Healthcare

Evaluate appropriate methods of healthcare data collection and interpretation for informing organizational decision-making.  Assess healthcare performance improvement initiatives for addressing gaps in organizational performance.  Evaluate requirements of current quality and safety initiatives for how they promote the culture of safety in healthcare organizations.  Formulate communication and teamwork strategies in quality management that engage diverse stakeholders within healthcare organizations.  Evaluate information management systems and patient care technologies that promote healthcare quality Prompt Begin by identifying an organizational problem within your own workplace healthcare setting or a hypothetical healthcare organization.  Propose an initiative that addresses this chosen problem, utilizing evidence-based literature and quality standards.  If you choose a problem in your workplace, be sure to utilize data from that healthcare organization; if you have created a hypothetical healthcare organization, you may use a public domain database with instructor permission. As this is a scholarly initiative, this assignment must adhere to all APA requirements and formatting, and include peer-reviewed and evidence-based sources to support any and all claims. Specifically, the following critical elements must be addressed: I. What Is the Organizational Problem?  A. Provide a contextual basis for the organizational problem that you have chosen. How does this problem fail to meet quality or other regulatory requirements?  B. Articulate organizational challenges posed by the problem (e.g., interdepartmental conflicts, communication failure, budgeting issues).  II. Evidence-Based Support A. Provide data that supports the existence of the problem. You may utilize public sources to find data related to your selected problem.  B. How has this problem been addressed in the past? What information management systems or patient care technologies have been utilized when addressing this problem? Be sure to use peer-reviewed literature to support your answer.  C. Discuss relevant accreditation standards, safety standards, compliance standards, and quality initiatives. How do these standards promote a culture of safety within the department? Be sure to cite the appropriate standards within your answer.  III. Performance Improvement Initiative A. Propose an initiative that will address this problem within the department of your chosen healthcare organization. What specific relevant quality standard will this quality initiative address?  B. Discuss the data determinants of success, as related to this initiative. In other words, what type of data will be indicative of a quality outcome?  IV. Implementation of the Plan in the Organization A. What interdepartmental communication channels will be used for plan implementation?  B. What manner of data interpretation will be used to communicate the findings within the organization?  C. If this initiative was implemented, what do you believe would be the hypothetical effect(s) on patient care outcomes?  How will health information systems support those improvements in patient care?  D. What do you think the hypothetical effect of the quality or performance initiative will be on the culture of safety within the organization?  V. Success of the Performance Improvement Plan  A. If this initiative is successful, what would be the financial implications for the healthcare organization?  B. How would the existing information management systems contribute to the success of your proposal?  C. What organizational processes will permit continued viability of the performance improvement initiative, if it is successful?  D. Analyze interdepartmental communication that would be necessary for continued engagement in the proposed initiative.

Explain at least two individual rights for patients regarding EMR and their health care information. Next, describe three basic safeguards required to protect the security of electronic protected health information (e-PHI). Lastly, speculate on what happens if a breach occurs. Provide support for your response.

Management strategies for ARDS include correcting hypoxemia and acid-base disturbance, restoring cardiac function, and treating the underlying disease or precipitating factors. This is generally accomplished with mechanical ventilation at 6-8 ml/kg ideal body weight and the application of PEEP to correct refractory hypoxemia. High levels of positive pressure may be required to produce adequate ventilation and oxygenation, but its adverse effect on cardiac function must be monitored closely. Some patients may benefit from pressure control (PC) ventilation to minimize the mean airway and parenchymal lung pressures. In PC mode the inspiratory time is increased and pressures are generally reduced, but the mean airway pressure may remain the same or slightly increased. This ultimately shortens the inspiratory time, inverts the I:E ratio, and potentially increases alveolar ventilation. As inspiratory time increases, and the elastic limit of the lung is reached, intrinsic PEEP increases air trapping and thus, may increase the PaCO2 while also increasing the occurrence of pneumothorax in an already stiff lung. These important considerations must be kept in fine balance with each factor receiving equal attention. More information about ongoing studies for ARDS can be found at www.ardsnet.org  (Links to an external site.) Management of ARDS A multitude of causative factors may produce acute respiratory distress syndrome (ARDS). The clinical manifestations associated with ARDS usually appear within 6-72 hours of an inciting event, and worsen rapidly. The patient initially presents with dyspnea, cyanosis, bilateral crackles, tachypnea, tachycardia, diaphoresis, and use of accessory muscles on inspiration. A cough and chest pain may be present. The general clinical course is characterized by several days of hypoxemia that requires moderate to high concentrations of FiO2. The bilateral alveolar infiltrates and diffuse crackles are persistent during this period, and the patient’s overall health status is fragile as a result of the severe hypoxemia. Most patients who survive this initial clinical course begin to show oxygenation improvements and decreasing alveolar infiltrates over the next several days. Permissive hypercapnia, allowing the patient’s PaCO2 to increase, is used as a tradeoff to protect the lungs from high airway pressures. In most cases, an increased ventilator rate adequately offsets the decreased tidal volume used in the management of ARDS. The PaCO2, however, should not be permitted to increase to the point of severe acidosis (a pH below 7.2). Inverse Ratio Ventilation (IRV) IRV is a subset of PCV where the inflation time is prolonged, (In IRV, 1:1, 2:1, or 3:1 may be used. Normal I:E is 1:3). This lowers peak airway pressures but increases mean airway pressures. The result may be improved oxygenation but at the expense of compromised venous return and cardiac output, thus it is not clear that this mode of ventilation leads to improved survival. IRV’s major indication is in patients with ARDS with refractory hypoxemia or hypercapnia in other modes of ventilation. Prompt Case Study: Adult Respiratory Distress Syndrome History: Ms. Y is a 23 year-old woman who was feeling fine until the morning of admission when she began having severe chills, vomiting, diarrhea, headache, and fever of 40*C. The symptoms persisted throughout the day and caused her to seek medical attention at the local ED. Ms. Y had an intrauterine device (IUD) inserted at a local family planning clinic 3 days before admission. At the time of admission, she denied shortness of breath, wheezing, sputum production, cough hemoptysis, orthopnea, chest pain, illicit drug use, or exposure to TB. Physical Exam: -General Patient is well nourished, alert & oriented; she appears anxious but there is no evidence of respiratory distress -Vital Sign: Temp 40*C; RR 24 bpm; HR 104/min; BP 126/75 -Chest: Normal configuration & expansion while breathing; normal resonance to percussion bilaterally -Lungs: Clear to auscultation bilaterally -Abdomen: Lower abdominal tenderness to palpation -Extremities: No cyanosis, edema, or clubbing Lab Data: -CBC WBC 15,500 (high) Question #1 Does the patient appear to have a pulmonary problem at this time? Why or why not? Question #2 Does the patient’s medical problem predispose her to the development of ARDS?   Ms. Y has been started on IV antibiotic therapy. Results of a uterine swab show gram-negative diplococci, and a preliminary blood culture also shows gram-negative cocci. Twelve hours later, she begins complaining of increased shortness of breath. Assessment: RR 34 bpm; HR 120/min She is using accessory muscles to breathe and chest auscultation now reveals fine, inspiratory crackles bilaterally. ABG: on RA -pH: 7.25 -PaCO2: 21 mmHg -HCO3: 16 mEq/liter -BE: -17 -PaO2: 62 mmHg -SaO2: 88% Question #1 What is the pt’s acid-base & oxygenation status? Interpret the blood gas and explain your answer. Question #2 What pathophysiology accounts for the adventitious lungs sounds (fine, inspiratory crackles)? The patient continues to experience severe respiratory distress and is placed on an air entrainment mask with a FiO2 of 60%. ABG on 60% FiO2: -pH: 7.26 -PaCO2: 35 mmHg -HCO3: 16 mEq/liter -PaO2: 49 mmHg Assessment: -RR 38 bpm -HR 134/min The chest film demonstrates an onset of diffuse bilateral infiltrates in the lower lobes; greater on the patient’s right side. Question #1 Interpret the ABG. Question #2 What initial settings would you place the patient on? Include mode of ventilation and indicate Why? Submit your answers in at least 500 words on a Word document. You must cite at least three references to defend and support your position.

Final Paper The Final Paper must have depth of scholarship, originality, theoretical and conceptual framework, clarity and logic in its presentation and adhere to grammar guidelines. You select either one of the emerging managed healthcare delivery models, Accountable Care Organizations or Patient-Centered Medical Homes, for your Final Paper. The 10-15 page paper (excluding title and reference pages) must follow APA style as outlined in the Ashford Writing Center  (Links to an external site.)  and contain at least 10 scholarly, peer-reviewed, and/or other credible sources published in the past five years in addition to the course text. Your paper must address the following bolded topics, which should be titled appropriately in your paper: Include an Abstract which is a synopsis of the overall paper. Managed Health Care Quality – Address what the selected emerging managed healthcare delivery model has done to improve quality of care. Cost Containment – Describe how the selected model has striven to contain the costs. Provider Contracting and Payments – Identify healthcare providers’ contracts and payment methods in the selected model. Effects on Medicare and Medicaid – Summarize the impacts of the selected model on both Medicare and Medicaid. The Emerging Role of Government Regulations – Examine the Patient Protection and Affordable Care Act (PPACA) policies in relation to the selected model. Recommendations – Include three suggestions for improvement in relation to quality and cost. The final assignment for this course is a Final Paper. The purpose of the Final Paper is for you to culminate the learning achieved in the course by developing a research paper to address the selected emerging managed healthcare delivery model. Must be 10 to 15 double-spaced pages in length (excluding title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center.  (Links to an external site.) Must include a separate title page with the following: Title of paper Student’s name Course name and number Instructor’s name Date submitted Must include an introduction and conclusion  (Links to an external site.)  paragraph. Must use at least 10 scholarly, peer-reviewed, and/or other credible sources published in the past five years in addition to the course text. The Scholarly, Peer Reviewed, and Other Credible Sources  (Links to an external site.)  table offers additional guidance on appropriate source types. If you have questions

Choose from the following topic areas…  The Pro’s and Cons of the Affordability Care Act Health Insurance for All Americans – Does it help or harm? Health Information Technology and the Impact on the Quality of Care The Emotional State of America – Mental Health services for women and men for emotional health and mental well being.

To begin, research a news article about a policy that impacts population health. Some topic ideas include policies relating to physical activity, drinking and driving, texting and driving, and nutrition. In your initial post, address the following: Using the example you found, discuss how the specific policy either positively or negatively impacts public health. Be sure to link to the specific article for your peers’ review.

Read “The ‘ICE’ Strategy” on Human Resource Management (pp. 8–9) of the PDF in Aetna: Investing In Diversity Case. Also review Exhibits 6 and 7 on pp. 22–23 of the case study to see the link between Aetna’s strategic focus and the diversity outcomes that can result. From Exhibit 7, select one of the eight strategic focuses and one of the 10 diversity implications that you feel relates to that focus. Discuss the relationship between the two and describe three specific actions Aetna could take to accomplish the diversity implication. Include at least one citation and reference in your initial post.

ou just finished analyzing information for the current compensation and benefits program. You find that some changes should be made, as the majority of employees (you have 120 employees) are not happy with what is being offered. In fact, the plan had not been revised in over fifteen years, making it dated and definitely ready for some changes. One of the major points of contention is the PTO the organization offers. Employees feel the current system of sick time and vacation time offers too few options. For example, one employee says, “I often come to work sick, so I can still have my vacation time for my vacation.” Another employee says, “I have given nine years to this organization, but I receive only three days more than someone who has just started.” Here is the current PTO offering: 1+ year 7 days 5+years 10 days 10+ years 14 days What cost considerations would you take into account when revising this part of your compensation plan? What other considerations would you take into account when developing a new PTO plan? Propose a new plan and estimate the cost of your plan on an Excel spreadsheet. Be prepared to present to the board of directors.  Include the plan you have developed and discuss the HR concepts and alternative options that you considered while developing your plan.

Depending upon how you’ve decided to address the community’s health needs, select and use a Microsoft Word newsletter template (Links to an external site.) https://templates.office.com/en-us/newsletters to create either a policy brief, that proposes an advocacy agenda OR a fact sheet, that will be used to communicate health information. After reading: Advocacy 101: Getting Started in Health Education Advocacy (SOPHE, 2004) (Links to an external site.) and How to Write A Policy Brief (APA) (Links to an external site.), follow the guide to Policy Briefs (UNC at Chapel Hill Writing Center) (Links to an external site.) to create an appropriate advocacy agenda that is aimed at legislators, public officials, and other government policy makers who are interested in formulating or influencing policy. Your policy brief must include these required elements: Title: A good title quickly communicates the contents of the brief in a memorable way. Executive Summary: This section is often one to two paragraphs long; it includes an overview of the problem and the proposed policy action. Context or Scope of Problem: This section communicates the importance of the problem and aims to convince the reader of the necessity of policy action. Critique of Policy Options: This section discusses the current policy approach and explains proposed options. It should be fair and accurate while convincing the reader why the policy action proposed in the brief is the most desirable. Policy Recommendations: This section contains the most detailed explanation of the concrete steps to be taken to address the policy issue. Appendices (optional): If some readers might need further support in order to accept your argument but doing so in the brief itself might derail the conversation for other readers, you might include the extra information in an appendix. Consulted or recommended Sources: These should be reliable sources that you have used throughout your brief to guide your policy discussion and recommendations for further reading. Examples: Search Google for “health policy brief example (Links to an external site.)” and view the print/pdf versions of CDC policy briefs, or any of the other briefs that interest you.

A hospital, Beds R Us, entered into the following three arrangements with various healthcare providers:  First, Beds R Us had a five year contract with a physician, I.M. Cure, to serve as a part-time Medical Director on an independent contractor basis. The contract specified the amount of hours Dr. Cure was to work as well as the hourly rate he was to receive, which was consistent with fair market value and was commercially reasonable.  At the time Dr. Cure originally signed the five year contract, he was referring approximately 50 Medicare patients a month for outpatient services to Beds R Us.  Six months in to the contract, however, his Medicare referrals dropped to about 10 patients per month, at which point Beds R Us advised Dr. Cure that if he did not increase his Medicare referrals to his prior level, Beds R Us would not renew his contract. Dr. Cure never increased his referrals beyond 10 patients per month, and as promised, Beds R Us did not renew his contract.  Second, Beds R Us had an arrangement with an orthopedist, Pai Mee.  When Dr. Mee had a Medicaid patient requiring physical therapy, Dr. Mee provided the patient with a plan of care and a list of hospitals providing physical therapy services.  Dr. Mee never told a patient to choose any particular hospital.  Under its arrangement with Dr. Mee, Beds R Us nevertheless paid Dr. Mee a fixed sum whenever one of his patients selected Beds R Us for physical therapy services. Third, Beds R Us had an agreement with Mix Up, a pharmaceutical company, to buy its disfavored pain killer in exchange for a 50 percent discount on its highly touted cancer drug.  The drugs were billed only to private pay plans. None of the claims or charges submitted to these plans disclosed the existence of the discount arrangement. Explain which of the foregoing three arrangements, if any, violates the Anti-Kickback Act and why, and what the potential criminal, civil, and administrative consequences would be for any such violation.