hsma final 1

IE5400 Spring 2023 Jay Bhavsar 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 possible. 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. relies heavily on randomized controlled trials 2. when evidence did not exist, it used effective multidisciplinary groups for consensus-driven recommendations 3. 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 improv e Econo mic Stabilit y, 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. Proposals to cap beneficiary drug spending and limit price increases would improve access, to those with low incomes and historically marginalized groups. 4. Congress must enable Medicare negotiation for drug prices to allow Americans to access the medications they need at reasonable and affordable 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, shortage of resource availability Timeliness in information transfer is related to improved PICU outcomes. Multiple processes and personnel must interact to provide high-quality, error-free care. Multidisciplinary critical care teams are required. A vital role that affects the functioning of the team is the communication. Machine learning and prediction models can be used by health systems to enhance patient flow for various organizational departments. Reducing staff overtime, increasing patient outcomes, and increasing clinician and patient satisfaction are all benefits of better patient flow in hospitals. 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 combine all data sources. 3. Form a comprehensive leadership team to regulate 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. Operati ons Resear ch can be used to providi ng system atic ways for diagno sing, treating

y to both help lower long waiting times by getting sick patients into beds rapidly and discharge people faster, thereby shortening their stay. Health care systems engineers are the highly skilled who can bring the skills necessary, expertise, and techniques to bear on such an optimization. 2. Healthcare Engineers Help with Doctor Shortages.There has been a premonition about shortages of health care professionals by 2025. Making sure there is an adequate supply of health care in the right places, in the right specialties, and at the right times, is a health care system engineering challenge. 3. Healthcare systems engineers are also working 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 also help in cutting down costs and resources used. 4. Systems engineers can used OR and Logistics and warehouse scheduling to deliver life-saving drugs on time and economically.

Question 2 Quality aim 1: Safe Very few studies have been done regarding lumpectomy and mastectomy . 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

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.

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