Please see paper below for proofing and confirming that all competencies (bolded)were addressed properly. Please let me know if I need to further improve this paper and what is needed. Thank you.
“Evaluate the outcomes of a population health improvement initiative.
Propose strategies for improving the outcomes of the population health improvement plan, or ensuring that all outcomes are being addressed, based on the best available evidence.
Develop an individualized personal care approach that incorporates lessons learned from a population health improvement initiative.
Justify the value and relevance of evidence used as the basis for your personal care approach to your patient.
a framework that could be used to evaluate desired outcomes of your approach to personalizing care for your patients and areas that could be applied to similar situations and patients in the future.
content is clear and logical, with correct use of grammar, punctuation, and spelling.”
Traumatic Brain Injury Care Report
The Centers for Disease and Control Prevention (CDC) decided in 2010 to make improvements to healthcare by spearheading a program called Patient Health Improvement Initiative or PHII. This idea was created because of challenges in the health sector that were becoming increasingly complicated, for example limited resources (funds, staff, materials, facilities etc.), health care system changes (high premiums, no insurance, distribution etc.) and most importantly public health challenges (Lack of transparency, physician and nursing shortages, restrictions on choosing health insurance, mortality etc.). PHII was established to provide credible evidence-based data on patient centered care to mitigate rising costs and provide improved clinical outcomes across various populations.
Utilizing the data provided by PHII, evidenced-based data most times may not be about the exact situation for the current issue. The healthcare provider must disseminate the data and interpret the evidence-based care information in a constructive way, whereby it can benefit another medical case. Uptown Wellness Clinic (UWC) presented a patient named Mr. Novak, who suffered a traumatic brain injury after a fall many years ago. Recently he has been complaining that he keeps losing his balance and thinks that it might be attributed to his TBI. The nurse has been instructed to apply a nonprofit organization called Safe Headspaces’ PHII that gathered evidence-based data on improving the lives of TBI and PTSD patients (Capella, 2022). The information from this study will be carefully gauged to derive and use in context, information that favors a plan of treatment exclusively for Mr. Novak, this will allow new informed strategies to be considered, identify, and correct any disparities in the data provided and build a stronger framework for Mr. Novak’s plan of care.
Evaluation of a Population Health Improvement Initiative’s Outcomes
Safe Headspace was created by Ms. Alicia Balewa who is the daughter of a combat veteran that suffered with Post Traumatic Syndrome Disorder (PTSD) and Traumatic Brain Injury (TBI) in the 1970’s. At that time the options for treatment for PTSD, depression and TBI had many different treatments that did not necessarily help patients entirely. Much later investors started funding treatment and recovery options for combat veterans presently. Ms. Balewa’s dad unfortunately did not benefit from this because he was now a senior who had gone through his mid-life to present with his PTSD and TBI. Ms. Balewa decided to start a PHII program called Safe Headspace that targets seniors who lived with their trauma for years (Capella, 2022).
The program had four phases which were physical exercise, medications, meditation, and memory exercise. Safe Headspace PHII started with 800 participants and provided evidenced based results for only 400 persons that actively participated in each segment. The data showed that of the 400 participants most were males aged 45-80 years old and after 4 weeks of engaging in various moderate aerobic exercises, they showed some improvement in mood, memory, and muscle control. Initially, the PHII program started with 400 but lost 325 participants, so they continued with 75 persons for an additional 3 months that revealed a 15% increase in muscle control, moods improved by a further 22% and short- to- medium term memory was boosted by 61% (Capella, 2022).
The next part of the study focused on medication and psychotherapy treatments that were started after the group was interviewed by a psychotherapist since these older people had little to no therapy for years after their trauma happened. The assessment confirmed medications were required and 40% of the participants were given anti-depressant medications and 9% were give anti-psychotics. Moods were enhanced by 26% over a period of 6 months and 6% progress in memory. These patients continued to have their care managed by their therapist (Capella, 2022).
The third part focused on meditation with 23 participants. The results were favorable showing 70% improvement in mood and memory, and 32% in muscle control after having participants meditate at home for 15-30 minutes with a 1-hour long group guided session for 3 weeks. 2 of the 23 participants left the study after the 3-week period. Finally, the memory exercises using games like Sudoku and crossword puzzles proved to be the least successful of the program since there were no improvements to report (Capella, 2022).
After assessing all the information in Safe Headspace’s study, it is safe to conclude that the areas that could be strengthened were the actual number of the participants and the way the study focused simultaneously on PTSD and TBI. Mr. Novak was not diagnosed with PTSD, so without him having that PTSD medical history, it would mean that further evaluations need to be completed for a successful outcome. It was noticed that throughout the course of the PHII the number of persons became less and less, thus making the data collected from this group not as diverse, there was no information detailing why that occurred and what factors might have contributed to those participants leaving the program. Continuing this study with strategies to close the identified gaps would strengthen the evidenced already collected and improves the information required to create a plan that could be tailored to treat patients with unique ailments, events, and history.
Strategies to Improve Outcomes of a Population Health Improvement Plan
Strategies in any PHII plan aims to create meaningful change from a clinical point of view using evidence-based data. The first strategy for building a successful foundation would be to have dedicated participants. It is necessary to retain this faction to gather the evidence-based clinical information required for the respective study. In this case with Safe Headspace PHII study, the constant exit of participants through each phase disabled what could have yielded a stronger outcome. Employing the ecological framework for participation retention would prove useful to strengthen Safe Headspace’s PHII. The model follows three phases – Panning (encourage participation and prevent the corroding of participation interest before research begins), recruitment and engagement (approved participants and early recognition of dissent) and lastly, maintenance (prolonged participant interests and re-engagement of disinterested participants). Making sure that participants engaged, understanding the nature of the study, and recognizing that they are the focus of the respective research creates continued interest and a willingness to participate. Also, staff that has been recruited for the research require training and constant support since this component determines the successful interactions between them and the participants. The collecting of detailed and verified contact information of the participants, as well as finding alternative routes to stay in touch with those who might be displaced. Rewarding participants with gift cards or vouchers for actively being involved in a great incentive as well for long-term retention. Reinforcing flexibility during interviews i.e., understanding that some of your participants may have different ways of wanting to interview like texting vs phone calls or surveys vs in-person will discourage dissent and keep interactions respectful and productive. (Catherine, N., Lever, R., Marcellus, L., Tallon, C., Sheehan, D., MacMillan, H., Gonzalez, A., Jack, S. M., & Waddell, C. 2020).
Approaches to Individualized Personal Care Plan
The evidenced-base data collected from Safe Headspace’s PHII needs to be strengthened to create a solution that can benefit Mr. Novak and patients with similar symptoms, the brief received from UWC gave a specific symptom which was loss of balance. Whether or not Mr. Novak experienced PTSD, memory loss, loss of muscle memory or mood swings remains unknown, it is also pragmatic to note that in Safe Headspace’s PHII none of the participants had balance deficits. It is known that traumatic brain injuries can affect patients decades after it has occurred (Row, J., Chan, L., Damiano, D., Shenouda, C., Collins, J., & Zampieri, C. 2019). In the case of Mr. Novak there needs to be a complete evaluation of his medical history to determine if his balance was affected before and this is reoccurring or if the symptom is new.
Medical records detailing current medications and side effects also needs to be considered in confirming a diagnosis of balance deficit due to past TBI. When that information has been gleaned from the respective discipline the nurse can move forward and employ the Institute of Medicine’s (IOM) six steps for patient improvement which are safety, effectiveness, equality, timeliness, patient-centeredness, and efficacy (Wakefield MK. 2008). These steps will guide, enhance, and tailor a treatment plan for UWC’s patient Mr. Novak’s case.
The first step is safety and based on the evidence at hand from Safe Headspace’s PHII, it would not be a safe decision to treat Mr. Novak utilizing the information from this study as it was not very controlled, nor was there any individual research conducted of PTSD and TBI singularly with the participants in that program and none of the participants presented with balance deficits. The second step is effectiveness – the patient care that is required for this patient should align within parameters of his issue of loss of balance. Thirdly, equitable care regardless of economic standing, race, and income, which means that all available options need to be considered. The fourth step touches on timeliness of treatment, since preexisting comorbidities in older patients with moderate to severe TBI are associated with worse outcomes (Gardner, R. C., Dams-O’Connor, K., Morrissey, M. R., & Manley, G. T. 2018). It would not be in Mr. Novak’s best interest to wait for Safe Headspace’s study to become more reliable. Fifth step touches on including the wants of Mr. Novak’s cultural, and personal preferences in the pursuit of his treatment. Finally, the efficacy of the approved treatment needs to result in the intended outcome of optimizing balance in Mr. Novak’s care. Reiterating that the PHII of Safe Headspace detailed aerobics helps with mood, muscle control and memory, the study did not report what types of aerobic exercises were done and as a result the nurse cannot incorporate aerobics into Mr. Novak’s plan of care without a consult from physical therapy.
When these six steps are implemented and juxtaposed against the current care plan from UWC. There will be a clearer idea of what direction the treatment plan should take to bring about the most favorable results. By allowing Mr. Novak to contribute he would be more inclined to learn about his balance issue and if it was because of his earlier life TBI. Continued compliance with the new care plan treatment and enthusiasm to follow up with healthcare providers on progress or concerns. For UWC they will be able to use these steps to carefully evaluate evidence-based studies and contrast said evidence against the patient’s current issue alongside patient reported measures to ensure that it can be used in the context that is most beneficial to the patient.
Value and Relevance of Evidence Used in Patient Care Plan
Utilizing IOM’s framework which entails six steps eliminates the probability of endorsing a care plan that does not fully take into consideration the current requirements needed for effective treatment. Patients who have experienced traumatic brain injuries requires comprehensive remedial interventions. In the case of Mr. Novak who sustained a TBI in mid-adulthood, the long-term effects of that injury will coincide with the normal aging process. As a result, differentiating between TBI related symptoms and the normal aging process is important if the PHII submitted by Safe Headspace is to be incorporated into formulating a treatment plan for UWC’s patient. Studies have shown that there has not been enough evidenced based information available to correlate how earlier-life traumatic brain injuries impact the aging process (Griesbach, G. S., Masel, B. E., Helvie, R. E., & Ashley, M. J. 2018) and it would bode well to follow IOM’s six steps to allow a more comprehensive plan of treatment to be created. IOM’s six steps would take into consideration all facets of patient centered care in lieu of conclusive evidenced based data for TBI and balance deficits decade after the injury. The six domains namely- safety, effective, patient-centered, timely, efficacy and equitable helps the healthcare providers to map the success measures implemented along with the patient measured reports of relief or the need to reevaluate the treatment plan, since the patient is truly the only reliable gauge to determine if the care plan is working or not. The cons of this quality framework suggests that the involvement of an interdisciplinary team following a person-centered care model tends to overlook the order of needs, specifically safety and physiological needs. Which is obvious in the dialogue between Janie Poole and the nurse tasked with evaluating Safe Headspace’s PHII. The charge nurse should have immediately actioned a neuro consultation (to ascertain if this symptom is neuro issue), an otolaryngologist consult (confirm or rule out inner ear issue), physical therapy (determine if it is safe for this patient to continue ADL’s without assistive devices and/or advise what exercises can this patient undergo safely) and a psychologist (to help assuage Mr. Novak’s concerns and treat his anxiety).
Framework for Evaluation of Patient Care Plan Outcomes
To effectively measure the outcomes of a patient care plan that incorporates IOM’s six patient centered tiers, the patient reported measures are crucial to confirming that patient centered care model has improved the quality of health care for that patient. Examining each step of the care plan, the patient’s physiological response, the patient’s self-report can confirm that the outcomes are successful or needs revisiting.
Understanding the patient’s values, needs and preferences and allowing them freedom to express their concerns, be in control of their health planning that is in tandem with their desired preferences and the health care providing respecting their patient’s views makes the relationship between the two precludes patient satisfaction and compliance with treatment plans. Delivering care between interdisciplinary teams should be well coordinated where the patient transitions seamless from one healthcare setting to another. The patient reporting on how easy or difficult it is to move through the specialists to get the necessary care can be collected via Care Coordination Measure for the Consumer Assessment of Healthcare Providers and Systems (CAPHS) surveys. Important tool to correct shortfalls and improve healthcare delivery outcome (Tzelepis, F., Sanson-Fisher, R. W., Zucca, A. C., & Fradgley, E. A. 2015).
Educating patients on their disease/s helps them to formulate questions, suggest options on care has shown that more favorable health outcomes are expected (Benbassat, J., Pilpel, D., & Tidhar, M. 1998). For patients who experience loss of balance a patient reported measure to assess information could be the ABC scale which is a self-report on the confidence of the patient to perform activities without losing balance or experiencing unsteadiness. The patient reported scale is possible when the patient has understood the information and can recall information taught on symptoms of loss of balance i.e., they know what to expect and what warrants a call to their provider. In addition, the patient’s psychological well-being can be evaluated using the Hospital Anxiety and Depression scale to determine if the therapy sessions have been helpful in alleviating anxiety and depression.
Conclusion
Using PHII data to assist in favorable patient outcomes is not without it’s fair share of pros and cons. The ups and downs of attaining evidence-based information is a lot more complicated and is not without gaps or short comings. Providers must have a clear idea of their patient’s medical history (past and present), current interventions and results, and what evidence- based data can create the best plan of care. What remains positive about PHII is that it continues to evolve, and it provides a guide for other clinicians who have the same or similar patient issues, the data can be tailored to improve on treatment plans and expand on the evidence that is already available. In the case of Mr. Novak, the evidence from Safe Headspace PHII was evaluated and found to be missing key factors that ties into his current diagnosis and as a result the nurse must locate another PHII that has relevant data that can be extracted and used in the patient’s care plan.
References
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Catherine, N., Lever, R., Marcellus, L., Tallon, C., Sheehan, D., MacMillan, H., Gonzalez, A., Jack, S. M., & Waddell, C. (2020). Retaining participants in community-based health research: a case example on standardized planning and reporting. Trials, 21(1), 393. https://doi.org/10.1186/s13063-020-04328-9
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Gardner, R. C., Dams-O’Connor, K., Morrissey, M. R., & Manley, G. T. (2018). Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions. Journal of neurotrauma, 35(7), 889-906. https://doi.org/10.1089/neu.2017.5371
Griesbach, G. S., Masel, B. E., Helvie, R. E., & Ashley, M. J. (2018). The impact of traumatic brain injury on later life: effects on normal aging and neurodegenerative diseases. Journal of neurotrauma, 35(1), 17-24.
Tzelepis, F., Sanson-Fisher, R. W., Zucca, A. C., & Fradgley, E. A. (2015). Measuring the quality of patient-centered care: why patient-reported measures are critical to reliable assessment. Patient preference and adherence, 9, 831-835. https://doi.org/10.2147/PPA.S81975
Row, J., Chan, L., Damiano, D., Shenouda, C., Collins, J., & Zampieri, C. (2019). Balance Assessment in Traumatic Brain Injury: A Comparison of the Sensory Organization and Limits of Stability Tests. Journal of neurotrauma, 36(16), 2435-2442. https://doi.org/10.1089/neu.2018.57554
Wakefield MK. The Quality Chasm Series: Implications for Nursing. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Table 2, [IOM’s Six Aims for Improving Health Care Quality]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2677/table/ch4.t2/
