The healthcare of the United States has seen significant improvement ever since the development of the ‘Triple Aim

Introduction

The healthcare of the United States has seen significant improvement ever since the development of the ‘Triple Aim.’ The Triple Aim is focused on reducing the costs associated with healthcare, improving the health of the population, and improving the experiences of care. The initiative is aimed at solving the numerous issues that affect the healthcare industry in the country.  The components of the ‘triple aim’ are complementary to each other. The changes in one component might have a huge impact on the other two components. This analytical paper will discuss the major health population issue that the ‘triple aim’ is trying to eliminate. It will discuss how the issue affects the general population and how the triple aim is critical in eliminating the negative impacts of the issue.

Healthcare Issue

The primary healthcare issue that will focus on the report is the quality and safety of patient care. Over the years, the healthcare quality and safety of care in the United States were on the decline. Quality of care has been a health agenda in the country for a long time.  The interest in safety and quality of patient care has developed due to changes in the healthcare delivery system. The growth of new healthcare practices, organizational structures, and healthcare process strategies has led to the rise of concern over patient care quality and safety. Many current healthcare systems are likely to improve the outcomes of the populations. Others, however, increase the risks of the population to overlying healthcare issues.

Definition

The term quality in healthcare is defined by the Institute of Medicine (IOM) as the degree to which healthcare services are likely to achieve the intended outcomes consistent with the current professional knowledge.  High-quality healthcare services will mean that patients receive the appropriate care in a manner that illustrates the utmost competency. Quality care is characterized by effective communication practices between all stakeholders, cultural competency and sensitivity, and shared decision making in the process of care.  Poor quality of care can be defined as too much care or too little care that negatively impacts the patient’s outcomes. Too much care could include providing unnecessary tests and medications and medical procedures that are not aimed at solving a patient’s underlying condition.  Too little care means that healthcare providers lack to provide necessary diagnostic services or life-saving procedures without justification, which leads to poor patient outcomes.

Quality and safety of care can be evaluated based on the outcomes, the processes, or the structure of care offered in the industry.  Process quality assesses the types of interactions between patients and their physicians. Outcomes act as and evidence of better change in the conditions of a patient after they receive treatments.  Structural quality, on the other hand, is evaluated by the characteristics of the health system.  The three dimensions are critical in determining the levels of safety and the quality of patient care. Quality care involves using the right diagnostic tools, the right or qualified personnel to give care services and presenting the appropriate treatment to the patient that corresponds to their healthcare problem.

The World Health Organization defines the quality of care as healthcare services’ ability to achieve the intended outcome. The organization defines the characteristics of high-quality care.  Safe care leads to an increase in the quality of healthcare services to individuals within a population.  Safe care is one that reduces or eliminates risks that are associated with the prices of care. Such risks could include preventable injuries and medical errors. Quality care is also effective in that the services provided are evidence-based and based on scientific knowledge. Such care is also delivered promptly, which reduces delays in providing necessary healthcare services. Quality is also marked by the efficiency in which it is delivered. Efficiency means that healthcare should be delivered to maximize the use of available resources and avoid any waste. Quality care is also people-centered taking into account the preferences of the population that is being treated.  Equitable care also helps eliminate safety and quality issues experienced in the healthcare industry. Equitable care is one that does not differ due to personal characteristics such as age, gender, socioeconomic status, and ethnicity, among others.

Literature Review

The research by Zohrabian et al. (2018) indicates that healthcare in the USA is deteriorating. The study focuses on the rates of readmissions in the country due to factors related to the poor quality of health that patients receive. The researchers focus on heart failure cases where poor coordination and increasing healthcare costs were associated with hospital readmissions. Heart failure conditions are among the most expensive healthcare conditions treated in the United States. The cost of care is way too high compared to what the general public can afford to care for. The lack of finances leads to poor services and poor quality of care, leading to constant readmissions to healthcare facilities. The study proposes a self-insurance plan where individuals who have heart problems could insure themselves against such healthcare conditions. The bottom line is that the healthcare system is reimbursement oriented other than being patient-centered. The services that a patient receives are proportional to the finances that they can throw into healthcare services.

Percutaneous coronary interventions (PCI) are common in the United States. They are an area of concern due to the quality and safety of care delivered to the population ailing from the condition.  Kwok et al. (2018) carried out a study to measure PCI’s national readmission rates. The study was carried out between 2013 and 2014 using the U.S Nationwide database.  The study focused on a 30-day unplanned re-hospitalization.  The study results showed that 9.3% of the individuals involved in the study were readmitted within 30 days of leaving the healthcare facilities.  The length of stay for PCI individuals was higher than normal stays (4.7 vs. 3.9 days). The cost of hospitalization was higher in the readmitted patients than those that were not readmitted.  The readmissions were associated with patients that had been discharged against medical advice.  The research shows that poor quality of care and less patient-centric care lead to negative patient outcomes.

Clinical practice guidelines have played a prominent role in healthcare quality and safety for the last two decades.  Many healthcare organizations have grown over the years, and so has the clinical practice guidelines. Many organizations, however, are not in compliance with the IOM standards, which affect the quality of care delivered to patients. Kung et al. (2012) review the compliance of IOM standards in relation to the organization’s guidelines. Their research carries out an independent screening of 130 guidelines selected randomly from the National Guidelines Clearinghouse (NGC) website. The study results showed that most practitioner guidelines were not in line with the 18-25 IOM standards. Most organizations failed to involve information scientists and/or patients or their representatives when formulating the guidelines. The result is a negative impact on the quality of care that such facilities deliver to their patients.

The relevance of Understanding Quality and Safety of Healthcare

Healthcare providers must understand the role that the quality and safety of care play in developing the health of a population. The World Health Organization (2019) cites that the occurrence of adverse events in healthcare is one of the top 10 leading causes of death and disability globally. The study was done through the organization also shows that two-thirds of adverse events in healthcare result from unsafe care that patients receive.

The burden of poor quality and safety of care

The WHO (2019) cites that millions of patients worldwide suffer due to the poor quality of care they receive in healthcare facilities.  Unsafe and poor quality of care causes harm to the patient directly or indirectly. The health organization states that medical errors are the leading causes of unintended injuries to healthcare systems. It is estimated that medical errors cost the global healthcare system US$ 42 billion each year. In 2008, medical errors in the United States alone resulted in costs of over $ 17.1 billion. By 2019, the rates of medical errors are still very high, as shown in the Patient Safety Network (2019). Despite the developed technology, the cost of medical errors stands at $617 million for 12 months (Agency for Healthcare Research and Quality, 2019).

(Agency for Healthcare Research Quality)

Diagnostic errors occur in 5% of all adult outpatients, and more than half of those impacted suffer severely. The United States healthcare organizations are characterized by healthcare malpractices that increase the risk of associated healthcare infections. In developed countries, 7 out of 100 hospitalized patients are likely to develop healthcare-related infections.  Sepsis is another problem that the country’s population is suffering from.  The lack of proper diagnosis or early interventions leads to sepsis’s rapid development, which increases the mortality rate.

Initiatives to Increase Quality of Care

The ‘Triple Aim’ ‘s primary focus is to improve the safety and quality of care, which will, in turn, influence the three major objectives of patient satisfaction, improved overall health, and reduced costs of care (White et al., 2015). Quality care is directly associated with costs, as seen in the literature review. Poor quality leads to readmissions, which increases the cost of care to patients and healthcare facilities. The following are a few initiatives that could help increase the quality of care in the country.

Payer and Reimbursement Reforms

One of the greatest initiatives adopted in the United States to improve the quality and safety of care is the reform of the country’s reimbursement systems. Reimbursement goes hand in hand with the quality of care that patients receive. The traditional payer or reimbursement system was volume focused other than being value-focused. The con of such a system is that physicians were more focused on the number of patients they treat other than the quality of services they offered. The healthcare reforms spearheaded by the Institute of Medicine led to a shift from a pay-for-service approach to pay-for performance approach. In the latter, the patient’s perception of the service by the patient would be considered when reimbursing healthcare providers.

The Patient Protection and Affordable Care Act (PPACA) has led to great changes to healthcare stakeholders such as payers, providers, and individuals under the care plan. The act increases the differentiation between payer products. To create better and safer care, the act also makes it possible to increase healthcare services through the payer system.  The act also redefines the reimbursement methods. Payers are excluded from denying coverage, and the reimbursement models also affect the spending caps of healthcare facilities. Fee-for-service models lacked the capabilities of allowing payers to manage new populations with changing risk profiles. The adoptions of different payment models have resulted in better healthcare outcomes and have reduced problems associated with poor quality and safety of care. Since 2010, the number of readmissions in healthcare facilities has reduced as physicians focus on offering quality care for better remuneration.

(Source: Patrick Conway)

Accelerating implementation of key payment reform provisions

Development of Accountable Care Organizations

Accountable care organizations (ACOs) are formed by healthcare providers and agree to take responsibility for the quality and the total cost of care that a particular population receives.  The Affordable Care Act (ACA) in 2012 developed the Medicare Shared Savings program in 2012 that encouraged the formation of ACOs.  The programs work in a way that health care organizations receive half the savings they earn on meeting quality benchmarks and cutting patient care costs to amounts below the set budget. By 2015, the number of ACPs was very high, with over 400 organizations and 7.2 million Americans benefiting from the programs (White et al., 2015).  Medicare participants made 14% of the population.

(Source: Center for Medicare and Medicaid Services)

Perspectives on Quality and Safety

There are three basic perspectives when it comes to the quality and safety of healthcare services:

The ‘Healthcare Service’ Perspective

The perspective is based on the quality and safety of care a patient receives under a healthcare program. It is divided into three entry points. The first is patient quality, which focuses on providing the patient with the type of healthcare services they want and expects during and after the healthcare process. The second is a professional quality, and such services follow methods and procedures that are thought to be most impactful and effective in meeting the patients’ medical needs. The effectiveness of the methods is determined by the healthcare professional (Rocca & Anjum, 2020). The third entry point is management quality, where the service uses the available resources at any one given time in the best way to achieve professional and patient quality.

The three dimensions are critical in the process of providing safe and quality care. However, they can conflict, especially when the patients’ expectations are not in line with the management and professional recommendations. Quality services therefore have to balance all the three area. A good example is the collaborative effort between a professional and a patient in deciding the best form of treatment for a particular condition. The healthcare service perspective could also be used to measure the progress in improving the quality of care. The safety and quality of care could be measures through complaints given by patients and understanding the patients’ level of satisfaction. Professional safety and quality are measured by collecting error reports or understanding patients who did not appropriate treatment plans.  The unit costs and lengths of stay in healthcare facilities could be used as metrics for identifying management safety levels and quality inpatient care.

 

The Populations’ Public Health’ Perspectives

This is a broader view of the healthcare system. It views the quality and safety of care as more than just providing care to patients who visit healthcare facilities and those that require services within the community. Many individuals within a community do not seek healthcare interventions, but they might need the services (Stanhope & Lancaster, 2019).  The vulnerable populations are the most affected as they have little to no access to healthcare services. Public health perspectives determine how well healthcare services reach community members, especially those at high health risks.

System of Care Perspective

It is a broader perspective of quality and safety of care that looks beyond the healthcare service facility and focuses on an interdisciplinary healthcare approach. Patients might be satisfied with the care at one point in their treatment but show high degrees of dissatisfaction when the care is transferred to another service. Many patient errors and harm are caused through such transfer due to the lack of the needed information to make accurate care decisions. Therefore, the quality of care will be determined by the quality of all interconnected services that a patient receives.

Recommendations

The ultimate goal of healthcare is to improve the health and living standards of a population. To control the quality and safety of care at a national level, the healthcare industry must adopt various strategies.  Such strategies will utilize available resources to ensure the optimal provision of healthcare services to the general public.

Safety and Quality Strategies Aimed at Healthcare Professionals

Healthcare professionals are required to possess certain levels of skill and expertise in medicine. They are also expected to have a certain attitude that affects how they deliver care to patients.  The knowledge that healthcare professionals have is based on scientific evidence, and skills are based on training. A healthcare professional delivers care through intensive interactions with the patients.  Safety and quality of patients is a core value for healthcare professionals. However, the field of medicine constantly changes, and the techniques of delivering care change. The scientific knowledge used two decades ago is different from the knowledge available today. Medications have changed, and there are better ways to deliver care. Care delivery competence is, therefore, an important element of health care professionals. To ensure such competence, the following is recommended.

The first is continuous training for healthcare professionals in their careers. Such training will ensure that they are up to date with care-related skills and deliver safe care. Technology is an integral part of ensuring the quality of care, and professionals have to obtain the necessary skills and expertise to optimize it (Milani & Lavie, 2015). There should be policies in the legislature that relate to the validation of healthcare professionals. A certain level of knowledge should be required when dealing with high-risk patients to ensure low instances of medical errors and readmissions.  Professional bodies should also be vigilant of formulating standards and regulations that govern healthcare professionals. They affect the relationship between a patient and a professional and the fiduciary duty the professional has towards the patient. The legislature will ensure ethical conduct and integrity in the process of care, thus improving the quality and safety of care.

Healthcare professionals should also be monitored, and their performance measured through a national database. Keeping count of recognized professionals helps patients decide the professionals that are likely to provide a high quality of care. Data collected through the national database could also help measure performance, which would rank each professional.  Legislatures and policies should also ensure that healthcare professionals have access to educational opportunities. Continuous education is critical to the delivery of care as it affects professionals’ understanding of current healthcare issues and trends.  Proper human resource planning also eliminates health worker burnout instances, which influences attitudes during care delivery and affects the quality and safety of care.

Quality and Safety Strategies for Healthcare Organizations

Healthcare organizations include facilities such as hospitals and healthcare clinics, among others. Such facilities can greatly impact the quality and safety of care that a patient receives.  The services offered in a healthcare facility are determined by the type of care facility and the technology the facility adopts. Technologically advanced healthcare facilities have a higher probability of providing safer and high-quality care to patients. Setting legislation and policies that govern healthcare facilities and their activities could, therefore, influence the quality and safety of care delivered. Healthcare facilities should be required to have particular licensing that proves the facility can provide the services it advertises. Such licensure will ensure that facilities have the right equipment and healthcare professionals to meet their patients (Haeder & Yackee, 2020).

The facilities should also be monitored continuously and performance measured. Such will show the safety and quality levels within the facility and thus attract the appropriate course of action.  Through healthcare databases, the ministry of health in the country can monitor the activities of healthcare facilities. The government should also offer financial aid incentives to healthcare organizations that are community-based and need technological advancements. Poor quality of care is related to the lack of necessary equipment to diagnose and treat various conditions. The measurement of safety and quality is dependent on the quality of the facility’s information system.  Facilities should also seek accreditation from approved national bodies to enhance the quality of care offered in such facilities.

Quality and Safety Strategies aimed at medical products

The safety and quality of care are also heavily dependent on the products and equipment used to deliver such care. Medication and tools used in care are as good as the professionals that use them.  Healthcare organizations are characterized by the use of large quantities of medical technologies and products. Most such products are sourced from different suppliers and manufacturers (Haeder & Yackee, 2020). It is advisable for healthcare organizations and the federal government to set standards that will regulate the amount and types of products that enter the American markets. Pharmaceutical products are crucial as any error could lead to devastating effects on the public. The bureau of standards ensures that such medical equipment meet the expected standards and that citizens are not exposed to dangerous healthcare products. If particular products allowed in the market are harmful to individuals’ health, then the governments should intervene through its agencies. Such regulations will improve the safety of care and eventuality the quality of care that patients receive.

 

 

Conclusion

The quality and safety of care in the country is an issue of concern as it affects public health levels. Health care organizations and professionals should ensure that patients have access to quality and safe care.  Quality and safety affect the overall health outcomes of the patients. The Affordable Care Act ensures that safety measures are put into place to increase a patient-oriented healthcare system. Through reimbursement model reforms and the development of ACOs, the legislature can increase the quality of care. The recommendations to deal with the issue would be the government, physicians, and healthcare organizations in the process of providing quality care services. Policies and legislation that regulate physicians and healthcare organizations’ activities will help improve the safety and quality of care. Governments should also support the healthcare professional’s education and training to keep their skills and expertise up to date.

 

 

 

 

 

 

 

 

 

References

Agency for Healthcare Research and quality. (2019, June 19). The financial and human cost of medical error… and how Massachusetts can lead the way on patient safety. PSNet. https://psnet.ahrq.gov/issue/financial-and-human-cost-medical-error-and-how-massachusetts-can-lead-way-patient-safety

Haeder, S. F., & Yackee, S. W. (2020). A Look Under the Hood: Regulatory Policy Making and the Affordable Care Act. Journal of Health Politics, Policy and Law45(5), 771-786. https://www.researchgate.net/profile/Simon_Haeder/publication/342487392_A_Look_Under_the_Hood_Regulatory_Policy_Making_and_the_Affordable_Care_Act/links/5efb479292851c52d609f880/A-Look-Under-the-Hood-Regulatory-Policy-Making-and-the-Affordable-Care-Act.pdf

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Kwok, C. S., Rao, S. V., Potts, J. E., Kontopantelis, E., Rashid, M., Kinnaird, T., … & Mamas, M. A. (2018). Burden of 30-day readmissions after percutaneous coronary intervention in 833,344 patients in the United States: predictors, causes, and cost: insights from the Nationwide Readmission Database. JACC: Cardiovascular Interventions11(7), 665-674. https://www.sciencedirect.com/science/article/pii/S1936879818303650

Milani, R. V., & Lavie, C. J. (2015). Health care 2020: reengineering health care delivery to combat chronic disease. The American journal of medicine128(4), 337-343. https://www.amjmed.com/article/S0002-9343%2814%2901035-3/fulltext

Rocca, E., & Anjum, R. L. (2020). Erice call for change: Utilising patient experiences to enhance the quality and safety of healthcare. Drug Safety, 1-3. https://link.springer.com/content/pdf/10.1007/s40264-020-00919-2.pdf

Stanhope, M., & Lancaster, J. (2019). Public health nursing e-book: Population-centered health care in the community. Elsevier Health Sciences.

White, C., Reschovsky, J. D., & Bond, A. M. (2014). Understanding differences between high-and low-price hospitals: implications for efforts to rein in costs. Health Affairs33(2), 324-331. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2013.0747

World Health Organization. (2019, September 13). Patient safetyhttps://www.who.int/news-room/fact-sheets/detail/patient-safety

World Health Organization. (2020). What is quality of care and why is it important? https://www.who.int/maternal_child_adolescent/topics/quality-of-care/definition/en/

Zohrabian, A., Kapp, J. M., & Simoes, E. J. (2018). The economic case for US hospitals to revise their approach to heart failure readmission reduction. Annals of translational medicine6(15). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123214/

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