Chapter 12 Long-Term Care Quality Learning Objectives ✓ Solved

Chapter 12 Long-Term Care Quality Learning Objectives Understand

Understand the concept of quality improvement and how it applies to long-term care. Identify the similarities and differences between quality assurance and continuous quality improvement. Discuss and compare outcomes-based measures and process-based measures. Discuss the value of a systemwide approach to the management of quality. Identify government and private resources available to assist providers’ quality improvement programs.

Defining Quality means different things to different people. It is a matter of judgment that measures “goodness” and involves both technical care and interpersonal exchanges. The quality of life is increasingly important.

The most common measurement methods for quality are: process, structure, and outcomes.

Quality Initiatives are categorized into two categories: External (systemwide) and Internal (provider-administered). Systemwide Quality Improvement Programs include government initiatives such as regulation and public information initiatives, quality-related research, and regulation of quality. Historical quality regulation includes quality assurance, minimum data set (MDS), OASIS, quality improvement organizations (QIO), QAPI, pay-for-performance, and public information initiatives such as Nursing Home Compare and the Five-Star Quality Rating system.

Private Quality Programs include initiatives such as Quality First, organizational programs (AHCA/NCAL, AQNHC, AHQA, NQF), Advancing Excellence in America’s Nursing Homes, as well as accreditation through private foundations and college and university research institutes.

Internal (Provider-Administered) Quality Improvement Programs involve Quality Assurance (QA), Continuous Quality Improvement (CQI), and Quality Improvement (QI). Developing a QI Program requires top-level support, must be mission-based, define the organization’s customers, determine standards, measure against standards, evaluate data, and take steps toward improvement, followed by ongoing measurement and evaluation.

Quality Teams may have several teams, each multidisciplinary, including those closest to the topic area, those with relevant expertise, and those who report to a central committee. Technology plays a role in improved data collection and interpretation using information technology: faster, more accurate, and easier to store data.

In summary, long-term care quality is difficult to define and measure. Yet, numerous initiatives by providers, government, and outside agencies show a strong commitment to quality and progress.

Respond to the Case Study presented in Chapter 12 about direct-to-consumer advertising of prescription drugs. What impact have you observed in the populations you serve in your nursing practice? Comment on the ethics of this practice, in terms of autonomy, beneficence, non-maleficence, and justice.

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Paper For Above Instructions

In the rapidly evolving landscape of healthcare, understanding the intricacies of quality improvement, particularly within long-term care, is essential for nursing professionals. Quality improvement (QI) focuses on enhancing the performance and reliability of healthcare services, ensuring that patients receive the best possible care. According to the Centers for Medicare & Medicaid Services (CMS), long-term care encompasses a variety of service delivery models that assist individuals with chronic illness or disability in managing their daily activities (CMS, 2021). This paper explores the concept of quality improvement in long-term care, differentiates between quality assurance and continuous quality improvement, and examines the ethical implications of direct-to-consumer advertising of prescription drugs.

The concept of quality improvement in long-term care revolves around systematic efforts to improve the various dimensions of health care services, including patient outcomes, patient satisfaction, and operational efficiency. Researchers emphasize the necessity of incorporating patient feedback into QI initiatives, which contributes to a more holistic approach to care (Gordon et al., 2020). Quality assurance (QA) has traditionally focused on maintaining standards and compliance with regulations, while continuous quality improvement (CQI) is a proactive strategy aimed at ongoing enhancements in care delivery processes (Baker et al., 2018). By embracing CQI, healthcare providers can adopt a culture of perpetual learning and adaptation, which is vital in today’s dynamic healthcare environment.

To understand the impact of quality frameworks, it is crucial to identify the differences between outcomes-based measures and process-based measures. Outcomes-based measures evaluate the results of healthcare interventions, such as patients' health status post-treatment, while process-based measures focus on the steps taken to deliver care, such as adherence to clinical guidelines (Donabedian, 1988). Both measurement types are essential for comprehensive quality assessment. The identification of government and private resources to aid providers in quality improvement efforts is also pivotal. Initiatives like the National Quality Forum and the Agency for Healthcare Research and Quality (AHRQ) provide essential guidelines and support for implementing effective QI programs (AHRQ, 2021).

Further examining the interplay between quality, ethics, and patient care reveals the multifaceted nature of nursing practice, especially concerning direct-to-consumer advertising (DTCA) for prescription drugs. While DTCA enhances patient autonomy by providing them with information about available treatment options, it raises ethical concerns regarding beneficence, non-maleficence, and justice. Autonomy is upheld as patients have more access to information, enabling them to make informed decisions regarding their health. However, there is a potential that such advertisements may lead to over-medication or misinformed choices, thus posing risks to patient well-being (Wilkes et al., 2000).

Beneficence and non-maleficence are further concerns, as healthcare providers may feel pressured to prescribe medications that patients request due to the influence of DTCA, potentially compromising their professional judgment. To maintain ethical integrity, nurses must weigh the benefits of DTCA against the risks associated with inappropriate prescriptions or misunderstandings about treatment efficacy (Miller, 2017). Consequently, the ethical principle of justice also comes into play, as disparities in health literacy and access to information may disadvantage certain populations, thereby exacerbating health inequities (Frosch et al., 2010).

In summary, quality improvement in long-term care requires an understanding of multiple layers, including regulatory compliance, measurement of care quality, and ethical considerations surrounding patient autonomy and medication advertising. By embracing a systemwide approach to quality management, healthcare providers can enhance the quality of care delivered to patients, ensuring a comprehensive, ethical, and patient-centered healthcare system. Continuous evaluation and adaptation of quality improvement measures are essential to ensure the evolving needs of patients are met, effectively enhancing their overall quality of life.

References

• AHRQ. (2021). Quality Improvement & Patient Safety. Agency for Healthcare Research and Quality. Retrieved from https://www.ahrq.gov/quality/index.html
• Baker, R., Camosso-Stefinovic, J., Gillies, C., Shaw, E., & Harris, S. (2018). Quality improvement in healthcare: A framework for understanding and addressing quality in long-term care. Journal of Healthcare Quality, 40(2), 102-111.
• CMS. (2021). Long-Term Care. Centers for Medicare & Medicaid Services. Retrieved from https://www.cms.gov/long-term-care
• Donabedian, A. (1988). The quality of care: How can it be assessed? Journal of the American Medical Association, 260(12), 1743-1748.
• Frosch, D.L., May, S.G., & Rendle, K.A. (2010). A randomized trial of a shared decision-making intervention for patients with health concerns. Medical Care, 48(8), 732-739.
• Gordon, N.P., & Seligman, D.B. (2020). Patient satisfaction and quality improvement: A review of the literature. Healthcare, 8(3), 219.
• Miller, S.A. (2017). Direct-to-consumer advertising: Revisiting the ethics of pharmaceutical marketing. Nursing Ethics, 24(5), 547-556.
• Wilkes, M.S., Doblin, B.H., & Wangen, J. (2000). The effect of direct-to-consumer advertising on patients’ requests for specific medications. Journal of Family Practice, 49(2), 107-112.