Running Head Clinical Issue Article Analysis Step 41

Running Head Clinical Issue Article Analysis Step 41clinical Issue A

CLINICAL ISSUE ARTICLE ANALYSIS -STEP Clinical Issue Article Analysis -Step 4 Summary of Article Findings Problem Our team was asked to identify a clinical issue within the healthcare system that could be addressed by performing an in-depth research literature review. The first step was to associate a problem with factual evidence that it exists. Our team decided that heart failure readmission was an issue we were familiar with, so the process began. One of the first articles we reviewed stood out with a statement by Elixhauser as cited by Hilbert, Zasadil, Keyser, and Peele (2014) that stated, “Table 1 lists the 30 most frequently treated conditions in U.S. hospitals, with their 30-day readmission rates. Among these most frequent conditions, the highest readmission rates were seen for congestive heart failure (24.7%)…” (p. 2). This article, supported by numerous others including the Centers for Medicare and Medicaid Services website, demonstrated that heart failure readmission was a real problem in the United States. Our team also wanted to demonstrate that there was an inherent cost factor to the health care system as it relates to this readmission dilemma, so our literature search continued. A report by Hernandez et al. as cited by McClintock, Mose, and Smith (2014) states, “Approximately 90% of the readmissions attributed to HF are not planned and potentially preventable, translating into $17 billion or nearly 20% of Medicare’s hospital payments” (p. 430). Further findings like the Center for Medicare and Medicaid Services (CMS) Readmissions and Reduction program, which place penalties that are now as high as 3% of the total charge for admissions deemed excessive, gave final support to the validity of our initial question (CMS, 2014). Solution. The next aspect of our search was to determine if there were acceptable practices that had been proven to reduce hospital readmission rates in the heart failure population. In an article by the Veterans Administration, results of a quantitative study demonstrated a significant reduction in admissions using a nurse practitioner team in the first year, but not in year 2 (Lowery et al., 2012). Numerous reasons were given, including disease progression in the second year versus the first. Mortality rates were diminished between the intervention and the control group in both year 1 and year 2, which is a significant finding as well. Overall, the use of trained NP staff demonstrated a reduction in overall admissions and bed days over the first year, which would represent financial savings for a healthcare facility. Another study from the UK looked at non-medical prescribing nursing staff in the care of heart failure patients. According to Shannon and Spence (2011), "This qualitative study employed focus group and one-to-one interviewing" (p. 450). Other studies that were reviewed prior to the implementation of this project found that patients were satisfied or very satisfied with NMP (non-medical prescribers) since they were easier to get in touch with and demonstrated great compassion. The conclusion of the study found that the HFNS (heart failure nurse specialist) could be beneficial but that communication and training were needed to ensure the success of the nurse. As our team continued to review literature, we discovered a study that examined certain discharge criteria that health care providers could take to ensure patients are discharged appropriately and that health care does not end there. These instructions include medication use, diet and exercise adherence, what to do if heart failure symptoms are noted, and the need for compliance with their future physician appointments (Feltner et al., 2014). The problem we discussed would be that it will take close follow-up with the patient and family to ensure these measures are met. Patients who are non-compliant and have multiple chronic health conditions will need extra assistance from skilled professionals. The research article revealed that a high-intensity home visiting program prevented 30-day readmits of all the trial studied. Finally, a study that explored current approaches to management of CHF and their challenges in Uzbekistan was reviewed. The article discussed the challenges and factors that affect the implementation of quality care about CHF, both physician and patient perspectives. One barrier mentioned that could be overcome in the CHF population included hospitalization of CHF patients every 6 months on average. This process did not show evidence of clinical effectiveness and posed a financial burden to patients and their families as well as the health care system (Ahmedov et al., 2013). Multiple barriers were noted in Uzbekistan and included a lack of general overall consensus towards managing this disease. As a result of the study, it was concluded that data collection would be needed to improve overall quality factors. The study of these results would allow their health care systems to produce national standards that address multiple aspects of this care process.

Paper For Above instruction

The issue of hospital readmissions for heart failure (HF) has garnered significant attention due to its clinical, economic, and systemic implications. Readmission rates, particularly within 30 days of discharge, serve as a critical quality metric for healthcare institutions and influence reimbursement policies, especially under programs like the Centers for Medicare and Medicaid Services (CMS). Heart failure remains one of the most prevalent conditions leading to hospitalization, with a 24.7% 30-day readmission rate in the United States as highlighted by Elixhauser et al. (2014). This statistic underscores the urgent need for strategies to reduce readmissions, which not only affect patient outcomes but also contribute to substantial financial burdens on the healthcare system, estimated at nearly $17 billion annually as indicated by Hernandez et al. (2014). These costs include expenses related to unplanned readmissions, many of which are potentially preventable through targeted interventions.

The literature demonstrates various approaches that have been effective in minimizing readmission rates among heart failure patients. One promising strategy involves the deployment of specialized nursing roles, such as nurse practitioners and heart failure nurse specialists, who provide comprehensive follow-up care. The Veterans Administration study by Lowery et al. (2012) reported a significant reduction in readmissions during year one of implementing a nurse practitioner-led disease management program. Although the benefits diminished in the second year, the initial reduction indicates the value of early intervention. Similarly, the study from the UK by Shannon and Spence (2011) highlighted patients' satisfaction with non-medical prescribing nurses, emphasizing improved communication and increased accessibility, which contributed positively to patient adherence and disease management.

Discharge planning and post-discharge follow-up are crucial components of effective HF management. Feltner et al. (2014) identified specific discharge criteria—such as medication adherence, diet, and exercise recommendations, symptom monitoring, and scheduled follow-up appointments—that can improve patient outcomes and reduce readmissions. Moreover, high-intensity home visiting programs have shown promise in preventing recidivism, particularly within vulnerable populations who require extra support in managing symptoms and medication regimens.

International perspectives reveal unique challenges, particularly in developing countries. A study conducted in Uzbekistan by Ahmedov et al. (2013) described significant barriers, including inconsistent disease management protocols, lack of data-driven standards, frequent hospitalizations (average of every six months), and financial burdens on patients. This highlights the importance of developing robust national policies, standardizing care protocols, and ensuring healthcare provider training to improve chronic disease management effectively.

In conclusion, reducing heart failure readmissions requires a multidisciplinary approach encompassing patient education, medication management, enhanced follow-up, and systemic reforms. Evidence-based practices such as comprehensive discharge planning, nurse-led management, patient satisfaction enhancement, and context-specific system improvements form the backbone of effective strategies. Addressing systemic barriers, especially in resource-limited settings, remains critical in advancing quality care and achieving better patient outcomes. Continued research, policy development, and healthcare provider training are imperative to sustain these improvements and mitigate the high costs associated with HF readmissions (Feltner et al., 2014; Lowery et al., 2012; Shannon & Spence, 2011; Ahmedov et al., 2013; CMS, 2014).

References

• Ahmedov, M., Green, J., Azimov, R., Avezova, G., Inakov, S., & Mamatkulov, B. (2013). Addressing the challenges of improving primary care quality in Uzbekistan: A qualitative study of chronic heart failure management. Health Policy and Planning, 28(5). https://doi.org/10.1093/heapol/czs091
• Centers for Medicare & Medicaid Services. (2014). Readmissions reduction program (CMS FY 2015 IPPS Final Rule).
• Feltner, C., Jones, C. D., Cene, C. W., Zheng, Z., Sueta, C. A., Coker-Schwimmer, E. J., & Jonas, D. E. (2014). Traditional care interventions to prevent readmissions for persons with heart failure: A systematic review and meta-analysis. Annals of Internal Medicine, 160. https://doi.org/10.7326/M
• Hilbert, J. P., Zasadil, S., Keyser, D. J., & Peele, P. B. (2014). Using decision trees to manage hospital readmission risk for acute myocardial infarction, heart failure, and pneumonia. Applied Health Economics and Health Policy, 12(6). https://doi.org/10.1007/s
• Lowery, J., Hopp, F., Subramanian, U., Wiitala, W., Welsh, D. E., Larkin, A., & Vaitkevicins, P. (2012). Evaluation of a nurse practitioner disease management model for chronic heart failure: A multi-site implementation study. Congestive Heart Failure, 18(1), 64-71. https://doi.org/10.1111/j..2011.00228.x
• McClintock, S., Mose, R., & Smith, L. F. (2014). Strategies for reducing the hospital readmission rates of heart failure patients. Journal For Nurse Practitioners, 10(6). https://doi.org/10.1016/j.nurpra.2014.04.005
• Shannon, E., & Spence, W. (2011). The attitudes and views of GPs and physicians to prescribing by heart failure nurse specialists. British Journal of Cardiac Nursing, 6(9), 450-456.