Topic: Health Care Quality
Question: (150 words each)
Based on the following questions, kindly help me respond to the attached peers submission to the discussion
Visit the
Agency for Healthcare Research and Quality
–
https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/summary/All_Measures/All_Topics
Select one of the achievable measures from Diseases and Conditions.
Identify:
- one area where nationally we are at benchmark.
- one area where we are close to benchmark.
- one area where we are far from benchmark.
On the area where we are far from benchmark, suggest a policy to move us closer to Quality.
Bess Trevino
For this discussion, I chose to identify national benchmarks related to preventive care. Since preventive care is the foundation of value-based models and helps contain healthcare costs, it is essential to focus on such benchmarks. Such benchmarks are also crucial for addressing population-based health, reaching Triple Aim goals, and meeting healthy people goals.
One area where nationally we are at benchmark and have exceeded the benchmark relates to blood cholesterol measurements in adults in the last five years. The benchmark goal was to have 82.3% of adults nationally. To date, adults who have had a blood cholesterol test over the previous five years are 89.5% (AHRQ, n.d). High blood cholesterol raises the risk for heart disease, the leading cause of death, and stroke, the fifth leading cause of death in the US (CDC c, 2021). 12% of US adults over age 20 had cholesterol higher than 240mg/dL (CDC c, 2021).
We are close to the benchmark to ensuring women ages 21-65 receive a PAP smear test in the last three years or the HPV vaccine during the previous five years. For this category, the benchmark is 84.2% of women in this age group to receive a PAP smear. Nationally we are at 75.1% (AHRQ, n.d.). While this is about 10% from reaching the goal, preventing cervical cancer in women of all ages is critical. Cervical cancer deaths have decreased in the US in the last 40 years, but it used to be the leading cause of cancer death in women (CDCa, 2021). This decline is associated with regular PAP smear screening. HPV is the leading cause of cervical cancer.
Finally, we are far from the national benchmark to prevent hospital admissions for hypertension in adults 18 and over. The benchmark is 62.6%. Currently, we have achieved 19.1% nationally. This is 227.7% below the benchmark. I chose this benchmark because it is also part of the CDC’s 6|18 initiative previously discussed in this course. One of the strategies to achieve this goal is to improve care coordination using primary care teams, standard protocols, and medication management programs (CDCb, 2018).
A policy I suggest is to enlist a standard protocol for checking blood pressure more frequently in high-risk adults 18 and over. High blood pressure is diagnosed when systolic blood pressure is consistently above 130 or diastolic BP is greater than 80. Diagnoses usually require three measurements a week apart (Fogoros, 2021). Other labs can determine if elevated BP is either essential or secondary hypertension. Annual Well visits should be conducted and are covered at no cost under all health plans. The Well visit provides a prime opportunity for primary care providers to address suspected high blood pressure. The policy should require a month of blood pressure monitoring and reporting. A small portable monitor can be sent home with patients to capture weekly or biweekly BP for capable adults. For patients unable to take their own BP, a home health program should be utilized to check weekly or bi-weekly BP on patients. A one month follow up exam would be required and should be included at no cost to patients, and would initiate the labs- blood (electrolytes, thyroid, blood glucose, BUN/Creatinine) or urine(ketones, kidney failure, illegal substances) (Fogoros, 2021) to rule out secondary hypertension. If hypertension is diagnosed, medication or lifestyle management can be initiated. Policies that provide methods to diagnose and follow-up at no cost to patients are integral for reaching this benchmark.
Agency for Healthcare Research and Quality (AHRQ). (n.d.) .National quality measures.
https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/table/All_Measures/All_Topics#achieved
CDC a. (2021). Cervical cancer statistics.
https://www.cdc.gov/cancer/cervical/statistics/
CDC b. (2018). CDC’s 6|18 initiative. control high blood pressure.
https://www.cdc.gov/sixeighteen/bloodpressure/index.htm
CDC c. (2021). High cholesterol facts.
https://www.cdc.gov/cholesterol/facts.htm
Fogoros, R. (2021). How hypertension is diagnosed.
https://www.verywellhealth.com/all-about-hypertension-diagnosis-1746064
Ashlyn Rudd
Hello Everyone,
I decided to focus on the national diabetes quality measures. The one area where we have nationally achieved the benchmark or better is in the category of adults ages 40 and over who were diagnosed with diabetes who had received at least two hemoglobin A1c measurements in the last year. It was estimated that it would be 74.3, which the benchmark being 79.5 meaning we achieved within 6.5% of that estimate goal. (Agency for Healthcare Research and Quality, n.d.).
One area where nationally we were close to the benchmark is in the category of Adults who have a diagnosis of diabetes that had their feet checked for any type of sores or irritation in the last calendar year. The estimated percentage was 64.1, where we were hoping about 84 % would do it. Sadly, we are deficient 23.7% in hitting the benchmark with is devastating because that is how people we diabetes end up possibly losing their foot. (Agency for Healthcare Research and Quality, n.d.).
Lastly, one area where we as a nation are far away from the benchmark is in hospital admission for lower extremity amputations per 1,000 population in adults with diabetes. The estimated number is about 32.5%, with the benchmark being at 13.5%. That is a 140.0% difference which is crazy to me. Like I said above, if patients do not check their own feet or have someone else do it for them it could end in an amputation. As you can see here it is more common than not, which saddens me. (Agency for Healthcare Research and Quality, n.d.).
One policy that I think could move us closer to quality would be making the patients follow up with their doctor once a year, which they should already be doing, but at that appointment the doctor should check the feet of the patient for any sores that are not healing or any discoloration from damage to the feet and even loss of circulation, as well as ask about any numbness or tingling the patient might be experiencing. If this were on each check-up the patient did with their doctor then maybe we could increase the estimated number to be closer to the benchmark that we hope for as a nation.
Reference:
National Healthcare Quality and Disparities Reports. NHQDR Web Site – National Diabetes Benchmark Details. (n.d.). Retrieved February 22, 2022, from
https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/table/Diseases_and_Conditions/Diabetes#achieved
Jessica Fisher
The National Healthcare Quality and Disparities Report assesses the performance of our healthcare system and identifies areas of strengths and weaknesses, as well as disparities, for access to healthcare and quality of healthcare. According to current national quality measures we have achieved benchmark on respiratory diseases and are close to benchmark on cancer quality measures. However, we are far from benchmark on quality measures related to mental health and substance use disorder (Agency for Healthcare Research and Quality [AHRQ], 2021).
Because several of the measures are related to opioid substance use disorders and overdoses, I think that passing of H.R. 2364 – the Synthetic Opioid Danger Awareness Act, could help enact legislative changes that could help us meet these quality measures. In November 2021, the CDC announced that drug overdose deaths in the United States had surpassed 100,000 per year for the first time ever. Deaths due to opioids—mostly synthetic opioids like fentanyl—accounted for more than 75% of these deaths (Centers for Disease Control and Prevention [CDC], 2021).
The Synthetic Opioid Danger Awareness Act legislation requires the Centers for Disease Control and Prevention (CDC) to implement a public education campaign related to synthetic opioids, including fentanyl and its analogues. The legislation also requires that the National Institute for Occupational Safety and Health produce a training guide and webinar for first responders and other individuals related to exposures to synthetic opioids. Provisions mentioned in the legislation above offer solutions to closing the substance use disorder treatment gap and stopping SUDs before they start. According to the American Psychiatric Association, in order to fully combat SUDs, we must continue to work on legislation that increases access and literacy, decreasing stigma, coordinates care, and encourages everyone to work together to help patients and communities recover from the impact that the opioid crisis has had on our country (American Psychiatric Association [APA], 2021).
References
Agency for Healthcare Research and Quality. (2021, June). National healthcare quality and disparities reports. AHRQ. Retrieved February 22, 2022, from
https://nhqrnet.ahrq.gov/inhqrdr/National/topics/Diseases_and_Conditions
American Psychiatric Association. (2021). APA letter to House leadership requesting action on MH/SUD bills advanced by the Energy & Commerce Committee [pdf]. file:///Users/jessicafisher/Downloads/APA-Letter-House-Leadership-Energy-Commerce-MH-SUD-Bills-08242021%20(2)
Centers for Disease Control and Prevention. (2021, November 17). Drug Overdose Deaths in the U.S. Top 100,000 Annually. CDC. Retrieved February 22, 2022, from
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm
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Melinda
Pariser-Schmidt
On the area where we are far from benchmark, suggest a policy to move us closer to Quality.
The National Healthcare Quality Disparities Reports documents what “quality measures are compared to achievable benchmarks, which are derived from the top-performing States” (NHQDR, 2022). “Low values are desirable for measures such as infant mortality, whereas high values are desirable for measures such as preventative screening” (NHQDR, 2022).
According to the National Healthcare Quality and Disparities Reports we have reached benchmark for children ages 19-35 months who received 4 or more doses of diphtheria-tetanus-pertussis vaccine, we are close to benchmark for infants born in the calendar year who received breastfeeding exclusively through 3 months, and we are far from benchmark for birth trauma – injury to neonate per 1,000 selected live births.
The benchmark I’ve chosen to focus on for our “far from benchmark” category is that we are far from benchmark for birth trauma – injury to neonate per 1,000 selected live births. These benchmarks are derived from the top-performing states which means that even in the best case scenario we still fall quite short of our goal. For this measure the graph shows us that the benchmark is 2.8 / 1000 live births experience birth trauma-injury to neonate, our performance lands us at 4.7/1000, putting us approximately 64.7% shy of achieving the benchmark.
According to The National Vital Statistics Report birth injury is defined as “an impairment of the neonate’s body function or structure due to an adverse event that occurred at birth” (Dumpa, V., 2021). “These injuries include a wide range of minor to major injuries due to various mechanical forces during labor and delivery. Birth injuries are different from birth defects or malformations and are often easily distinguishable from congenital defects by a focused clinical assessment” (Dumpa, V., 2021). Examples of birth trauma that are more common may be cranial or peripheral nerve injuries, intracranial hemorrhage, or fractures (such as clavicle or humerus during difficult extraction). “A vital element in this context is the prevention of birth trauma in the first place using an interprofessional team involving obstetricians, neonatologists, pediatricians, radiologists, and specialty trained nurses” (Dumpa V. 2021). Collaboration and communication, along with education, may help identify early risks, help parents make informed decisions, and expeditiously carry out potential interventions to prevent risk or injury. The table on the breakdown of birth trauma – injury to neonate shows us that the highest rates of birth trauma occurred in small, public, rural, Community Access Hospitals (CAH) (NHQDR, 2021). Rural Health Information Hub states “the CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities” (Rural Health Information Hub, 2022). To me, this data points toward supporting a solution that includes increasing opportunities for collaboration, communication, and education in these settings. Thus, a policy that I would support would be the Federal Office of Rural Health Policy’s National Rural Health Policy Community, and Collaboration Program. This program was slated to distribute funding to “identify, engage, educate, and collaborate with rural stakeholders on national rural health policy issues and promising practices in an effort to improve the health of people living in rural communities nationwide” (HRSA.gov., 2022). Though the Federal Office of Rural Health Policy offers collaborative policies and programs, another institution is also making strides toward helping this demographic. The Centers for Medicare and Medicaid Services has published a brief with aims of “Improving Access to Maternal Health Care in Rural Communities” (CMS, 2019). This brief states “CMS has aligned health policies to its Rural Health Strategy and its new Rethinking Rural Health Initiative, released its first Medicaid and Children’s Health Insurance Program (CHIP) Scorecard to evaluate state progress on maternal health outcomes, and is preparing to implement the recently enacted Improving Access to Maternity Care Act and Preventing Maternal Deaths Act. This issue brief was developed by CMS to provide background information on the scope of this problem and to focus attention on the need for national, state, and community-based organizations to collaborate on developing an action plan to improve access to maternal health care and improve outcomes for rural women and their babies” (CMS, 2019).
Support of the CMS Rethinking Rural Health Initiative and Improving Access to Maternity Care Act, as well as any Federal Office of Rural Health Policy measures which specifically targets communication, collaboration, and education of the maternal/fetal population, would likely provide great strides toward improving our performance on the measure of birth trauma – injury to neonate.
Citations:
Centers for Medicare & Medicaid Services. (2019, September 3). Improving Access to Maternal Health Care in Rural Communities: Issues Brief. Retrieved February 2, 2022, from
https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-Maternal-Health-Care-in-Rural-Communities #:~:text=These%20innovative%20solutions%20include%20opportunities%20to%20improve%20access,scope%20of%20practice%20laws%20for%20maternal%20health%20providers
Dumpa, V. (2021, September 6). Birth trauma. StatPearls [Internet]. Retrieved February 2, 2022, from
https://www.ncbi.nlm.nih.gov/books/NBK539831/
National Healthcare Quality and Disparities Reports. NHQDR Web Site – National Benchmark Details. (n.d.). Retrieved February 2, 2022, from
https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/table/All_Measures/All_Topics#achieved
National Rural Health Policy, community, and collaboration program. Official web site of the U.S. Health Resources & Services Administration (HRSA). (2022, February 2). Retrieved February 2, 2022, from
https://www.hrsa.gov/grants/find-funding/hrsa-19-021
Rural Health Information Hub. Critical Access Hospitals (CAHs) Overview. (n.d.). Retrieved February 2, 2022, from
https://www.ruralhealthinfo.org/topics/critical-access-hospitals#:~:text=Critical%20Access%20Hospital%20is%20a%20designation%20given%20to,hospital%20closures%20during%20the%201980s%20and%20early%201990s
.
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