NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution PS

Introduction

Microvascular complications have been ascribed to emerging in high prevalence in every age group, adults, kids, and older age. The duration of diabetes and the age of onset of diabetes determines the risk and prevalence of the complications (Walinjkar et al., 2019). The physiological explanation for the microvascular complications is the metabolic disease related to the consistent hyperglycemia leagf\cding to cause damage of the small blood vessels (Khalil, 2017). 

The readmission rate is considered a high-quality health measure indicator for reducing the costs of the health care system, specifically during the first 30 days of discharge. The burden of diabetes in the hospitalized patients is enormous and growing substantially with the increased costs and readmissions (Rubin, 2015). The risk factors leading to readmission of diabetic patients are socioeconomic factors, ethnicity, presence of comorbidities, emergency measures, public insurance, and a history of hospitalization (Rubin, 2015).

NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution PS

  The role of nurses is high in the provision of safe quality health care to the patients, any medication error, associated poor administration or monitoring of insulin,  poor post-amputation care may lead to the readmission of the patients as well (Healy et al., 2013; Hardee et al., 2015).  The appropriate health care safe and efficient is required for the care of diabetes and its complications. The role of self-care and family-centered care is essential for better health outputs. Dietary interventions and medication compliance is required for the initial management of the disease as well as in a later stage. The psychological aspects of the disease require management from personal and family intervention (Baig et al., 2015).

Federal, local governments, and taxpayers bear the loss of diabetes expenditures. In the view of comprehensive information, the economic burden for diabetes is increasing which causes and indirect health costs which further disrupts the employers, health payers, government plans, and health care providers. The health care system is disturbed in assessing the appropriate opportunities, service delivery and provisions, medication resources, and health outcomes of the diabetics (O’Connell and Manson, 2019). 

Costs Of Diabetes Care

Diabetes and its complications make it an expensive disease. In 2017 the US estimated $327billion for the diagnosed diabetes cases.  The cost of microvascular complications is due to the hyperglycemia-induced health effects and the microvascular damage apparent in both type 1 and type 2 diabetes (Dimitrova et al., 2015). The major part of these expenses is used in the hospitalization charges and medication use (Mandel et al., 2019).  It has been proved that nonadherence to the diabetes compliance guideline increases the risk of complications and cost expenditures as well (Fukuda, H. and Mizobe, 2017). 

Diabetes also enhances individual expenses, people diagnosed with diabetes tend to incur an average of $16,750 of average medical expenses per year. The people with diagnosed diabetes have relatively higher expenses, 2.3times higher. The indirect costs of diabetes are experienced in the professional losses of the human capital. The indirect costs are reported in the form of absenteeism costs for $3.3 billion and reduce the overall productivity of the workaround $ 26.9 billion in the employment-population groups (American Diabetes Association, 2018). The prevalence of diabetes concerning the microvascular complications in a cohort study reported accounting for 30% of the secondary care costs in a total of 7% of the reported cases (Chapman et al., 2019).  The economic burden of the upper and lower end amputations has also put a load on the economic resources affected by the demographic, socio-economic, and age-related factors (Al-Thani et al., 2019). Diabetic foot ulcers cost expenses of $1 billion annually. The incidence of foot ulcers admissions is also 11 folds high in diabetes with more than 80% leading to amputations (Hicks et al., 2016).

NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution PS

Strategies

The strategies required to mitigate the increasing health care costs of the diabetics, and resources available along with safe, efficient, and quality of care for the patients. Reducing the rates of readmission can significantly lead to the efficiency of hospital economic resources as well. It will reduce the health care costs and burden of diseases. The risk of readmission can be reduced by inpatient education, complete guidelines of the discharge instructions, specialty care, patient and nurse coordination of care practices, and post-discharge adherence to guidelines (Rubin, 2015). In-patient diabetes care compliance has been reported to have low readmissions within 30 days of discharge, low-cost expenditures for the individual and health care system, and reduced hospital stay as well (Bansal et al., 2018).

 The Center of Medicare and Medicaid Services implements certain initiatives of avoiding readmission using a reward and penalties system to improve readmission rate to the minimum (Mandel et al., 2019). The nurse role in diabetes care can be expanded by incorporating diabetes educator’s case management. The resources establishment for the diabetes resource program can provide highly skilled and educated nurses with an evidence-based approach towards diabetes and its complications. The application of this educating strategy has been found to reduce the hospital admission rate of diabetics frequently (Drincic et al., 2017).

Role Of Policies Standards And Organizations

Diabetes self-management education (DSME) is a national program implemented to facilitate the skills, knowledge, and abilities of the nurses in diabetes care. It ensures the decision-making ability, self-care behavior, and active collaboration with the health care providers to improve the clinical outcomes of the patient’s health and quality health (Funnell et al., 2008). American Diabetes Association (ADA) has a set of guidelines for preventing initial diabetes to go into chronic complications. State boards of nursing are responsible for making guidelines for ensuring safe nursing practices and protect public health. The US laws in every state implement laws for Nursing Practice Act (NPA). The self-management and education programs are critical in education awareness and preventing acute complications and can reduce the risk of long-term complications. 

NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution PS

Standards for Medical Care in Diabetes are the standards of care that provide the health care workers, clinicians, nurses, physicians, and policymakers for making general treatment goals as well as the quality of care. It includes screening, diagnosis, and therapeutic guidelines. These guidelines are also cost-effective and provide patient-centered health outcomes (American Diabetes Association, 2019).

The self-management strategy and education program have been found to help manage hyperglycemia, postprandial glucose concentration, weight management, and cholesterol level. It has also evidently proved to be cost-effective and reduces economic expenditures as well as the readmission rate of the hospitals (Vas et al., 2019; Chatterjee et al., 2018). The ADA provided recommendations of the insulin infusion and administration guidelines to provide efficient and quality care in the hospital settings (American Diabetes Association, 2019). 

These policies, guidelines, and programs have been practiced in hospital care settings. The adherence to the guidelines and standards will provide a better understanding of the necessary health measures for diabetes care. It is comprehensive in the analysis of the Insulin infusion rate that is often mismanaged at the hospital care settings including in one of the most reported medication errors. The insulin infusion is necessary for patients with diabetes type 2. These guidelines promote individual patient care that is a key to ensure patient-centered care practices. The Glycemic Trageet Control can comprehensively analyze hyperglycemia and the respective managemental requirements. The overall practice of the standards and general guidelines of the policies of diabetes and its education programs will enhance the practice benefits as well as ensure safe, efficient, and quality health provisions. 

Reference

Boyko, E.J., Monteiro-Soares, M. and Wheeler, S.G. (2018). Peripheral arterial disease, foot ulcers, lower extremity amputations, and diabetes. Diabetes in America. 3rd edition.

Khalil, H., 2017. Diabetes microvascular complications—A clinical update. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11, pp.S133-S139.

Walinjkar, R.S., Khadse, S., Kumar, S., Bawankule, S. and Acharya, S., 2019. Platelet indices as a predictor of microvascular complications in type 2 diabetes. Indian journal of endocrinology and metabolism, 23(2), p.206.

American Diabetes Association, 2019. Introduction: Standards of medical care in diabetes—2019.

Healy, S.J., Black, D., Harris, C., Lorenz, A., and Dungan, K.M., 2013. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes care, 36(10), pp.2960-2967.

Mandel, S.R., Langan, S., Mathioudakis, N.N., Sidhaye, A.R., Bashura, H., Bie, J.Y., Mackay, P., Tucker, C., Demidowich, A.P., Simonds, W.F. and Jha, S., 2019. Retrospective study of inpatient diabetes management service, length of stay, and 30-day readmission rate of patients with diabetes at a community hospital. Journal of community hospital internal medicine perspectives, 9(2), pp.64-73.

NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution PS

Rubin, D.J., 2015. Hospital readmission of patients with diabetes. Current diabetes reports, 15(4), p.17.

Chatterjee, S., Davies, M.J., Heller, S., Speight, J., Snoek, F.J. and Khunti, K., 2018. Diabetes structured self-management education programmes: a narrative review and current innovations. The Lancet Diabetes & Endocrinology, 6(2), pp.130-142.

Bansal, V., Mottalib, A., Pawar, T.K., Abbasakoor, N., Chuang, E., Chaudhry, A., Sakr, M., Gabbay, R.A. and Hamdy, O., 2018. Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical care units: impact on 30-day readmission rate and hospital cost. BMJ Open Diabetes Research and Care, 6(1), p.e000460.

Vas, A., Devi, E.S., Vidyasagar, S., Acharya, R., Rau, N.R., George, A., Jose, T. and Nayak, B., 2017. Effectiveness of self‐management programmes in diabetes management: A systematic review. International journal of nursing practice, 23(5), p.e12571.

American Diabetes Association, 2018. Economic costs of diabetes in the US in 2017. Diabetes care, 41(5), pp.917-928.

Hardee, S.G., Osborne, K.C., Njuguna, N., Allis, D., Brewington, D., Patil, S.P., Hofler, L. and Tanenberg, R.J., 2015. Interdisciplinary diabetes care: a new model for inpatient diabetes education. Diabetes Spectrum, 28(4), pp.276-282.

Hicks, C.W., Selvarajah, S., Mathioudakis, N., Sherman, R.L., Hines, K.F., Black III, J.H. and Abularrage, C.J., 2016. Burden of infected diabetic foot ulcers on hospital admissions and costs. Annals of vascular surgery, 33, pp.149-158.

Fukuda, H. and Mizobe, M., 2017. Impact of nonadherence on complication risks and healthcare costs in patients newly-diagnosed with diabetes. Diabetes research and clinical practice, 123, pp.55-62.

Dimitrova, M., Doneva, M., Valov, V., Yordanova, S., Manova, M., Savova, A., Mitov, K., Petrova, G., Petkova, V. and Czech, M., 2015. Cost of hospitalizations due to microvascular and macrovascular complications in type 1 and type 2 diabetic patients in Bulgaria. Biotechnology & Biotechnological Equipment, 29(4), pp.805-813.

NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution PS

O’Connell, J.M. and Manson, S.M., 2019. Understanding the economic costs of diabetes and prediabetes and what we may learn about reducing the health and economic burden of these conditions. Diabetes Care, 42(9), pp.1609-1611.

Drincic, A., Pfeffer, E., Luo, J. and Goldner, W.S., 2017. The effect of diabetes case management and Diabetes Resource Nurse program on readmissions of patients with diabetes mellitus. Journal of clinical & translational endocrinology, 8, pp.29-34.

Chapman, D., Foxcroft, R., Dale-Harris, L., Ronte, H., Bidgoli, F. and Bellary, S., 2019. Insights for care: the healthcare utilisation and cost impact of managing type 2 diabetes-associated microvascular complications. Diabetes Therapy, 10(2), pp.575-585.

Al-Thani, H., Sathian, B. and El-Menyar, A., 2019. Assessment of healthcare costs of amputation and prosthesis for upper and lower extremities in a Qatari healthcare institution: a retrospective cohort study. BMJ open, 9(1), p.e024963.

Funnell, M.M., Brown, T.L., Childs, B.P., Haas, L.B., Hosey, G.M., Jensen, B., Maryniuk, M., Peyrot, M., Piette, J.D., Reader, D. and Siminerio, L.M., 2008. National standards for diabetes self-management education. Diabetes care, 31(Supplement 1), pp.S97-S104.

Baig, A.A., Benitez, A., Quinn, M.T. and Burnet, D.L., 2015. Family interventions to improve diabetes outcomes for adults. Annals of the New York Academy of Sciences, 1353(1), p.89.