hsma final 1

IE5400 Spring 2023 Question 1-Building a better delivery system Quality Aim 1: Safety The Institute of Medicine's report on medical errors and patient safety brought considerable attention to the problem of injury suffered by hospitalized patients. The increasing focus on improving patient safety through reducing medical errors and adverse events in the high-risk PICU (Pediatric Intensive Unit) environment are palpable. We need to design better interventions to reduce adverse occurrences and improve our understanding of the types of errors and the circumstances within the environment of care that contribute to these errors. There are various Categories that the Institute of Medicine has categorized the errors 1. Diagnostic error- Autopsies have been used to detect missed diagnoses that may have had ante mortem (before death) problems. 2. Treatment Errors-Medication errors are the most common errors. The potential of error with high-risk drugs are great due to the fact complex drugs, which when administered often require meticulous calculation. The way to reduce this error is to use Unit-Based Pharmacist. Studies show that the average Clinical ICU pharmacist intervened approximately 35% of the time. Quality Aim 2: Effectiveness Evidence- based practice incorporates the best research evidence, clinical experience, and patient values to achieve the best solutions for the patient. The pediatric traumatic brain injury guideline is an excellent guideline 1. a) it relies heavily on randomized controlled trials 2. b) when evidence did not exist, it used effective multidisciplinary groups for consensus-driven recommendations 3. c) the guidelines are clearly a “work in progress” recognizing that recommendations will change as new data become available Quality aim 3: Equity The Goal of equity is to provide impartial care for populations and to individuals that is free from bias related to race, insurance status, income, or gender. A 25-yr study of mortality associated with congenital heart disease found that black patients had a 20% higher mortality rate than white patient. Solutions 1. Reduce poverty and improve Economic Stability, people who do not hold a fixed job have poor health outcomes. 2. Health care access and affordability remain a major problem for many Americans, especially those with low incomes and historically marginalized groups. Policymakers could expand access to health coverage, lower costs for care and treatment, and improve the quality of health care services. 3. Proposa ls to cap benefici ary drug spendin g and limit price increase s would improv e access, to those with low income s and historic ally margina lized groups. 4. Congre ss must enable Medica re negotiat ion for drug prices to allow Americ ans to access the medicat ions they need at reasona ble and afforda ble rates. Quality Aim 4: Timeliness

The IOM report characterizes timeliness in two ways. A “customer service” looks for issues such as timely and effective communication and wait times. Second, and more important to ICU patients, lack of resource availability can risk adverse outcomes. Timeliness in information transfer is related to improved PICU outcomes. The ICU is a complex and dynamic, tightly coupled system. Multiple processes and personnel must interact to provide high-quality, error-free care. Multidisciplinary critical care teams are required. A principal component that affects the functioning of the team is the communication. Health systems can leverage machine learning and predictive models to improve patient flow for different departments throughout the organization. Improving hospital patient flow results in reduced patient wait times, reduced staff overtime, improved patient outcomes, and improved patient and clinician satisfaction. By focusing on three critical areas, health systems can foster successful data science that will lead to improved hospital patient flow: 1. Build a data science team. 2. Create a machine learning pipeline to aggregate all data sources. 3. Form a comprehensive leadership team to govern data. Quality aim 5: Patient Centerness Patient centeredness as an IOM aim helps to characterize the interactions between practitioners and their patients.In multiple institutions study in hospitals patients reported problems with more than 25% of health care processes. The most common were inadequate information and lack of coordination. Solution 1. Operations Research can be used to providing systematic ways for diagnosing, treating, and preventing disease, as well as developing many more processes for improving population health and quality of care and life. OR can also be used to allocate shifts to hospital staff for better coordination. 2. William P. Pierskalla is another pioneer of healthcare Operations Research. He built models for scheduling nurses and optimizing patient care in hospitals and developed a better system for scheduling, as well as including a behavioral analysis component – such as how many days off nurses typically wanted and how often to schedule them for weekends. This work was implemented in over a dozen hospitals in the first year of use. 3. -Increasing family involvement, A partnership between members of the PICU team and the family of the patients Quality Aim 6: Efficiency- Certain websites such as Patient Care Link allow consumers and healthcare industry workers to view hospital data and trends. Review data and see which organizations excel in a particular area in which you are looking to improve. Question 1 part 2. If used correctly, technology and analytical tools with unprecedented power (such as artificial intelligence and machine learning) will reduce costs, extend the reach of health care services, and save lives. Experts are needed who are well-versed in both technology and health care. In other words, the new health care system will need healthcare systems engineers. Healthcare systems engineers represent an important part of the engine that is going to drive health care forward. They will streamline processes, improve the way patients receive treatment, and develop efficiencies to reduce costs.

Question 2 Quality aim 1: Safe Health care delivery should be safely administered by reducing medical errors and adverse events. Medications errors are most common treatment errors there is a huge risk with complex medication and how the wrong medication could give rise to side effects. More studies relating to lumpectomy and mastectomy would give Mrs. Martinez a better chance to fight her ailment. Quality aim 2: Effectiveness Mrs. Martinez would have an Effective treatment if the different multidisciplinary groups Mentioned like the surgeon, an oncologist, and a radiologist would have come together sooner and discussed her problems for consensus recommendations. Quality aim 3: Equity Ms. Martinez was a single parent in her early 50's she had trouble getting an appointment with the doctor and two of the doctors refused to take new patients.Ms. Martinez was shown discrimination by the two doctors by them refusing her health care access. Secondly, she was discriminated on basis of her insurance plan or the fact that she was a single parent with two kids. Solutions Improve Economic conditions, due to centuries of marginalization, certain populations suffer from economic instability more than others. Working parents need access to quality and affordable child care to find and keep a job. Yet the cost of child care is at least equal to the average mortgage payment and more than twice the average car payment per month. Quality aim 4) Timeliness the first available non-urgent appointment was in 2 months, Ms. Martinez had to wait for an hour to meet her doctor, was given an appointment for a mammogram in 6 weeks, the first opening with the surgeon was 9 weeks later. All these instances show that Ms. Martinez had problems with timely Health care access. She was not told about abnormal finding about her Mammograms which were circled the previous year Solution Multidisciplinary critical care teams are required. A principal component that affects the functioning of the team is the communication, especially nurse-physician communication. When the practitioners can participate in an open dialogue and exchange opinions concerning a patient’s condition, timely interventions can be made that improve patient outcomes. These issues are related to the recent observation that better management associated with improved outcomes Quality aim 5- Patient Centeredness she hoped she would not run out of her blood pressure medication in the interim, staff suggested that she arrange to have her old films mailed to her. Personnel traits comprising service quality include empathy, compassion, and respect were missing in Ms. Martinez' case. She did not receive the quality of care expected, having to wait for long hours being told to deliver her mammograms, and being told to schedule meeting on her own. Solution:

1. Better coordination between the nurses and health professionals in delivering the possible care needed. 2. Adequate Research about lesser studies Ailments could have improved Ms. Martinez situation. Quality aim 6: Efficiency The System was not efficient at all, Appointments being scheduled after months, mammograms not being mailed on time and aberrant findings not being delivered to the patient on time are all inefficient methods Solution- The Appointments must be better organized and according to the severity of the sickness furthermore. Employ healthcare systems engineers to cut waste — for example, the time taken up by unnecessary procedures — and reapplying that capacity to increase the capabilities of the health care system. Question 3- problems involving in emergency department (ED) Emergency departments (ED) are a critical and indispensable component of the U.S. healthcare system which is why crowding has become a concern. A vast majority of people use it for nonurgent care and conditions which can be treated in a primary care setting. Here are five causes of emergency department overuse: Patients have limited access to timely primary care services. 1. The emergency department provides convenient after-hours and weekend care. 2. The emergency department offers patients immediate reassurance about their medical conditions. 3. Primary care providers refer patients to the emergency department. 4. Hospitals have financial and legal obligations to treat emergency department patients. 5. Lack of health care rehabilitation and respite facilities leads to a shortage of beds. The consequences of ED Overuse: 1. 1) ED becomes Overwhelmed, filling up the waiting room and delaying care for those patients leading to a risk of patient harm. 2. 2) Excess costs - the cost of ED is between 2 to five times that of primary care 3. 3) Fragmented care - the ED patients do not understand the emergency department instructions and the ED rarely coordinates with the other departments because it is loaded with patients. The solution: 1. Increasing access to primary care services can reduce ED overuse by up to 60% 2. Direct Primary care is when patients pay a monthly fee in exchange for unlimited primary care services such as all-day access and unlimited appointment scheduling 3. Study patient volume over time, ED can avoid triage by staffing appropriately and accurately. Refrences