Week8 Final Project
Interpreting Performance Measures
Maria Duplantier
DHA 7005: Interpret Performance Measures
Dr. Ramon
Performance Assessment
- Differences in health status, quality of healthcare and use of health services are essential when dealing with different demographics and socio-economic subgroups (Bethell, Carter, Latzke & Gowen, 2003).
- Both public and private sector healthcare plans and purchase demonstrate difficulties of offering quality care.
For individuals to enjoy optimal health either as individuals or as a populace, high-quality care services are needed (Bethell, Carter, Latzke & Gowen, 2003). Reimbursement of hospital A and B would ordinarily depend on their spending on healthcare delivery and the quality of healthcare provided. Therefore, there are several factors to consider when assessing hospital reimbursement for facilities that deal with different demographics.
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Considerations
- Education is a significant determinant of health.
- The level of education of the population is a significant consideration when making reimbursement decisions.
Reading ability and education, in general, has a strong relationship to knowledge regarding health and healthcare. As indicated by (Bethell, Carter, Latzke & Gowen, 2003), Individuals who read at a lower level are likely to record adverse outcome as compared to those with a higher level of knowledge. In the case of facility A and B, individuals who are well educated and with higher socioeconomic status (A) are more likely to follow medication guidelines unlike those of lower socioeconomic status (B) and with little education.
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Considerations
- Also, older patients make up a larger population of society.
- Geriatric patients use more health services as compared to other demographics.
- Aged patients have a high demand for acute care, unlike other populations.
- Therefore, the demand for healthcare in hospital A is not similar to hospital B.
Geriatric care is an essential aspect of healthcare. The elderly population has more health care needs, and the cost of caring for geriatric patients is high. Also, older patients have a high demand for acute care since most of them suffer from critical illnesses (Joshi et al., 2014). Given that the patients in hospital B are more of older patients, have a lower level of education and low economic status, the percentage of patients receiving hospital care and other chronic conditions is high. Therefore, quality and patient outcome may be impacted. As such, the reimbursement of Hospital B cannot be measured the same way as hospital A whose patients are from all populations and have knowledge that translates to a positive interpretation of healthcare services.
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Considerations
- Socio-economic status also affects patient outcome.
- Individuals will less income spend less while taking care of themselves.
- They are likely to skip a patient visit or purchase medications.
- Reimbursement of facility X and Y should be compared on different scales.
Historically, the quality of care varies based on racial background, socio-economic status ethnicity, age, and sex as well as disability status. Today's quality measures include healthy living, effective treatment, care coordination, person-centered care as well as patient safety (Joshi et al., 2014). Elements like income and social status as well as a lower level of education may negatively affect the attitude of individuals towards healthcare and how the quality measures are achieved. The low level of knowledge and socio-economic status of hospital B would affect patient outcome unlike in hospital A, and therefore their reimbursement cannot be calculated on the same scale.
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Reimbursement Considerations
- When assessing both facilities for reimbursement, they should not be treated equality due to the staff to patient ratio (Allen, 2016).
- Among other issues, hospital B has a higher disproportional ratio or physician to the patient.
- While many states have not defined the required minimum of a nurse to patient ratio, it is essential for a facility like a hospital B to have an almost equal physician to patient ratio.
Critical care units and specialty care require more staffs who will ensure that appropriate care is given to patients. In the long run, this will enhance patient satisfaction, reduce medical errors, patient mortality and length of stay in hospital (Allen, 2016). Hospital A has a good ratio of nurse to patient, unlike hospital B which deals with patients suffering from chronic illnesses and may require personalized care. Therefore, when assessing the hospitals for reimbursement, the patient to nurse ratio would determine which hospital gets more compensation.
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Assessment Considerations
- Nursing burnout is among the issues that affect quality delivery in the United States.
- Physical, emotional and mental exhaustion may disengage nurses while attending to patients (Woodhead, Northrop & Edelstein 2016).
- Long shifts and high-stress environments like that of hospital B significantly affects nurses and in the long run experience emotional distress.
The acceptable working hours for nurses is 36 to 40 hours per week. However, nurses in both facilities work for 50 hours and 60 hours in hospital A and B respectively (Woodhead, Northrop & Edelstein 2016). Some hospitals pay nurses overtime, but it is not a guarantee that the nurses will not experience burnout. Therefore, based on the working hours, the reimbursement assessment will be done on the same scale.
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Reimbursement Assessment
- Nurses and physician continuing education and patient safety are intertwined (Havercamp & Macho, 2016).
- Continuing education among medical professionals is essential given the evolving nature of healthcare.
As indicated by Havercamp and Macho (2016), continuing education on issues like patient error must be undertaken in a manner that translates to patient safety and quality care. Medical practitioners develop their competence through learning clinical problem solving (Havercamp & Macho, 2016). Environments that offers practitioners the opportunity to explore and understand the concepts that underpin their practices is essential. However, both hospital A and B are the need for continuing practitioners education. Therefore, their assessment will be done on the same scale. Even though other factors favor hospital A, developing competency is crucial for all practitioners.
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Reimbursement Assessment
- Undoubtedly, hospitals face difficulties in showing high quality and culturally diverse care.
- Assessing medical facilities for health care quality and reimbursement decisions for culturally diverse populations that possess different economic and education stats is of importance.
Numerous measures are used to assess the quality and make reimbursement decisions but comparing quality across facilities like A and B requires consideration of the characteristics of the hospitals. Use of health care services across a wide range of demographics and socioeconomic groups present different patient outcome. Hospital A, for example, would record a striking difference in patient outcomes because it deals with chronic illnesses and older patients who are economically disadvantaged and not well educated.
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References
References
- Allen, S. B. (2016). Nurse-Patient Assignments: Moving Beyond Nurse-Patient Ratios for Better Patient, Staff and Organizational Outcomes.
- Bethell, C., Carter, K., Latzke, B., & Gowen, K. (2003). Measuring and interpreting health care quality across culturally-diverse populations: A focus on consumerreported indicators of health care quality. Portland: Foundation for Accountability.
- Joshi, M. S., Ransom, E. R., Nash, D. B., and Ransom, S. B. (2014). The healthcare quality book: Vision, strategy, and tools. In K. D. Acquaviva & J. E. Johnson (Eds.), The quality improvement landscape (pp. 470-474). Chicago, IL: Health Administration Press.
- Havercamp, S. M., & Macho, P. N. (2016). Continuing Education for Health Care Providers. In Health Care for People with Intellectual and Developmental Disabilities across the Lifespan (pp. 2133-2140). Springer, Cham.
- Woodhead, E. L., Northrop, L., & Edelstein, B. (2016). Stress, social support, and burnout among long-term care nursing staff. Journal of Applied Gerontology, 35(1), 84-105.