Please respond to these two commentary:
1. Health Care Quality
Observing existing health care quality measures against a predetermined benchmark reflects the performance of a state’s healthcare institutions. An analysis is conducted to rate healthcare performance based on the desired outcomes. Measures by race and ethnicity facilitate a reflection on prevailing disparities in the delivery of healthcare. Individual quality measures provide a particular meditation on healthcare delivery. Quality measures specific to the black have been adopted to curtail racial and ethnic healthcare disparities. Resultant data from the performance of long-staying home residents exhibit areas of benchmark performance, average performance, and achievements way below the benchmark.
Black long-stay nursing home residents with moderate to severe pain show improved reception to medical intervention over the past few years. Disparity reports showed an overall performance that was above the benchmark. Steady improvements have been achieved between 2013 to 2017, surpassing the national benchmark by 4% (Agency for Healthcare Research and Quality, n.d.). The persistence of pain in long-stay nursing home residents has substantially reduced when compared to historical records. The gains are credited to increased attention to pain treatment facilitated by the adoption of pain quality indicators. Surveyor guidance tools consequence increased accountability for pain treatment and assessment among nursing homes. Advocacy for the resident voice has spearheaded patient-based nursing care. Increments in hospice visits and palliative care have positively impacted long-stay nursing home residents.
While improvements have been recorded, low-risk, long-stay nursing home residents with loss of control of bowels or bladder only came close to the national benchmark. Records show a 15% gap between the benchmark quality and the current patient treatment conditions (Agency for Healthcare Research and Quality, n.d.). With at least 50% of nursing home residents experiencing urinary and fecal incontinence, nursing home management must focus on the establishment and treatment of the underlying causes (Leung & Schnelle, 2009). Bids to reduce bowel and bladder conditions include the treatment of urinary tract infections, dietary interventions, and fecal impaction. However, management interventions have been frustrated by poor financing and resourcing to facilitate sufficient toileting assistance.
High-risk, long-stay nursing home patients with pressure ulcers have exhibited a poor response to healthcare interventions. Healthcare records exhibit a performance that is way below the benchmark. Collected data shows a 138.9% disparity between the set target and the practical situation specific to black patients (Agency for Healthcare Research and Quality, n.d.). Although nursing homes have adopted electronic medical records to minimize un-house pressure ulcers, it remains a serious problem. Regulatory and marketing approaches motivating ulcers treatment and prevention have proved ineffective. Pressure ulcers consequence disfigurement, pain, and increased infection risk among black high-risk long-stay nursing home patients.
Healthcare quality and disparities reports provide insight on the impact of medical intervention. They analyze healthcare delivery from various societal fronts that include race, ethnicity, and income levels. The reporting provides a performance scale against a set benchmark, informing medical interventions.
References
Agency for Healthcare Research and Quality. (n.d.). NHQDR web site national benchmark summary. https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/summary/All_Measures/All_Topics
Leung, F., & Schnelle, J. (2008). Urinary and Fecal Incontinence in Nursing Home Residents. Gastroenterology Clinics of North America, 37(3),
2. The Agency for Healthcare Research and Quality shows an informative graph with details for advancement and opportunities for excelling healthcare outcomes and disparities. Healthcare topics are measured within different regions, and a national benchmark is set (AHRQ, 2017).
The first national benchmark discuses adults ages 40 and over, with diabetes, and get their A1C checked twice a year. Nationally we have achieved 79.5%, which is 6 percentage points more than the target benchmark (AHRQ, 2017).
Another area, where we are close to the benchmark, is for adults ages 40 and over, with diabetes, getting their feet checked for sores and irritation every calendar year. We are currently at 66.8%, which is 20.5 percentage points away from the benchmark goal. Unfortunately, since 2002 we have been plummeting at a downward trend (AHRQ, 2017).
One of the areas where we are far from the target benchmark is the number of diabetes-related amputations of people ages 18 and above, measured per 100,000 people. Currently, it is 104% away from the goal, and is continuously worsening, as the trend of amputations is still increasing. Between 2016 and 2017 alone it increased by a few points (AHRQ, 2017).
Diabetes-related injuries are known to be a significant cause of disabilities, and result in poor quality of life. Roughly 85% of amputations are associated with diabetic ulcers. The CDC’s 6/18 initiatives are the suggested path to control diabetes, with some of the policies promoting increased access to preventive care (CDC, 2019). There should be more community-involved incentives and initiatives given at the workplace, or directly by insurance companies. For example, we could make a deal with Health Insurance companies to not charge diabetic patients for their three-month A1C blood work, encouraging them to go to the doctor more frequently to get regular blood work. Another way we can help the most at-risk population is to ensure that they have convenient access to appropriate healthcare facilities, and take extra measures to address social determinants, such as lower-income neighborhoods that are at a higher risk of diabetes (ADA, 2016).
References
ADA. (2016). Strategies for Improving Care. American Diabetes Association, s6-s12.
AHRQ. (2017, n d). Agency for healthcare research and quality. Retrieved from National healthcare quality and disparity report: https://nhqrnet.ahrq.gov/inhqrdr/data/submit
CDC. (2019, October 10). Prevent Type 2 Diabetes | 6|18 Initiative | CDC. Retrieved from CDC.GOV: https://www.cdc.gov/sixeighteen/index.html
