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Public Health

Effective health care leaders maintain simultaneous internal organizational and external industry environmental awareness. Leaders are challenged to focus upon vision, mission, strategic direction, goals, and objectives while remaining mindful of emerging trends that may affect an organization's viability. Monitoring the external environment for issues that may represent major challenges to an organization requires ongoing diligence. Health care administrators must identify and prioritize issues affecting their organizations.

Leaders must select methods and tools with which to analyze data for identification of potential solutions. You will have an opportunity to select a health care problem that is relevant to your career interests, and one that adds value to a current or future health care organization. Your discussion question will provide a supportive environment in which to practice problem solving related competencies for health care leaders.

For this assignment, you will identify a relevant, contemporary health care problem that may affect your current or future desired workplace (such as a hospital, home health, hospice, or ambulatory clinic). The problem should be addressed in health care literature and should be one for which data is readily available. Your selected problem should be specific enough that you can articulate the current state or baseline by describing major factors and how each factor is measured. For example, your selected problem may be analyzed by data that includes average length of stay (in days) and cost (dollars).

You will be challenged to provide a rationale for how the analysis of data is relevant to your career interests, as well as those of a health care organization. This assessment allows an opportunity to explore relevant issues in the health care industry and apply your health care administration competencies in the first step toward analysis and recommendation of solutions.

Instructions
Create a 36 page paper that uses at least six authoritative sources that will support the identification of a relevant problem, rationale for the selection of the problem, and the selections of appropriate measures. The goal is to be succinct yet substantive and to provide sufficient detail for adequate coverage of your topic. The material from this assignment will be condensed and utilized as part of your final PowerPoint presentation in Week 9.

Identify a specific, relevant problem and associated rationale for the selection for the problem.
Describe, using an authoritative source, how the selected health care problem is assessed and measured for quality improvement purposes. Your performance metrics, and the associated benchmarks, should examine the causes of the problem, rather than the results of the problem.
Identify an industry measure of performance (benchmark) that is relevant to the type of organization you have selected for problem analysis. There are several keys in selecting performance benchmarks: specificity, relevance, reliability, and validity. Be sure to consider specific metrics that the organization can use to set goals and compare (benchmark) performance. Be sure to review recent scholarly literature this can help you make a well-informed choice.
Provide a bulleted list of the preliminary action plan steps to review the problem and propose solutions. The action plan should offer specific steps that will improve organizational performance. In creating an action plan, be sensitive to organizational mission, limitations, and constraints. Actions should be realistic, specific, and feasible be sensitive to the idea that resources (especially financial and staffing) are always scarce, and organizations must make wise choices in allocating those resources.

Full Answer Section

Quality of Care Indicator: High readmission rates can reflect deficiencies in care transition planning, patient education, and overall care coordination. They serve as a crucial indicator of the quality and effectiveness of healthcare delivery.

2. Problem Assessment & Measurement

Measuring Readmission Rates:
- 30-day Readmission Rate: This is the most common metric, measuring the percentage of patients who are readmitted to the hospital within 30 days of discharge.
- Readmission Rates by Diagnosis: Analyzing readmission rates for specific diagnoses (e.g., heart failure, pneumonia) can help identify areas for targeted improvement.
- Factors Contributing to Readmissions:
  - Patient-level factors: Age, comorbidities, socioeconomic status, adherence to medication regimens.
  - Hospital-level factors: Quality of care, communication between providers, discharge planning, patient education, access to community resources.
  - System-level factors: Access to primary care, availability of community-based services, socioeconomic disparities.
Data Sources:
- Hospital administrative databases: Electronic health records (EHRs), claims data, patient registries.
- Agency for Healthcare Research and Quality (AHRQ) data: AHRQ collects and analyzes data on hospital readmissions and other quality-of-care measures.
- Centers for Medicare & Medicaid Services (CMS) data: CMS collects and publicly reports data on hospital readmissions, including the Hospital Readmissions Reduction Program (HRRP) penalties.

3. Industry Benchmark:

Hospital Compare: This website, maintained by the Centers for Medicare & Medicaid Services (CMS), provides publicly reported data on hospital performance, including readmission rates for various conditions.
- Benchmark: Hospitals can compare their readmission rates to national averages, state averages, and the performance of peer institutions.
- Relevance: This benchmark provides a standardized and comparable measure of hospital performance related to readmissions, allowing for identification of areas for improvement and benchmarking against best practices.

4. Preliminary Action Plan:

Conduct a thorough root cause analysis: Investigate the underlying causes of readmissions for specific diagnoses, focusing on both patient-level and system-level factors.
Strengthen discharge planning:
- Develop and implement comprehensive discharge plans that address patient-specific needs, including medication reconciliation, follow-up appointments, and home care services.
- Enhance communication with patients and their caregivers regarding discharge instructions and post-discharge care.
Improve care coordination:
- Enhance communication and collaboration among healthcare providers, including primary care physicians, specialists, and community-based services.
- Implement care transitions programs to ensure smooth and coordinated care across different settings.
Enhance patient education:
- Develop and implement patient education programs to improve patient understanding of their condition, medications, and self-care strategies.
Address social determinants of health:
- Identify and address social determinants of health that may contribute to readmissions, such as poverty, food insecurity, and lack of social support.

Note: This is a preliminary framework. A more comprehensive analysis would require a deeper dive into the specific characteristics of the target organization, including its patient population, resources, and existing quality improvement initiatives.

This analysis demonstrates the importance of data-driven decision-making in addressing the challenge of hospital readmissions. By carefully analyzing data, identifying root causes, and implementing targeted interventions, healthcare organizations can improve patient outcomes, reduce costs, and enhance the overall quality of care.

Sample Answer

Addressing Rising Healthcare Costs: A Focus on Hospital Readmissions Within 30 Days of Discharge

1. Problem Identification & Rationale

This analysis will focus on the issue of high 30-day hospital readmission rates. This is a critical problem in healthcare due to its significant impact on patient outcomes, healthcare costs, and overall system efficiency.

Rationale:

Human Impact: Readmissions often indicate unresolved health issues or complications, potentially leading to poorer patient outcomes, increased morbidity, and even mortality.
Financial Burden: Readmissions significantly increase healthcare costs for both patients and the healthcare system. They strain hospital resources, leading to increased bed occupancy rates and longer wait times for other patients.