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Exploring EBP Quality Improvement

Leticia Romeo

Walden University

Theor Sci Foundation Nursing

Dr. Barret

July 5, 2024

Exploring EBP Quality Improvement

Health care is a dynamic field undergoing constant changes to meet rising consumer needs and enhance service. These changes reflect payer reform, scientific advancement, technology, and consumer demand. Strategists must adapt their work as the landscape transforms to align with and foresee emerging trends. Quality Improvement (QI) is the continuing effort by stakeholders in healthcare to implement changes that achieve better professional development, improved system performance, and superior patient outcomes (Hammersla et al., 2021). Systematically, these changes are introduced to address specific practice issues within a facility or system. The QI procedures involve the analysis of the effectiveness of EBP interventions employed to solve issues in practice. Therefore, changes implemented in the system must successfully solve healthcare problems. This paper examines the application of evidence-based practice in quality improvement. It addresses practice issues identified in an outpatient clinic, a skilled nursing facility, and a physician's office in three varied healthcare settings.

Description of Healthcare Settings

Outpatient Clinic

An outpatient clinic serves patients who visit for medical consultations and treatments without being admitted overnight. The patient population includes individuals with various health conditions requiring periodic medical attention, follow-ups, and routine check-ups. The usual mission of an outpatient clinic is to offer convenient access to quality care to patients with walk-in services. The clinics can be public or privately run, and the facility alone or part of a giant healthcare corporation (Snoswell et al., 2022). The staff comprises an institutionally multidisciplinary team of physicians, nurses, nutritionists, and psychiatrists. The outpatient clinic I visited was a public facility and part of an extensive healthcare network with multi-faceted patients.

Skilled Nursing Facility

A skilled nursing facility is a place that provides both medical treatment and physical rehabilitation to patients who need help with daily activities and medical management for an extended period. The patient population primarily includes elderly patients and patients recovering from surgery with chronic diseases that require long-term care. The mission is to provide SNF services based on patient-centered care that enhances quality of life and functional activities. These agencies may fall under either public or private ownership, typically managed by companies that provide long-term care. The staff at these facilities comprise registered and licensed practical nurses, registered occupational and speech therapists, audiologists, and many others. The SNF I visited was a private organization belonging to a national enterprise that primarily treated and practiced remedial nursing care.

Physician's Office

A physician's office renders general medical care, preventive services, and routine patient checks. The patient population usually seeks primary care services, care for chronic conditions, and health maintenance advice. The mission of a Physician's Office is to provide personalized, high-quality care to patients to improve health and wellness (Saver, 2020). Mostly, these offices remain private entities with a small population of patients and are utterly independent of more extensive healthcare networks. It primarily includes physicians, though sometimes accompanied by nurses and administrative staff. The physician's office I assessed is an individual private practice with independent operation and a personal commitment to its patients to ensure individual care.

Comparison of Settings Strengths and Weaknesses

Outpatient Clinic

The major strengths of outpatient clinics are accessibility, diverse services, and community focus. Outpatient care patients receive treatment and go home on the same day without necessarily having been hospitalized. Care is done such that the patient does not even necessarily spend a few hours and exit to go on with life. Various services are offered under outpatient care, from primary to home health care. Primary care helps patients to have a trustworthy relationship with a primary care physician who can provide them with comprehensive, detailed care and yearly physical examinations. Immediate medical attention in cases where patients cannot get hold of their primary care physician is also facilitated with outpatient care centers through after-hours care. Outpatient care centers can hence perform diagnostic testing and follow-up appointments. Nurse practitioners can give medical advice and treatment. Outpatient care also includes home health care, where patients can be treated from the comfort of their homes. This approach is particularly useful for older adults or those with disabilities, whereby they can stay at home while getting the necessary healthcare. Most outpatient clinics also boast a strong sense of community service and attending to public health issues.

However, weaknesses related to outpatient care include limited interaction and resource constraints. Healthcare personnel have little time with patients, affecting their care and management quality. Resource constraints may impact the quality and range of services offered by public outpatient clinics. The availability of treatment alternatives may be restricted to specific illness categories, and the patient may not consistently receive the same standard of care as they would in a hospital setting (Snoswell et al., 2022). Furthermore, specific medical interventions such as orthopedic surgery may necessitate a greater amount of post-treatment care than what can be offered by outpatient facilities.

Skilled Nursing Facility

Skilled nursing facilities offer comprehensive care and dedicated staff. Skilled nursing facilities must provide extensive medical and rehabilitative care to treat patients with extensive health needs. Such centers can handle various complex medical conditions and services like wound care, intravenous therapy, physical therapy, occupational therapy, and speech-language pathology. It does so by offering integrated care at one location, maximizing it on all treatments and interventions for the patient, improving the patients' experience, and achieving better health outcomes for them (Templeton et al., 2023). SNFs also uphold a multidisciplinary team of healthcare professionals: licensed nurses, physical therapists, occupational therapists, speech pathologists, and other health professionals. These dedicated staff members are skilled enough to deliver quality care alongside specialized services that meet individual patients' needs. It allows for individual care plans addressing patients' medical and rehabilitative needs, making sure to take a holistic approach toward their recovery and the maintenance of health with such a skilled, diversified team.

Weaknesses are limited patient turnover and high costs. The residents in most SNFs are relatively stable as a population, and many must remain for extended periods due to their high levels of care. Stability can strengthen patient-provider connections but limit clinical case diversity. SNF physicians will face less acute or diverse medical illnesses than institutions with higher patient turnover, which may limit exposure and professional advancement. The cost of SNFs is remarkably high and would pose financial strains to patients and their family members. SNFs have high costs involved in these facilities' extensive medical and rehabilitative services, coupled with the highly specialized staff and facilities. Although some patients may have insurance or qualify for counties, the rest may be severely strained under out-of-pocket expensive procedures. Moreover, the high costs may deny various patients access to SNF, creating disparities in care.

Physician's Office

Physicians working in private offices tend to know their patients and maintain good relationships with them, giving highly personalized and continuous services. Regular contact allows physicians to learn about their medical history, preferences, and special health needs. This personal care will establish trust and improve communication between the patient and his doctor, leading to correct diagnosis, effective treatment, and medical advice compliance. Continuity in care, provided for by regular visits to the physician's office, is critical in managing chronic conditions and promoting health in general. The consistent care monitored patients' progress with readjustment of the treatment plan on time and without complications. This ongoing relationship between physician and patient contributes to better health outcomes and increased patient satisfaction ratings since patients feel supported and cared for over time.

However, physician's offices have limited services and access issues . The services offered within a physician's office are typically more limited than in an outpatient clinic or SNF. Although physicians can provide patients with primary care services, preventive care, and management of their chronic conditions, it is doubtful that they would have the necessary facilities or highly educated personnel to provide large numbers of diagnostic tests, advanced treatment services, or rehabilitative services (Saver, 2020). Patients needing such services may be sub-referred to providers of other healthcare or facilities, making the treatment process fragmented and slow. Private physician offices are less accessible to lower-income populations due to higher costs. Unlike public clinics or SNF residences, which may accept a broader range of insurance plans, including Medicaid, private physician office supplements may be costly, and the affordability of such supplements to public insurance could be limited. This financial barrier can erect a barrier to accessing the personalized and continuous care offered by private physicians for lower-income patients, thus sowing disparities in health outcomes and overall healthcare access.

Practice Problems Explored

High no-show rates for follow-up appointments were identified as a practice problem in outpatient clinics. The issue results in continuity of care problems and poor patient outcomes from missed appointments that may indicate conditions are not being managed and treatment may be delayed (Marbouh et al., 2020). Outpatient clinics also face challenges in managing chronic diseases, such as those related to diabetes, hypertension, and asthma. The lack of interaction time between patients and healthcare providers is such that there is little explained to the patient, followed up on less, and it can result in poor management of the disease, leading to further readmissions into the hospital. Allowing the problems to be addressed improves patient adherence to directed treatment plans and health management overall.

In skilled nursing facilities, high rates of pressure ulcers among residents were determined to be a critical problem. Pressure ulcers are not only painful and uncomfortable, but they also increase healthcare costs and length of recovery for the residents (Elli et al., 2022). Pressure ulcers can enhance patient comfort and decrease the financial strain on the facility. In a physician's office, a lack of proper mental health services, which in most cases may be lacking, breeds the aspect of underdiagnosis and undertreatment of mental health conditions. Integrating mental health care within the primary care setting will ensure access to the kind of services needed and the patients' overall health. Developing the integrated mental health care model will focus on screening, diagnosis, and treatment conducted in the physician's office, supported by mental health professionals.

Stakeholders and Their Approval Requirements

Key stakeholders in outpatient clinics include clinic administrators, healthcare providers (physicians, nurses, etc.), and patients. Approval would be required from the clinic administration and the healthcare team. Patients' feedback and cooperation are also crucial for the project's success. Skilled nursing facility stakeholders include facility management, nursing staff, therapists, patients, and their families. Approval would be needed from the facility's management team, nursing staff, and therapists. Residents' families should be informed and involved to ensure comprehensive care. Physician's office stakeholders include the physician, office staff, and patients. Approval would primarily come from the physician, who runs the practice, and the office staff. Patient cooperation is essential for implementing and evaluating the project's effectiveness.

P roposed Setting and Practice Problem for Hypothetical Presentation

The hypothetical presentation to stakeholders focuses on the outpatient clinic and how chronic illness management enhanced by treating a broad and diverse patient population benefits public health. There is a high burden of chronic diseases in the outpatient setting, and management can reduce hospital readmissions, healthcare costs, and patient quality of life (Mahumud et al., 2022). Comprehensive chronic illness management programs like patient education, regular follow-up appointments, and telehealth services support the clinic's aim of providing community-accessible quality care.

Conclusion

Healthcare is constantly changing, and quality improvement must match health requirements and improve delivery systems. The exploration of the application of evidence-based practice in quality improvement across different healthcare settings introduces uniqueness in the strengths and weaknesses of any particular practice. While an outpatient clinic offers access and a range of services, an SNF majorly provides comprehensive, specialized care for chronic cases. The physician's office offers personalized, continuous care, albeit somewhat limited in providing the scope of services and access. Targeted QI projects can improve patient outcomes and system performance by addressing practice issues like outpatient clinic no-show rates and skilled nursing facility pressure ulcers. The hypothetical focus on chronic illness management in outpatient clinics highlights the potential changes in public health benefits and improvements in healthcare delivery.

References

Elli, C., Novella, A., Nobili, A., Ianes, A., & Pasina, L. (2022). Factors associated with a high-risk profile for developing pressure injuries in long-term residents of nursing homes. Medical Principles and Practice, 31(5). https://doi.org/10.1159/000527063

Hammersla, M., Belcher, A., Ruccio, L. R., Martin, J., & Bingham, D. (2021). Practice and quality improvement leaders survey of expectations of DNP graduates’ quality improvement expertise. Nurse Educator, Publish Ahead of Print. https://doi.org/10.1097/nne.0000000000001009

Mahumud, R. A., Sultana, M., Kundu, S., Rahman, Md. A., Mistry, S. K., Kamara, J. K., Kamal, M., Ali, M. A., Hossain, Md. G., Brooks, C., Khan, A., Alam, K., & Renzaho, A. M. N. (2022). The burden of chronic diseases and patients’ preference for healthcare services among adult patients suffering from chronic diseases in Bangladesh. Health Expectations, 25(6), 3259–3273. https://doi.org/10.1111/hex.13634

Marbouh, D., Khaleel, I., Al Shanqiti, K., Al Tamimi, M., Simsekler, M. C. E., Ellahham, S., Alibazoglu, D., & Alibazoglu, H. (2020). Evaluating the impact of patient no-shows on service quality. Risk Management and Healthcare Policy, 13(13), 509–517. https://doi.org/10.2147/RMHP.S232114

Saver, R. S. (2020). Physicians’ elusive public health duties. North Carolina Law Review, 99, 923. https://heinonline.org/HOL/LandingPage?handle=hein.journals/nclr99&div=31&id=&page=

Snoswell, C. L., Cossart, A. R., Chevalier, B., & Barras, M. (2022). Benefits, challenges, and contributors to the introduction of new hospital-based outpatient clinic pharmacist positions. Exploratory Research in Clinical and Social Pharmacy, 5, 100119. https://doi.org/10.1016/j.rcsop.2022.100119

Templeton, Z. S., Apathy, N. C., Konetzka, R. T., Skira, M. M., & Werner, R. M. (2023). The health effects of nursing home specialization in post-acute care. Journal of Health Economics, 92, 102823–102823. https://doi.org/10.1016/j.jhealeco.2023.102823