Strategies for Eliminating Health Disparities

The following post has two assignments namely;

1.Strategies for Eliminating Health Disparities

Read the “Applying Exercise State of Change to a Low-income Underserved Population” article:

1) What was the behavior change theory that was used for this study? Why was this theory selected? Do you think it was the best choice for this study design? How was this model measured? (4
points)

2) Who was the target population for this study? Why was this population group selected? (4 points)

3) Propose how social disparities may have been a factor in the study results. (4 pts)

4) How can this study be used for future research on behavioral change within this population group? (4 points)

5) What are some limitations to this study? Will these limitations affect the applicability of the transtheoretical model to other low-income populations? (4 point

2.HCAHPS score

Analyze a healthcare system’s survey data (Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS) and develop a strategic plan for improvement of organizational scores. The
HCAHPS results posted on Hospital Compare, which is part of the government’s Medicare website (see attached form), allow consumers to make fair and objective comparisons between hospitals and state
and national averages on important measures related to the patient’s unique perspective of the care received. Incorporate the most recent survey scores data analysis (including comparison
scores/benchmarking), impact of scores (financial and quality), organizational structure/design, use of technology, and influential cultural and social/environmental factors into this project. You
will provide a thorough analysis, a plan that includes stakeholder involvement, and a timeline for implementation, evaluation, and outcome measurement.
Scenario:
You have been tasked with improving the most recently reported HCAHPS score for the entire organization.
The hospital board is requesting a detailed report, analysis, and plan to improve these results. You are instructed to complete the full data and impact analysis; develop a detailed strategic plan
to improve the scores in all areas of the hospital, incorporating quality improvement, shared accountability, technology, care delivery model, and financial stability; propose a rapid
implementation timeline; and outline the process of evaluation in an effective presentation.
Requirements:
You use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate work. Each requirement below may be evaluated by more than one
rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Provide the HCAHPS scores for a hospital (the University of Utah Hospital. See attachment)
Note: Refer to the web link to find HCAHPS scores for various hospitals.

B. Analyze the HCAHPS scores of your chosen hospital by doing the following:
1. Compare the scores to state and national averages. Discuss findings.

2. Compare the scores to two other hospitals in the region. (i.e. The University of Utah scored better than St. Marks Hospital in eight out of 10 categories. etc.)

3. In detail compare the survey response rates to two other hospitals in the region. (See attachment)

4. Describe the hospital’s demographic patient population and services provided. (May use graphs)
i.e. Averages for the 2016 tax year for zip code 84112, filed in 2017
i.e. For population 25 years and over in 84112 (City-Data.com, 2017)
i.e. Races in zip code 84112 (City-Data.com, 2017)
i.e. Hospital’s services provided.

5. Discuss how the following environmental and community factors could potentially influence HCAHPS scores:
(Use the information described in B4. Think about cultural preferences of the patients served and then discuss how this could potentially influence HCAHPS scores).

a. cultural dynamics
How does culture affects pain tolerance?
• What is the makeup of your staff versus your patient population?
• Does hospital provide instructions in other languages?
• Are there communication barriers?
• Does hospital have readily available interpretive services?

b. educational dynamics
• What is the impact on communication with nurses and physicians if lower than high school education:
• Is medical terminology in communication?
• What is the literacy level of discharge instructions? Note: A decreased literacy level may result in a decreased understanding of discharge instructions.
• Does organization call the patient if the survey is not completed and do a phone survey? This could impact response rate based on educational dynamics.

c. socioeconomic dynamics
• Do patients have high expectations of responsiveness?
• What are the relationships between personnel and patients?
• Is there bias among personnel if the patient is uninsured?
• Are the patients using ED as primary care?
o How does this affect communication? Responsiveness? Understanding their care when they discharged?
o Is the community affluent?
o Note: An increased expectation of the patients may cause the hospital to feel overwhelmed. A decreased responsiveness to patients may result in decreased HCAHPS scores. A hospital in a poor
socio-economic community may have increased HCAHPS scores due to patients feeling that receiving care is positive.
(Use the information described in B4. Think about cultural preferences of the patients served and then discuss how this could potentially influence HCAHPS scores).

6. Explain potential short- and long-term financial impact on the organization.
• Short Term Impacts
o What happens if HCAHPS scores are not at state/ national average?
• Decreased reimbursement
o What impact does a 30-day readmission have due to not understanding discharge instructions?
o What happens if patients quit coming to hospital?
• Lower census means lower revenue
• Lower census means calling off staff
• Long Term Impact
o What happens if you can’t increase you HCAHPS scores long term?
• Decrease in revenue
• Inability to invest in current technology for the organization
• Downsizing/ staff layoffs
• Potential mergers
• Potential closing of organization

a. Discuss potential impact on quality outcomes.
• What happens to quality if the responsiveness scores are low?
o Falls?
o Hospital acquired pressure ulcers?
• Think about what happen to the quality of care of patient if they do not understand what to do when they get home?
o Will they take their medications?
o Will they follow up with their primary care provider?
o Will the patient have a good outcome if they don’t take their medication or follow up with their primary care provider? Will they have to be readmitted?

C. Discuss the potential cause of the chosen hospital’s HCAHPS scores.
Identify 3 low scoring questions in your HCAHPS scores and then determine potential causes for each of the 3 low scoring questions (3 causes for each question).
Example:
Patients who reported that the area around their room was ”always” quiet at night.
Potential Causes
• Overhead paging
• Location of patient near the nursing station
• High number of admissions during nightshift

D. Develop an organizational strategic plan to improve the chosen hospital’s HCAHPS scores throughout the organization by doing the following:
1. Explain how organizational change can help improve the chosen hospital’s HCAHPS scores. Discuss ONE organizational change for each of the HCAHPS questions described in section C and how this
change will improve the HCAHPS scores.
Examples:
• Goal – Decrease noise at night
• Organizational Changes – Incorporate technology to avoid overhead pages
• Improvement in HCAHPS scores – By incorporating technology to avoid overhead pages, the environment will be quieter.

2. Discuss the structure (i.e., framework), process (i.e., actions), and outcomes of the strategic plan.
2. Address structure, process, and outcomes for each of the 3 HCAHPS

Structure Process Outcome
Decrease noise at night Literature search for Evidence Based Practice (EBP) to address noise at night
Work with IT to determine technology solutions
Involve Shared Governance (SG) to determine barriers to a quiet environment at night and development of policy for technology
Improve HCAHPS scores on question “Patients who reported that the area around their room was “always” quiet at night.

3. Discuss how you would incorporate evidence-based practice and shared governance to improve organizational quality. Discuss how to improve organizational quality by incorporating EBP and shared
governance. Must say HOW EBP and SG will be incorporated in plan AND HOW quality will be improved.
Examples:
• Do a literature search of Evidence-Based Practice related to low scoring HCAHPS areas
• Incorporate EBP in Policies and Procedures in plan for low scoring HCAHPS areas. Quality will be improved because implementing, quality will be improved because there will be more buy in from
staff.
• Involvement of team members will lead to increased compliance and buy in – which will decrease obstacles.

4. Explain methods you would use to incorporate concepts of shared accountability among patients, medical providers, payers (e.g., insurance providers, Medicare, Medicaid), and personnel.
• What Methods will be used for patients, providers, payers, and personnel to be accountable in plan? Think about how to keep each of these groups accountable.

Patients Medical Providers Payers Personnel

5. Explain methods you would use to incorporate technology trends within healthcare.
• What technology can be utilized to improve HCAHPS scores?
Examples:
Utilization of technology to address noise at night
New call light system to address responsiveness
Audits for medication timeliness using Electronic Medical Record

6. Explain methods you would use to improve the care delivery system, including the topics of quality, cost, access, and patient-centered care.
• HCAHPS?

Quality Cost Access Patient-centered care
Example:
Communication strategies will be implemented and will result in better patient compliance and improved quality outcomes
Example:
Teach back with discharge instructions will be implemented. By ensuring the patients understand instruction, there will be decreased readmissions and higher HCAHPS scores leading to higher
reimbursement Think about methods that can be used to provide access to information, education, services, healthcare, personnel The patient should be the center of everything. What methods are
being used to improve patient-centered care?

7. Explain methods you would use to improve financial stability. (Use key words that are in rubric)
Examples:
• Higher HCAHPS scores and a better reputation in the community will result in improved financial stability due to a higher census and higher reimbursement will result in improved financial
stability due to a higher census and higher reimbursement
• Improved patient outcomes will result in decreased readmission rates
• The organization will receive higher reimbursement with lower readmission rates.

E. Develop an implementation plan and timeline for the strategic plan you developed in part D by doing the following:
1. Discuss key roles and responsibilities of stakeholders (use only 4 stakeholders).
What roles and responsibilities do these stakeholders have in your plan?
Examples:
Nursing
Providers
Patients
Environmental Services
Administration Support
Pharmacy

2. Discuss how you would ensure stakeholder accountability and involvement. (Provide a discussion with detail, of how to ensure stakeholder accountability and involvement).
Use the same stakeholders you identified in E1
• Discuss how you are going to ensure accountability
Example: Expectations shared with stakeholders
• Discuss how you are going to ensure involvement
Example: Recognition and reward for improvement in HCAHPS scores

4. Discuss any training staff would need in order to implement the plan. (Provide a discussion with detail, of training staff would need in order to implement plan. Look back over your plan. Any
new process, policy, equipment, etc. will need training).
Examples:
• Educational program on benefits of plan
• Training on new technology
• Training on HCAHPS survey questions
• Training on new policy and procedure

5. Outline a timeline for implementation of your plan, including periodic review checkpoints to measure progress. (Provide an appropriate timeline, with detail, for implementation of the plan,
including periodic review checkpoint to measure progress. MUST include checkpoints to measure progress in the timeline.)
Example: Review of HCAHPS scores and review of documentation.

Months 0 – 3
• Describe what your plan (processes from D2) will include.
• Make sure to put in periodic review points to measure progress.
Months 4 – 6
• Describe what your plan (processes from D2) will include.
Months 7 – 9
• Describe what your plan (processes from D2) will include.
• Make sure to put in periodic review points to measure progress.
Months 10 – 12
• Describe what your plan (processes from D2) will include.

F. Discuss the process, with detail, you would use to evaluate the success of the strategic plan, including the following:
• method of measurement that would be used
Examples:
Review HCAHPS scores
Review attendance at training sessions
Review of documentation (audits)

• evaluation of the timeline
• method of analysis
Examples:
Review of HCAHPS scores quarterly to analyze if plan is improving scores.
Documentation audits to review documentation and share information with NM.

1. Discuss how you would involve key stakeholders in the evaluation process. (Use the same 4 stakeholders identified in E1).
Example:
Stakeholder nursing will review HCAHPS scores and review documentation. They will provide feedback to management on barriers.

2. Explain how the evaluation results will be communicated internally and externally. (Provide an explanation, with detail, of how to communicate the evaluation results internally and externally.)
Examples:
Internally (to staff)
• Staff Meetings
• Email
• Face-to-face
• Newsletters
Externally (to community)
• Hospital Website
• Mailers
• Social Media

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