementing telemedicine services can significantly enhance the quality of care, preserve patient safety, and lessen costs for patients like Claudia. Telemedicine delivers significant improvements in systolic and diastolic blood pressures by approximately 12.45mmHg to 13.2mmHg (Hoffer-Hawlik et al., 2021). Moreover, it reduces healthcare costs by decreasing the need for emergency visits and hospitalizations, providing a convenient and cost-effective way for patients. Telemedicine will allow for regular virtual consultations, enabling continuous monitoring of Claudia’s blood pressure and overall health without the need for frequent in-person visits. This approach will provide timely medical advice, ensure medication adherence, and address Claudia’s health concerns promptly, reducing the risk of complications and offering ongoing support.

Benchmark Data 

The effectiveness of hypertension management strategies can be evaluated using benchmarks from reputable organizations such as the National Committee for Quality Assurance (NCQA) and the Centers for Disease Control and Prevention (CDC). The Healthcare Effectiveness Data and Information Set (HEDIS) by NCQA provides the benchmark for assessing controlled blood pressure for the age group 18-85 years. The benchmark value is <140/90 mmHg (NCQA, n.d.). This benchmark provides a standardized way to measure improvements in Claudia’s disease management. 

Conclusion

To complete this part of the project, I spent two practicum hours with Claudia and her family. I conducted a thorough assessment of her hypertension management and its impact on crucial aspects. I learned about her hospital admissions, her safety risks, and the financial constraints she is encountering. In conclusion, poor medication adherence, a sedentary lifestyle, and economic constraints are leading to several quality, safety, and expense-related risks for my patient. Standards from ANA and policies like ACA and HIPAA substantially influence these risks and guide the nursing scope of practice. Moreover, evidence-based strategies like patient education and telemedicine have been effective in alleviating these risks, which can be applied in Claudia’s case to improve her well-being, provide efficient healthcare services, maintain safety, and minimize healthcare costs for the patient, her family, and the healthcare system. 

References

ANA. (2020). Nursing scope of practice. American Nurses Association; nursingworld.org. https://www.nursingworld.org/practice-policy/scope-of-practice/

Edemekong, P. F., Haydel, M. J., & Annamaraju, P. (2024). Health Insurance Portability and Accountability Act (HIPAA). Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK500019/ 

Ernstmeyer, K., & Christman, E. (2021). Scope of practice. Www.ncbi.nlm.nih.gov; Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK591808/ 

Hamrahian, S. M., Maarouf, O. H., & Fülöp, T. (2022). A critical review of medication adherence in hypertension: Barriers and facilitators clinicians should consider. Patient Preference and Adherence, 16(16), 2749–2757. https://doi.org/10.2147/ppa.s368784 

Capella 4900 Assessment 2

He, S., Park, S., Fujii, Y., Lange, S. J., Kraus, E. M., Wall, H. K., Therrien, N., & Jackson, S. (2023). State-Level hypertension prevalence and control among adults in the U.S. American Journal of Preventive Medicine, 66(1), 46–54. https://doi.org/10.1016/j.amepre.2023.09.010

Hoffer-Hawlik, M., Moran, A., Zerihun, L., Usseglio, J., Cohn, J., & Gupta, R. (2021). Telemedicine interventions for hypertension management in low- and middle-income countries: A scoping review. PLOS ONE, 16(7), e0254222. https://doi.org/10.1371/journal.pone.0254222 

Jiang, G. Y., Urwin, J. W., & Wasfy, J. H. (2023). Medicaid expansion under the Affordable Care Act and association with cardiac care: A systematic review. Circulation: Cardiovascular Quality and Outcomes, 16(6). https://doi.org/10.1161/circoutcomes.122.009753 

Mancia, G., Cappuccio, F. P., Burnier, M., Coca, A., Persu, A., Borghi, C., Kreutz, R., & Sanner, B. (2023). Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension. Journal of Internal Medicine, 294(3). https://doi.org/10.1111/joim.13678

Capella 4900 Assessment 2

Marques, C. R. de G., de Menezes, A. F., Ferrari, Y. A. C., Oliveira, A. S., Tavares, A. C. M., Barreto, A. S., Vieira, R. de C. A., da Fonseca, C. D., & Santana-Santos, E. (2022). Educational nursing intervention in reducing hospital readmission and the mortality of patients with heart failure: A systematic review and meta-analysis. Journal of Cardiovascular Development and Disease, 9(12), 420. https://doi.org/10.3390/jcdd9120420

NCQA. (n.d.). Controlling High Blood Pressure. NCQA; ncqa.org. https://www.ncqa.org/hedis/measures/controlling-high-blood-pressure/ 

Park, C., Wang, G., Ng, B. P., Fang, J., Durthaler, J. M., & Ayala, C. (2020). The uses and expenses of antihypertensive medications among hypertensive adults. Research in Social and Administrative Pharmacy, 16(2), 183–189. https://doi.org/10.1016/j.sapharm.2019.05.002

Wierzejska, E., Giernaś, B., Lipiak, A., Karasiewicz, M., Cofta, M., & Staszewski, R. (2020). A global perspective on the costs of hypertension: A systematic review. Archives of Medical Science: AMS, 16(5), 1078–1091. https://doi.org/10.5114/aoms.2020.92689