Describe the problem or issue and propose a quality improvement initiative based on evidence-based practice.

Introduction

Quality improvement is a critical part of achieving the goals of healthcare organizations within the country. Healthcare organizations are often faced with many problems as they try to improve patient quality and safety. The Affordable Care Act has the ‘Triple Aim’ that aims to improve healthcare, reduce health care costs, and make sure that quality care is easily accessible to all citizens. This paper will focus on a healthcare organization and a quality improvement opportunity that it has. It will use evidence-based research to prove the validity and credibility of the quality improvement initiative, explain the need for quality improvement, and also the steps necessary to implement the improvement initiative.

Problem Overview

The healthcare sector is faced with many issues. One of the most pressing issues is the increased costs of care. The United States has one of the most expensive healthcare systems globally, which is a burden to its citizens and government. The country spends billions of dollars in healthcare, even though healthcare is still not equally available and affordable. Such high costs of care could be attributed to improved technologies and low efficiencies within healthcare organizations. However, the main culprit of such costs is the increasing costs of providing care in the facilities that provide healthcare services. Overhead costs of healthcare delivery are often transferred to the patient and to the healthcare payer systems.  High administrative costs and medication costs increase the overall price that a patient has to pay to receive care.

Healthcare Setting

The setting is in a major hospital that has several clinics across the country. The hospital is facing high costs of operations and service delivery to patients, leading to the overall high costs of care. The patients have to part with a substantial amount of money to get services at the clinics. The cost of the care at the hospital is as high as it is due to overhead costs within the facility, such as high administration costs and high costs due to readmissions. The hospital will adopt a pharmacist-led medication therapy initiative aimed at reducing the economic burden placed on the healthcare system.

Quality improvement in relation to the costs of delivering care is thus a crucial factor in reducing care costs at the healthcare facility. Quality improvement is essential for achieving the triple aim of the Affordable Care Act (ACA) (Panny et al., 2019).  The pharmacist-led initiative will ensure that patients receive the right kind of medication and that the latter gets trusted medications from professionals, therefore avoiding readmission instances. Medications used in treatment make the costs of a care skyrocket. If a patient is given the wrong medication, their health problems will remain, and they will have to pay more to get healthcare services. Quality improvement is, therefore, needed to increase efficiency within the organization. The expected outcomes are better patient results and satisfaction with the quality of care and medication offered. Healthcare costs within the facility should also drop, and there will be fewer or no readmissions in the facility due to drug failures.

Literature Review

Previous research done on pharmacist-led medication therapy management shines a positive light on its benefits.  The first study by Jokanovic et al. (2017) shows a systematic review of pharmacist-led medication. The research tries to identify medication-related problems and solve them. The systematic reviews that were studied in the research were based on a community setting. The authors searched various databases such as MEDLINE, EMBASE, and the Cumulative Index to Nursing and Alliance Health Literature (CINAHL). The search was based on documents dated from 1995 to 2015. The study designs and the studies’ outcomes were considered, and two independent investigators carried out the data extraction and quality assessment.

The researchers identified 35 relevant reviews with seven of high quality and 24 of moderate quality. The studies showed favorable outcomes, such as diabetes control, cholesterol, and blood pressure control.  Significant reductions in medication and healthcare costs were also recorded in 35% of the primary study.  The meta-analysis results on 12 systematic reviews showed a positive impact on blood pressure, hemoglobin, and number and appropriateness of medications. The study’s conclusion was that pharmacist-led medication therapy had many benefits to the quality of health and reduced the cost of healthcare or/and medication. However, the researchers pointed out the need for more research on the cost analysis of the initiative.

Renaudin et al. (2015) review how pharmacist-led medication therapy leads to reduced hospital readmissions. The study uses a Meta-analysis and systematic review to support its thesis. The researchers identified the relevant studies from Medline and Cochrane Library databases. The studies used in the research had to be a randomized controlled trial of interventions without any restrictions on the language used or the dates. The primary outcome was all-cause readmission or Emergency Department (ED) visit at any time. The study used a 95% confidence level. The results of the study showed that the 19 reviewed controlled trials had non-differing readmission rates. The experimental groups and control groups’ readmission rates were not different, and so were the secondary outcomes. The authors concluded that the researches and systematic analysis showed an impact of pharmacist-led medication therapy. However, more studies focused on the influence of the initiative’s quality of life should be carried out.

Najafzadeh et al. (2016) discuss the medical discrepancies at the time of hospital discharge and its impact on the patient and the costs of healthcare delivery. The study’s objectives are to show how medication reconciliation by pharmacists could be used to prevent or reduce cases of medical discrepancies and adverse drug events (ADEs) resulting from them. The study aimed to estimate the economic value of such reconciliations at hospital discharge compared to the usual care. The study design employed was a discrete event simulation model that would model drug-related events from a payer’s perspective.  The data of the model was based on information from peer-reviewed literature.  The simulations showed that the total cost of ADEs that were preventable was $472 per patient with a credible interval of $247-$778 under the usual care.  Pharmacists’ medication reconciliation showed that the costs could be reduced to $266 per patient after accounting for the intervention costs. The study’s conclusion was that implementing pharmacist-led medication reconciliation at discharge could be a cost saving strategy compared to the usual care.

Steps Necessary to Implement the Initiative

The first step is patient and medication history tracking, where the pharmacist can get a comprehensive understanding of the patient and their medication therapy.  The physician collects the history of present and past medication history, including any complaints about the drugs’ adverse effects. The second step is a systematic review of the medication, which involves identifying medication-related problems. The step is important in that it helps to identify the potential solutions to such problems. The pharmacist uses drug medication databases to carry out the review. Through the process, they can identify inappropriate drugs and also identify medication that was previously omitted. The third step is carrying out interdisciplinary case conferences where healthcare professionals responsible for the treatment of the patient meet. The pharmacists represent the identified medication-related problems, and they are discussed by the team to reach a consensus about the action to be taken (Halvorsen et al., 2019).   The last step is the follow up of the pharmaceutical care plan after the case conference.  This step ensures that the medication-related problem is solved and the patient gets the right medication, thus reducing readmission chances.

Evaluation of the Initiative

The first way to evaluate the initiative’s success is by comparing the patient’s behavior before the initiative and after the initiative. The hospital will have to compare the numbers of patients taken in as readmissions before the initiative and the current number of patients taken in for readmission for medication-related issues after the initiative. A lower number of readmissions at the hospital will mean that the initiative was a success and that medication-related problems at the facility are lower (Balasubramanian et al., 2019). Another metric used to measure the success of the initiative is the patient’s perception of the care provided. The more satisfaction the customer shows with the care, the more efficient the hospital healthcare delivery services are. Patient satisfaction is an important metric to determine whether the initiative is headed towards the intended direction.

The most important metric used to measure the effectiveness of the initiative is the levels of care delivery costs at the institution. The hospital’s readmissions increase the overall cost of care delivery and the cost of care to the patient (Agency for Health Research Quality, 2015). If the costs reduce, it means that the initiative is a success.  Healthcare providers will also test the acceptance of the changes in healthcare delivery among the patients and staff members that deal with the treatment of the patient.

Conclusion

Quality improvement programs are very important in the field of healthcare. They help improve the efficiency and effectiveness of care. The quality improvement program at the hospital setting is an initiative that will encourage pharmacist-led medication therapy. The problem the facility is facing is increasing costs of delivery of care due to increased readmissions. Patients who are given the wrong medication or that develop medication-related problems after treatment increase care costs at the facility. The medication-related problems will be eliminated through the quality improvement plan and, therefore, reduce the number of readmissions and the costs associated with such readmissions.

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