Public Health Improvement Initiative

Apply public health improvement initiative to Mr. Nowak’s balance trouble

Medical organizations are increasingly recognizing the importance of health improvement initiatives targeted at large populations. Population health improvement initiatives (PHII) is one of the approaches that is being applied in effort to reduce costs while improving care outcomes in different population groups such as older adults and pregnant women. PHII is particularly noted for providing vital data that is leveraged to provide patient-centered care while controlling per capita costs in terms of measurable utilization, economic, procedural, humanistic and clinical outcomes. In applying PHII, medical personnel are expected to leverage evidence-based practice in the care plan with a view to meeting the patient’s individual needs. It recognizes that evidence encountered in the care environment may not be necessarily presented in the context of practice owing to differences in the care environment, illness and population. Faced with these situations, medical personnel use PHII to transfer evidence into practice (McGonigle & Mastrian, 2018).

In the present case, Mr. Nowak, a patient at Uptown Wellness Clinic (UWC), suffered a traumatic brain injury (TBI) following a fall. At a screening for cholesterol, he complained of losing his balance and believes this is resultant of a brain injury. Medical personnel at UWC has recommended that his care plan should be based on evidence collected from Safe Headspace, a non-profit PHII targeted at improving care outcomes for persons with TBI. The intention is to evaluate the PHII outcomes then transfer the evidence to Mr. Nowak’s context. The present analysis seeks to reveal knowledge gaps in the PHII approach to care and present strategies for addressing the gaps with the intention of improving Mr. Nowak’s care plan.

Evaluating outcomes of Safe Headspace PHII

The application of Safe Headspace PHII has resulted in improved care outcomes for older adult patients suffering from TBI. In applying a combination of approaches to include mediation, therapy and exercise, the initiative has reported significant improvements. Firstly, physical exercises resulted 15% of patients reporting muscle control improvements, 22% reporting mood improvements, and 61% reporting memory improvements. Secondly, therapy in combination with medication resulted in 26% of patients reporting improved mood and 6% reporting improved memory. Thirdly, the use of meditation improved memory by 70% and improved muscle control by 32% (Capella University, n.d.). Although these statistics are encouraging evidence supporting the use of PHII, they appear skewed. The first concern is that the initiative was applied for a population of patients suffering from TBI and post-traumatic stress disorder (PTSD). The initiative evaluates the impact of the different approaches on patients with the two conditions but does not evaluate the impacts on either TBI or PTSD patients in isolation. Mr. Nowak is reported as suffering from TBI, but there is no indication that he suffers from PTSD. Besides that, the initiative does not indicate whether extraneous variables were controlled and if they have an influence on the care outcomes. For instance, it is unclear whether the patients were advised not to follow the self-management plans or if they were demotivated by unsatisfactory care and high medical costs. These unexplored variables may have implications for the initiative, the evidence it presents, and influence the decision on whether or not to apply the initiative given the experiences, background and symptoms reported by the patient (Schmidt & Brown, 2019).

Strategy to improve outcomes of the PHII

Data from the Safe Headspace PHII reveals that the evidence it presents may not necessarily be useful evidence for the case of Mr. Nowak. The ideal PHII should be based on evidence collected from the initiative. Should the evidence collected from Safe Headspace PHII be applied to the case of Mr. Nowak, then the previously identified shortcomings are likely to result in unfavorable care outcomes. An appropriate strategy for improving the initiative is to adopt the Triple Aim in Care. This focuses on optimizing performance of health systems in terms of (a) improving the patient’s experience of care, (b) improving the health of populations, and (c) reducing per capita cost of health care. In adopting the Triple Aim, the PHII would meet five pre-conditions. Firstly, system integration and execution, Secondly, presenting a cost control platform. Thirdly, population health management. Fourthly, redesigning the primary care services and structures. Finally, focusing on individuals and families. The new strategy would help in setting achievable goals and improve the delivery of high quality care at the facility. Still, it is important to note that efforts to adopt the Triple Aim could face some challenges, key being the lack of shared vision and diverse patient populations that could make it impractical. These challenges must be addressed even as the PHII outcomes are improved (Joshi, Thorpe & Waldron, 2019).   Public Health Improvement Initiative Essay Paper

Approach to personalize patient care

There is need for a personalized patient care approach that adopts an evidence-based approach. The short-term goals are the diagnosis and treatment of health problems presented by Mr. Nowak. The long-term goal is to develop an idealized care plan that can be applied in similar cases. Achieving the short-term and long-term objectives requires that UWC change its organization and delivery systems. This would also be done by focusing on incorporating the Triple Aim, engaging competent medical personnel proficient in the application of evidence-based practice (EBP), and providing self-management support alongside cost-effective care. These needs can be met by adopting the patient-centered medical home (PCMH) approach. This approach would implement the Triple Aim by adopting innovative care delivery methods and technologies while establishing caring relationships with patients and families. In applying PCMH, it is anticipated that primary care would be delivered through a model that is accessible, coordinated, patient-centered, comprehensive and committed to patient safety and care quality. This approach would personalize patient care by presenting opportunities for understanding and incorporating the cultural, economic and health needs of patients. In applying PCMH and in support of EBP, there would be a need to train and evaluate the medical personnel. Training and evaluation helps to integrate EBP into care delivery to improve patient outcomes. In addition, this would help the medical personnel to support Mr. Nowak to gain a better understanding of his health condition, motivate him to adopt self-management methods, and improve health care access (LoBiondo-Wood, Haber & Titler, 2019).

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Framework for evaluating outcomes

There is a need to evaluate the care approach as part of EBP and in order to facilitate targeted improvements. This requires that measurable data be collected and evaluated to identify both the effective and ineffective components of the adopted PHII. For the present case, a unique approach has been adopted. Firstly, PHII progress will be tracked based on PHII with a framework developed to evaluate the entire health system. This is important as applying PHII involves the use of resources and funds, and these uses can only be justified for the organization if the anticipated benefits exceed the costs to include opportunity costs. To be more precise, a suitable framework for evaluating outcomes is System Level Measures (SLM) that evaluates the whole continuum of care. Changes in the SLM would be considered in terms of increases and decreases, with a focus on ensuring patient satisfaction, reporting efficiency and functional outcomes, reporting clinical outcomes, ensuring effectiveness, improving service provision process, and providing for patients with health care needs. Besides that, there is a need to monitor the clinical process and outcome indicators as they present population specific context. Still it is important to note that SLM presents some limitations. Firstly, it presents a methodological challenge from lack of standardization in defining the indicators and coding, and population variations. Secondly, it presents operational challenges since it requires the technical capabilities to capture, analyze and publish the required data. These challenges would be addressed by engaging data analysis to conduct data collection and analysis (Schmidt & Brown, 2019).

Conclusion

Presenting a population health improvement plan is a complex challenge with many strategies and steps. Even as PHII is applied, there are concerns that it may not necessary address the patient population needs even if it applies EBP frameworks and methods. Although there are challenges in applying any PHII, they are necessary for helping medical personnel to create comprehensive care plans for patients, as is the case for Mr. Nowak. In applying PHII as suggested, medical personnel would be directed to adapt to the changing care settings for the short-term and long-term.

Write a report on the application of population health improvement initiative outcomes to patient-centered care, based on information presented in an interactive multimedia scenario.

In this assessment, you have an opportunity to apply the tenets of evidence-based practice in both patient-centered care and population health improvement contexts. You will be challenged to think critically, evaluate what the evidence suggests is an appropriate approach to personalizing patient care, and determine what aspects of the approach could be applied to similar situations and patients.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Apply evidence-based practice to plan patient-centered care.
  • Evaluate the outcomes of a population health improvement initiative.
  • Develop an approach to personalizing patient care that incorporates lessons learned from a population health improvement initiative.
• Competency 2: Apply evidence-based practice to design interventions to improve population health.
  • Propose a strategy for improving the outcomes of a population health improvement initiative, or for ensuring that all outcomes are being addressed, based on the best available evidence.
• Competency 3: Evaluate outcomes of evidence-based interventions.
  • Propose a framework for evaluating the outcomes of an approach to personalizing patient care and determining what aspects of the approach could be applied to similar situations and patients.
• Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision.
  • Justify the value and relevance of evidence used to support an approach to personalizing patient care.
• Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions.
  • Write clearly and logically, with correct grammar and mechanics.
  • Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

I have a patient who might benefit from some of the interventions for TBI and PTSD you recently studied. What populations did your public health improvement initiative study?

My father came home from Vietnam with a kaleidoscope of mental health problems. That was the 1970s, when treatment options for things like PTSD, TBI, and even depression were very different. Since then there has been a lot of investment in treatment and recovery for combat veterans. That’s excellent news for veterans in treatment now, but they’re not looking at my dad, and how his TBI and PTSD have affected him through mid–life and now as a senior. That’s why I started Safe Headspace: to focus on older patients who are years or decades past their trauma, and find ways to help them.

Which treatments showed the strongest improvement?

Exercise. We were able to persuade about half of our participants — that’s around 400 people, mostly men ages 45–80 — to follow the CDC’s recommendations for moderate aerobic exercise. Almost everyone showed improvement in mood, memory, and muscle control after four weeks. After that a lot of participants dropped out, which is disappointing. But of the 75 who stuck with it for another three months, muscle control improved 15%, mood improved 22%, and short–to–medium term memory improved 61%. We didn’t specify what kind of exercise, but we did ask them to record what they did every week, so that data is available.

Second was medication and therapy. Most of our participants didn’t receive any kind of psychotherapy in the years immediately following their trauma, so we had everyone assessed by a team of psychotherapists. As a result of those assessments, 40% of participants started on anti–depressant medication and 9% started taking anti–psychotics. Those who started taking medications now have regular contact with a therapist to manage that care. With some help at home to stick to the regimen, all but a few have successfully followed their treatment plans. They’ve reported a 26% improvement in mood over six months, and a 6% improvement in memory.

The third treatment I want to mention is meditation. We only had a small group interested in trying it, but the results were dramatic. We prescribed daily meditation at home, just 10 to 15 minutes, with a weekly hour–long guided group meditation for all 23 participants. After three weeks we lost two to disinterest, but the other 21 showed improvements of over 70% in mood and memory, and 32% in muscle control.

Have you tried anything that hasn’t worked?

Sure. There are memory exercises for patients in elderly care, and things like Sudoku and crossword puzzles. We didn’t see any gains with those. Some of our participants preferred strength training to aerobic exercise, and the only improvement we saw in that group was in muscle control, but only 4%, which is significantly less than the aerobic group.

I should also say that we were working with a willing group of participants. They knew they needed help, and were motivated to get it. One of the hurdles we see with veterans, especially in older generations, is an unwillingness to acknowledge that they have a problem. We haven’t had to wrestle with that because everyone who volunteers to participate wants to be there.

Your organization is intervening with people who have TBI and PTSD simultaneously. We have a patient with moderate TBI suffered almost 40 years ago, but no history of PTSD. Have you separated your population and studied each separately?

We haven’t, no. In some cases we could, for those who come in with previous diagnoses and medical records. But we have participants who either weren’t diagnosed, were under–diagnosed at the time, or don’t have records to show us.

Conclusion

As you’ve seen, a PHII can apply to a patient under your care. But it’s not always a perfect fit, and it’s important to think carefully about how your patient’s condition, symptoms, background, and experience compare to that of participants in a PHII.

Suggested Resources

The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid.

Evidence-Based Practice

• Devine, D. A., Wenger, B., Krugman, M., Zwink, J. E., Shiskowsky, K., Hagman, J., . . . Reeves, C. (2015). Part 1: Evidence-based facility design using transforming care at the bedside principles [PDF]. JONA: The Journal of Nursing Administration, 45(2), 74–83.
• Jeffs, L., Beswick, S., Lo, J., Campbell, H., Ferris, E., & Sidani, S. (2013). Defining what evidence is, linking it to patient outcomes, and making it relevant to practice: Insight from clinical nurses. Applied Nursing Research, 26(3), 105–109.
• Krugman, M., Sanders, C., & Kinney, L. J. (2015). Part 2: Evaluation and outcomes of an evidence-based facility design project. JONA: The Journal of Nursing Administration, 45(2), 84–92.
• Rice, M. J. (2013). Evidence-based practice: A model for clinical application. Journal of the American Psychiatric Nurses Association, 19(4), 217–221.
• Evidence-Based Practice in Nursing & Health Sciences: Review Levels of Evidence.
• Evidence-Based Practice in Nursing & Health Sciences.

Research Guides

• Nursing Masters (MSN) Research Guide.
• Database Guide: Ovid Nursing Full Text PLUS.
• Kaplan, L. (n.d.). Framework for how to read and critique a research study. Retrieved from https://www.nursingworld.org/~4afdfd/globalassets/practiceandpolicy/innovation–evidence/framework-for-how-to-read-and-critique-a-research-study.pdf

Preparation

In this assessment, you will base your Patient-Centered Care Report on the scenario presented in the Evidence-Based Health Evaluation and Application media piece. Some of the writing you completed and exported from the media piece should serve as pre-writing for this assessment and inform the final draft of your report. Even though the media piece presented only one type of care setting, you can extrapolate individualized care decisions, based on population health improvement initiative outcomes, to other settings.

Requirements

Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance level descriptions for each criterion to see how your work will be assessed.

Writing, Supporting Evidence, and APA Style

• Write clearly and logically, using correct grammar and mechanics.
• Integrate relevant evidence from 3–5 current scholarly or professional sources to support your evaluation, recommendations, and plans.
  • Apply correct APA formatting to all in-text citations and references.
  • Attach a reference list to your report.

Report Content

Address the following points in a 4–6 page report:

• Evaluate the expected outcomes of the population health improvement initiative that were, and were not, achieved.
  • Describe the outcomes that were achieved, their positive effects on the community’s health, and any variance across demographic groups.
  • Describe the outcomes that were not achieved, the extent to which they fell short of expectations, and any variance across demographic groups.
  • Identify the factors (for example: institutional, community, environmental, resources, communication) that may have contributed to any achievement shortfalls.
• Propose a strategy for improving the outcomes of the population health improvement initiative, or ensuring that all outcomes are being addressed, based on the best available evidence.
  • Describe the corrective measures you would take to address the factors that may have contributed to achievement shortfalls.
  • Cite the evidence (from similar projects, research, or professional organization resources) that supports the corrective measures you are proposing.
  • Explain how the evidence illustrates the likelihood of improved outcomes if your proposed strategy is enacted
• Develop an approach to personalizing patient care that incorporates lessons learned from the population health improvement initiative outcomes.
  • Explain how the outcomes and lessons learned informed the decisions you made in your approach for personalizing care for the patient with a health condition related to the population health concern addressed in the improvement initiative.
  • Ensure that your approach to personalizing care for the individual patient addresses the patient’s:

• Individual health needs.
• Economic and environmental realities.
• Culture and family.

• Incorporate the best available evidence (from both the population health improvement initiative and other relevant sources) to inform your approach and actions you intend to take.

• Justify the value and relevance of evidence you used to support your approach to personalizing care for your patient.
  • Explain why your evidence is valuable and relevant to your patient’s case.
  • Explain why each piece of evidence is appropriate for both the health issue you are trying to correct and for the unique situation of your patient and their family.
• Propose a framework for evaluating the outcomes of your approach to personalizing patient care.
  • Ensure that your framework includes measurable criteria that are relevant to your desired outcomes.
  • Explain why the criteria are appropriate and useful measures of success.
  • Identify the specific aspects of your approach that are most likely to be transferable to other individual cases.
• Patient-Centered Care Report Scoring Guide

Public Health Improvement Initiative Essay Paper