Final Project Submission

3

Lowering Readmission rates for Head and Neck Cancer patients at University of Miami Hospital

Name

Capella University

Professor

August 2022

Lowering Readmission rates for Head and Neck Cancer patients at University of Miami Hospital

This paper examines a problem statement that focuses on presenting information associated with the Problem-Intervention-Comparison-Outcome-Time (PICOT) approach to nursing research. The paper also presents a brief literature review, which backs the need recognized in the problem statement and the suitability of the broad intervention approach.

Problem Statement

This section is split into various subsections, including the need statement, population and setting, intervention overview, comparison of approaches, initial outcome draft, and time estimate.

Need Statement

This paper addresses interventions that can assist in the reduction of readmission rates for head and neck cancer patients within the University of Miami Hospital. This need is crucial because head and neck cancer patients include populations that are at risk for readmissions because of several elements, comprising need for complex postoperative care, insurance status, high mortality, and recurrent disease (Yang et al., 2022). According to the American Cancer Society (2022), head and neck cancer is responsible for approximately 4% of all cancers within the United States. In 2022, about 66470 individuals, comprising of 17,950 women and 48,520 men will be diagnosed with head and neck cancer. In 2020, 562,328 individuals were diagnosed with head and neck cancer globally. Additionally, it is approximated that 15,050 deaths, including 4,110 women and 10,940 men for head and neck will occur within the U.S. in 2022. In 2020, about 277,597 deaths were recorded globally from the illness (American Cancer Society, 2022). Therefore, neck and head cancer shows a significant need that should be examined in order to identify appropriate interventions.

Population and Setting

The study by Stoyanov et al. (2017) established that out of the 180 head and neck cancer cases, 72.22% were males, while 27.78% were females. The mean diagnosis age was 63.67 ± 12.9 years and the median age was 65 years. Additionally, the study by Dhull et al. (2018) sampled 9,950 head and neck cancer patients. According to age classification, patients ages ranged between 20 to 70. Patients aged from 21 to 30 was a total of 241. Those aged between 31 and 40 were 1,127, those aged 41 to 50 were 2,783, those aged between 51 and 60 were 3,091, those aged from 61 to 70 were 2,055, and above seventy years old were 613. Therefore, based on these findings, this study will include a population of individuals aged between 40 and 70 years old. The population must be head and neck cancer patients.

The study setting will be within a hospital, particularly the University of Miami Hospital. The hospital delivers leading-edge patient care by the area’s best doctors, backed by groundbreaking research from the University of Miami Leonard M. Miller School of Medicine. It is the only university-based medical system in South Florida; therefore, it is a crucial component of the community. Through the hospital records, the researcher will examine the number of admissions and readmissions of patients within 30 days. This information will help calculate the readmission rates of the patients.

Intervention Overview

Treating Institution

Factors motivating head and neck cancer patients to seek chemoradiation or radiation in the community versus in an academic center are not completely understood, combined with the impacts of site of treatment on survival and treatment completion. Lassig et al. (2012) compared treatment completion and survival rates between patients in the community and at an academic center. The findings established that there was no statistically significant difference in the rate of planned treatment completion between academic and community centers. However, patients in the academic centers received concurrent chemotherapy. On the other hand, the 5-year survival rate was 53.2% for academic centers and 32.8% for community hospitals. Therefore, determining the kind of institution to seek Head and Neck cancer treatment affects the outcome of the treatment of the disease.

This intervention fits my target population because in the study the researchers’ sampled individuals with head and neck cancer with the median age of 58 for community center patients and the median age of 56 for academic center patients. The intervention fits my target setting because it is an academic-based hospital. The intervention effectively addresses head and neck cancer since it improves survival rate and treatment outcomes.

Comparison of Approaches

Monitoring quality and reporting Outcomes

Head and neck cancer needs high level multidisciplinary care to accomplish maximum outcomes. Certain health services have instigated the reporting of quality indicators (QIs) to enhance quality of care. Chilkuri et al. (2021). It examined the quality of care offered to patients with head and neck cancer within a single institution by investigating compliance with QIs and analyzing the utility and feasibility of the data collection. The findings established that compliance with post-, pre-, and treatment QIs was high. The 5-year overall survival was 69.4% and the cumulative locoregional relapse incidence for the whole study cohort was 18%. Therefore, monitoring quality and reporting outcomes with a multidisciplinary care team was effective in enhancing survival rate.

This intervention utilizes a multidisplinary care team in addressing head and neck cancer, while the institution type does not utilize an interprofessional care techniques. Both the interventions fit my target population since they sampled patients with head and neck cancer within the stated age. The earlier intervention is based on an academic hospital setting while this intervention utilizes a single institution retrospective chart review. This intervention is more effective in managing patients’ survival rates at 69.4% compared to the earlier intervention that achieved a survival rate of 53.2%.

Initial Outcome Draft

The one outcome the study seeks to accomplish is to decrease the readmission rates for head and neck cancer patients at the University of Miami Hospital using a tested and recognized intervention. The reduction of the readmissions will significantly improve the hospitals quality and experience of care and safety since the relevant stakeholders will be working to ensure the patients are not discharged prematurely or through conditions that will warrant a readmission.

Time Estimate

To develop the intervention, the researcher will require one month. This time will be used to decide the steps to take, collect relevant information concerning the level of the problem, discussing with the end users (care practitioners) and potential clients (patients) of the intervention, and recognize the problems or issues the intervention will try to solve. One significant challenge would be convincing the patients to participate in the study. Accessing patient information will require various permissions from the hospital and the patients. The researcher will have to get ethical approvals, which can take longer to access.

The implementation will take three months. The first month will involve identifying root causes, developing activities and objectives, and setting the selection criteria. The second month will include applying selection criteria and rating and selecting intervention alternatives. The third month will comprise planning and implementing interventions and monitoring and evaluating interventions. Challenges that might affect the timeframe include acquiring a sample that sufficiently represents the population and the stakeholders’ schedules since nurses can be busy.

Literature Review

This section reviews various peer-reviewed articles and journals relating to the research topic. The researcher utilized various search words, including head and neck cancer, decreasing readmissions of head and neck cancer, and interventions for addressing head and neck cancer. These were searched in various databases such as ResearchGate, Xplore, Wiley Online Library, and National Library of Medicine.

Demographics of Head and Neck Cancer Patients

Head and neck cancer includes a diverse classification of oncological entities, emerging from different organ localizations and tissue types situated within the topographical section of the neck and head (Argiris et al., 2008; Davies & Welch, 2006). The Neck and head section is the sixth most frequent region for malignancies (Hoffman et al., 1998). It also represents one of the few medical practices permitting for an uncomplicated diagnostic biopsy and endoscopy via a natural orifice in almost every case; therefore, ensuring detailed pretreatment staging and diagnostic (Ang et al., 2001). The global head and neck cancer incidence is about 3% of every cancer case, with men representing approximately 90% of the affected and epithelial neoplasms representing over 85% of every cancer type (Marur & Forastiere, 2008; Sturgis & Cinciripini, 2007). The most frequent factors for developing this disease are alcohol consumption and smoking. Use of topical substances, occupational exposures, e-cigarettes, and marijuana are also associated with head and neck cancer. Measures such as vaccination, smoking cessation, screening, and oral hygiene decrease the morbidity and incidence of head and neck cancers (Cohen et al., 2018).

Stoyanov et al. (2017) conducted a single institution retrospective study aimed at determining the head and neck cancer patient demographics and classifying the individual head and neck malignancies’ incidence, concerning primary histopathological type and organ origin. The researcher reviewed every histologically verified cases of head and neck cancer from one tertiary referral center in a descriptive retrospective approach. The data sampling period lasted for 47 months (Stoyanov et al., 2017). The findings indicated that male to female ratio of the registered cases of head and neck cancer was 3.24:1. Mean age was 63.84 ± 12.65 years. The most frequent head and cancer locations comprise the salivary glands 10.94%, pharynx 20.03%, oral cavity and lips 29.08%, and the larynx 30.37%. The primary histopathological comprise adenocarcinoma 6.14% and squamous cell carcinoma 76.74% (Stoyanov et al., 2017). Though head and neck cancer is considered rare, it represents a different group of oncological entities with specific and individual demographic features.

Reducing Readmission of Head and Neck Cancer

Hospital readmissions within thirty days of discharge have developed into a surrogate determinant of patient care quality. The notion is that substandard care or premature discharge during the index hospitalization may escalate readmission risks. Studies have established that if 20% of beneficiaries are readmitted in thirty days of being discharged, Medicare system cost increases by 26 billion dollars each year (Jencks et al., 2009).

Yang et al. (2022) conducted a study examining readmission rates before and after multidisciplinary quality enhancement initiatives that major on staff and patient education, utilizing targeted skilled nursing amenities, and suitable usage of patient observation status. The study was conducted from October 2015 to September 2018 when the head and neck oncology service reviewed its discharge practices for patients undergoing reconstructive or extirpative surgery. The changes, included improving patient education, escalating the usage of skilled nursing amenities with directed personnel education and patient handoffs by advanced practice nurses, and suitable usage of 23-h observation status for returning patients (Yang et al., 2022). The researchers sampled 449 patients, 35.9% were examined before the practice change, while 64.1% after the practice change. The results indicated that readmission risks decreased by 41.4% from the pre-intervention period. Patients at high or moderate risk of death were 2.31 times more probable than the patients at minor risk of death to readmit in thirty days. Additionally, patients with persistent or recurrent cancer were 3.33 times more probable than the patients undergoing first curative surgical cancer management to readmit in thirty days (Yang et al., 2022).

The Affordable Care Act

This act was signed into law in March 2010. Section 3025 denotes that newly formed Hospital Readmissions Reduction Program would hold hospitals financially responsible for every 30-day readmissions (Weinick & Hasnain-Wynia, 2011). The Medicare and Medicaid Centers required that hospitals report and track hospital readmission rates for five diagnoses, including elective total hip and total knee replacements, chronic obstructive pulmonary disease, pneumonia, congestive heart failure, and acute myocardial infraction. The reimbursements would be determined founded on adjustment factor established by the institutions projected versus observed 30-day readmission rate for the five diagnoses. The institutions that displayed higher than anticipated readmission rates would invite financial penalties (Weinick & Hasnain-Wynia, 2011). Although otolaryngology-precise processes are not within the present Centers for Medicare and Medicaid readmission policy, section 3025 encompassed a clause that allowed for expansion of the policy to more conditions in the future (Weinick & Hasnain-Wynia, 2011).

Interventions for managing Head and Neck Cancer

According to Lassig et al. (2012), factors motivating head and neck cancer patients to seek chemoradiation and radiation within an academic center versus community centers are not fully understood. The researchers conducted a historic cohort study within tertiary academic center and community facility settings. The study involved patients with mucosal HNCA recognized by International Classification f Disease, Ninth Revision (ICD-9) (Lassig et al., 2012). The researchers examined treatment completion rates and conducted multivariate and univariate analyses of various treatment outcomes. The study sampled 388 patients with 210 completing treatment at the academic center and 145 at the community center (Lassig et al., 2012). The results indicated that patients who underwent radiation at the academic center had more progressive disease and were more probable to get concurrent chemotherapy. The academic center had higher percentage of oropharyngeal tumors, higher median income, and higher proportion of noncurrent smokers (Lassig et al., 2012). There was no statistically significant difference between the academic and community centers in terms of planned treatment completion rates. The 5-year survival rate for the academic center was 53.2%, while for the community center was 32.8% (Lassig et al., 2012).

Chilkuri et al. (2021) examined the quality of care offered to patients with head and neck cancer within a single institution by investigating quality indicators (QIs) and to analyze the utility and feasibility of data collection. The study method was a single institution retrospective chart review of every patient with squamous cell head and neck cancer at Townsville Hospital treated with curative intent from June 2011 to June 2019. The researchers sampled 537 patients for the study (Chilkuri et al., 2021). The findings displayed that compliance with pre-treatment, treatment, and post-treatment QIs was high, excluding time to post-operative radiotherapy, post-treatment dental review, and smoking cessation support. The intervention’s 5-year general survival rate was 69.4%. The cumulative locoregional relapse incidence for the entire study cohort was 18% (Chilkuri et al., 2021). Gathering and assessing quality metrics is feasible and assists in recognizing sections for improvement. Head and neck treatment centers should endeavor to monitor quality against benchmarks and practice transparency regarding data results.

Conclusion

Head and neck cancer is a serious condition that affects the victims significantly. Statistics indicate that it kills numerous people globally. Most head and neck cancer patients are readmitted to hospitals within 30 days of discharge, which leads to more harm to their health and finances. Therefore, it is crucial to develop interventions that would effectively decrease the readmission rates of such patients. Decreasing readmission rates improves quality of health, safety, and better treatment experience.

References

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