During exacerbations of Congestive Heart Failure (CHF), older patients may receive care in multiple settings; often resulting in fragmented care and poorly-executed care transitions. The negative consequences of fragmented care lead to duplication of services; inappropriate or conflicting discharge instructions, medication errors, patient/caregiver anxiety, and increased costs of care. In light of changes in Medicare reimbursement penalizing hospitals with above set limits for heart failure (HF) readmissions, models of care are being evaluated for their effectiveness in satisfying this change as well as reducing fragmented care in this population. This paper reviews the Transitional Care Model created by Dr. Mary Naylor at the University of Pennsylvania (Penn Nursing Science, 2013). This model in introduces a patient-centered interdisciplinary team intervention designed to improve transitions across care settings.
Congestive Heart Failure
Congestive heart failure (CHF) is a condition in which the heart is incapable of adequately pumping blood throughout the body or unable to stop blood from backing up into the lungs. The most common cause of CHF is hypertension, previous myocardial infarctions, disorders of the heart muscle or the valves of the heart, and chronic lung diseases such as asthma or emphysema. CHF is a common diagnosis for individuals sixty five years and older. With the growing population of baby boomers, the rate of CHF is predicted to nearly double over the next forty years and will be a drain on healthcare resources. Treatment costs are estimated around $20 to $40 billon, with $8 to $15 billion spent on hospitalization alone (Quaglietti, Edwin, Ackerman, & Froelihe...
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...he Medicare Fee for Service Program. New England Journal of Medicine, 360: 1418-1468.
Naylor, M. (2012). Transitional Care Model. Retrieved from http://www.fiercehealthcare.com/special-reports/transitional-care-model
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Senthilraj, G., & Ganeshan, R. (2013). Effects of a Hospital Wide Quality Improvement (Doctoral dissertation, University of Connecticut). Retrieved from http://digitalcommons.uconn.edu/cgi/vecontent.cgi?article=1464&context=gs_thesis
A cardiac assessment: Listen to heart sounds listening for extra heart sounds, fast heartbeat, and monitor EKG looking for dysthymias. Assess vitals especially BP, BP should be kept low in heart failure patients to put less stress on the heart. Assess the patient for edema as a result of fluid retention. Listen for crackles in the lungs due to fluid built up. Watch I&O’s and weight the patient to assess for edema, ask about activity intolerance. Assess for changes in mental status, cool extremities, pale or cyanotic, fatigue, and JVD (Indications of poor perfusion) (Ignatavicius &Workman, p.756).
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With healthcare costs soaring in the United States, there is a continuous movement by hospitals and health systems towards reaching a number of patient and system oriented goals related to higher levels of quality, safety, and cost effectiveness. The Triple Aim captures the essential challenges and opportunities of this time within the U.S. Healthcare system. Formally introduce by the Institute for Healthcare Improvement (IHI) in October 2007, the Triple Aim is theoretical model for optimizing health system performance. The initiative has three components: improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita costs of health care (Berwick,
Today?s healthcare environment calls for continued cost containment while providing better, quality care. As a result of the advances of healthcare, life expectancies have increased resulting in a growing, aged population with more chronic conditions. Treatment options, outside the hospital, are the norm for most routine management of patient care, but when someone gets sick, and requires hospitalization, the combination of their age, chronicity of illness and increased comorbidity
Hypertension increases the risk of heart failure 2 to 3 fold. (He, et al, 2001) The American College of Cardiology (ACC) has identified 4 stages of heart failure. (Hunt, Abraham, Chin et al, 2009). Screening patients for heart failure is sometimes controversial. Health care administrators...
Katzenstein, Larry, and Ileana L. Pinã. Living with Heart Disease: Everything You Need to Know to Safeguard Your Health and Take Control of Your Life. New York: AARP/Sterling Pub. Co, 2007. Print.
Quality and quality improvement are important to any healthcare organization because these principles allows organizations to fulfill their missions more effectively. Defining what quality is may differ depending on whom is asking the question, as differing participates may have differing ideas about what quality means and why it is important. Being that quality is what unites patients and healthcare organizations, we can see the importance of quality and the need for strong policies and practices that improve patient care and their experience while receiving that care. Giannini (2015) states that this dualistic approach to quality utilizes separate measurements, conformance quality that measures patient outcomes against a set standard and Dinh et al. (2014) found that by employing a quality improvement system lowered trauma patient mortality by statically significant amount.
Blum,J.,(2011). Improving quality, lowering cost: The role of health care delivery system: U. S Department of health and human services.
A transitional care nurse or nurse navigator could be utilized to assure a smooth transition from the hospital into the community. The nurse navigator bridges the gap between the hospital care and post-acute care, while working closely with hospital staff, primary care doctors, specialists and community resources (Lamb, 2014, p. 191). Following the client’s discharge, a home health nurse would assume care and begin coordinating services. This nurse would be responsible to assure that all the care services are in place and there is a smooth
In the healthcare system, quality is a major driving compartment for patient outcomes. The quality of care reflects the outcomes in a patient’s care. According to Feeley, Fly, Walters and Burke (2010), “quality equ...
Nembhard, I. M., Alexander, J. A., Hoff, T. J., & Ramanujam, R. (2009). Why Does the Quality of Health Care Continue to Lag? Insights from Management Research. Academy Of Management Perspectives, 23 (1), 24-42. doi: 10.5465/AMP.2009.37008001
According to Fred Lee (2004) hospitals use clinical results and process improvement as a gauge of quality as this data can be readily measured and objective. Conversely, patients judge the quality of care by individual perception. Therein a gap of what the patient’s perception of quality care and how the healthcare providers perceive quality of care is created. The purpose of this paper is to discuss the Gaps Model of Service Quality while comparing the findings of the work done by Fred Lee in the book, If Disney Ran Your Hospital: 91/2 Things You would Do Differently.
... patients with heart failure: Impact on patients. American Journal of Critical Care, 20(6), 431-442.
Understanding quality measurement is essential in improving quality. Teams need to be able to understand whether the changes being made are actually leading to improved care and improved outcomes. For data to have an impact on an improvement initiative, providers and staff must understand it, trust it, and use it. Health care organization must understand the measurement of quality provided by the Institute of Medicine (patient outcomes, patient satisfaction, compliance, efficiency, safe, timely, patient centered, and equitable. An organization cannot improve its performance if it does not know how it is performing. Measuring quality improvements is essential as it reflects the quality of care given by the providers and that by comparing performance
Nguyen, N. (2009, August). Improving quality and value in the u.s. health care system. Retrieved from http://www.brookings.edu/research/reports/2009/08/21-bpc-qualityreport