Cost and Quality Analysis

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Cost and Quality Analysis
Effectiveness, safety, timeliness, patient-centered, equitable, and efficient are all elements of quality (McGlynn, 2005). The Institute of Medicine noticed that only half the time patients are getting effective care, disparities in direction remain extensive, medications errors are common, and enhancement of quality and efficiency could eliminate greater than 30% of healthcare costs (McClellan, 2013). It is estimated that in 2007 the national cost of healthcare was $2.2 trillion, or $7,500 per United States (US) resident. Health care expenditures explain 16.2 percent of the Gross Domestic Product and national health spending accounts for approximately 33% for hospitals, 20% for physician services, and 10% for pharmaceuticals. Costs are escalating rapidly in the US than any other country globally (“Guiding Principles,” 2008). Questions arise as to the relationship between quality and cost. Will increased cost result in superior care, or will superior outcomes assist in the containment of cost? Indication of the direction of quality and healthcare costs are unpredictable. Studies have shown that the link between the two is small to moderate, irrespective of whether the path is positive or negative (Hussey, Wertheimer, & Mehrotra, 2013). Roles

The Agency for Healthcare Research and Quality (AHRQ) is a branch of the US Department of Health and Human Services. Their role is to reinforce research intended to develop the quality of healthcare, decrease its cost, improve patient safety, reduce medical errors, an expand access to vital services (“Related Public/Private,” 2008). The Joint Commission’s role is to constantly advance the safety and quality of care delivered to the public through the establishment of health care accreditation and associated services that back performance improvement in healthcare systems (“Related Public/Private,” 2008). Activities

AHRQ has many major activities that address quality and cost in healthcare. One activity is the use of risk management theory by nurses. Effective risk management necessitates nurses to identify risks before they happen to the patient. Jointly with a medication database, the medication regimen complexity index tool is used for measuring numerous characteristics of drug regimen complexity to decrease adverse reactions and higher costs, which is yet another activity used by the AHRQ (“Automated Tool,” 2013). The Joint Commission, on the other hand, has the Core Measure Solution Exchange®. This is a web-based forum devoted to communicating solutions related to improving core measure performance rates (“Hospital Resources,” 2013). The National Patient Safety Goals is a sequence of exact activities to stop medication errors , for example miscommunication between healthcare providers, unsafe use of infusion pumps, and medication mistakes (“Joint Commission,” 2013). Both of these agencies are working together on some topics. The National Quality Measures Clearinghouse endorses extensive access to quality measures by the healthcare community (“Specifications Manuel,” 2013). It is sponsored by the AHRQ and includes Joint Commission measures. Current and Projected Initiatives

AHRQ funded a national attempt to stop central line-associated bloodstream infections in US hospitals by executing a Comprehensive Unit-based Safety Program (“Eliminating CLABSI,” 2013). Another initiative that is hallmark is their support of a culture of patient safety and quality enhancements in healthcare organizations in the Nation, entitled, Hospital Survey on Patient Safety Culture. They subsidized the progress of patient safety culture assessment tools and sponsored the development of a comparative database on the survey (“Hospital Survey,” 2013). AHRQ initiated the Healthcare Cost and Utilization Project. This empowers research on a comprehensive assortment of health policy issues, comprising cost and quality of health services, medical practice models, access to health care programs, and consequences of actions at the national, State, and local levels (“Healthcare Cost,” 2013).ealthH

The Joint Commission’s safety and cost initiatives revolve around quality improvements. They currently have an initiative to describe approaches for attaining improvement in the efficiency of the transitions of patients between healthcare facilities, which include continuance of safe, quality care for patients (“Hot Topics,” n.d.). They developed a tool, Targeted Solutions Tool (TST)™ for Hand-off Communications, which gauges the efficiency of hand-offs in hospitals and between facilities and offers solutions. They also have TSTs for hand hygiene and wrong site surgery. Another initiative is the National Quality Core Measures. They have 14 different actions that have specific core measure sets under them. Some core measures that they are reviewing are perinatal care, venous thromboembolism (VTE), tobacco treatment, immunizations, and stroke (“Core Measure,” 2013). Another initiative is the Cooperative Accreditation Initiative. This initiative’s focus is to decrease the cost and repetition of survey and review activity practiced by healthcare organizations (“Facts About,” 2013). Implications for Nurses

Nurses are instrumental to the delivery of high quality and efficient care. Efforts by organizations to maintain labor costs, while maintaining quality standards, have major effects on the nursing staff. A model that depicts this is Transforming Care at the bedside. The goal is to involve front-line staff and hospital leadership to make enhancements in four areas: refining the quality and safety of care; safeguarding a high-quality work environment to entice and retain nurses; cultivating the proficiency of care for patients and families; and improving the efficacy of the entire healthcare team. An advanced degree that describes this is the clinical nurse leader role. It is intended for nurses that want to bring about positive changes, but stay at the bedside. Staffing and organization of hospital nursing influences quality and cost (Needlemen & Hassmiller, 2009). What nurses do affects the patient’s quality of care and hospital cost. Nurses provide continuous monitoring and assessment, provide interventions to decrease or prevent complications and harm, collaborate with other healthcare workers, and provide education.

Analysis shows that the biggest cost savings of increased staffing result from decreased lengths-of-stay (LOS). Reduced stays not only reveal decreased problems that prolong stays, but the aptitude of nurses to perform their work and manage the work of others in a timely and effective way. This demonstrates their capability to affect efficiency as well as quality (Needlemen & Hassmiller, 2009). Emergency departments are diligently looking at ways to decrease LOS.

The insinuation of the evidenced-based practice (EBP) competency for nurses indicates that nurses are required to research the best resources of evidence; express strong, quantifiable questions; and understand how to assimilate new findings into practice (Wakefield, 2008). An example is the direction that organizations are moving to have work environments and procedures be lean, thus improving quality, process, cost, and production. Nurses will need to use EBP to work more efficiently and be lean. Conclusion

Improving the quality of hospital organizations has become an extremely notable public and private business, as clients, accreditors, and private facilities try to set norms and inspire accomplishments. Simultaneously, the management of hospital costs has been in the forefront. Attempts to influence labor costs have key effects on nurses. Many organizations are coming up with strategic ways to improve this quality, while controlling costs. The AHRQ and The Joint Commission have been enormously helpful in assisting hospitals with ways to improve quality by maintaining the basic elements of effectiveness, safety, timeliness, patient-centered, equitable, and efficient nursing care. They reveal opportunities to support our customers, healthcare workers, and healthcare organizations in improving care and thus preventing needless health care costs.

References
Automated tool to determine medication regimen complexity may help identify patients at high risk of adverse events. (2013). Retrieved, from AHRQ at http://www.ahrq.gov/news/newsletters/research-activities/13sep/0913RA7.html Core measure sets. (2013). Retrieved, from The Joint Commission at http://www.jointcommission.org/core_measure_sets.aspx Eliminating CLABSI, a National patient safety imperative: Final report. (2013). Retrieved from AHRQ at http://www.ahrq.gov/professionals/quality-patient-safety/cusp/clabsi-final/index.html Facts about the cooperative accreditation initiative. (2013). Retrieved, from The Joint Commission at http://www.jointcommission.org/facts_about_the_cooperative_accreditation_initiative/ Guiding principles for the development of the hospital of the future. (2008). Retrieved, from The Joint Commission at http://www.jointcommission.org/assets/1/18/Hosptal_Future.pdf Healthcare cost and utilization project (HCUP). (2013). Retrieved from AHRQ at http://www.ahrq.gov/research/data/hcup/ Hospital resources and tools. (2013). Retrieved, from The Joint Commission at http://www.jointcommission.org/accreditation/hospital_resources_and_tools.aspx Hospital survey on patient safety culture. (2013). Retrieved from AHRQ at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/ Hot topics in health care: Transitions of care: The need for a more effective approach to continuing patient care. (n.d.). Retrieved, from The Joint Commission at http://www.jointcommission.org/assets/1/18/Hot_Topics_Transitions_of_Care.pdf Hussey, P. S., Wertheimer, S., & Mehrotra, A. (2013). The association between health care quality and cost: A systematic review. Annual Internal Medicine, 158(1), 27-34. doi:10.732/0003-4819-158-1-201301010-00006. Joint Commission FAQ page. (2013). Retrieved, from The Joint Commission at http://www.jointcommission.org/about/JointCommissionFaqs.aspx McClellan, M.B. (2013). Improving healthcare quality: The path forward. Retrieved, from http://www.brookings.edu/research/testimony/2013/06/26-improving-health-care-quality-mcclellan McGlynn, E. A. (2005). U.S. health care: Facts about cost, access, and quality. Retrieved from Rand Health at http://www.rand.org/content/dam/rand/pubs/corporate_pubs/2005/RAND_CP484.1.pdf Needlemen, J. & Hassmiller, S. (2009). The role of nurses in improving hospital quality and efficiency: Real-world results. Retrieved, from Health Affairs at http://content.healthaffairs.org/content/28/4/w625.full.pdf+html Specifications manual for Joint Commission national quality measures (v20135). (2013). Retrieved, from The Joint Commission at http://manual.jointcommission.org/releases/TJC2013B/IntroductionTJC.html

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