NURS 372: Final Exam Review (Old Content)

NURS 372: Final Exam Review (Old Content) The triple aim was created by what organization? Institute for Healthcare Improvement (IHI) The three deminsions of triple aim and its focus - quality - safety - innovation What is a population? collection of people who share one or more personal or environmental characteristics -registry tracking a defined group of people over time Dimension 1: Improving population health the health outcomes of a group of individuals including the distribution of such outcomes within the group Dimension 2: Improve the patient care experience - The perspective of the individual as he or she interacts with the healthcare system - The perspective of the healthcare system focused on designing a high quality experience for patients. Dimension 3: Reducing Per Capita Healthcare Costs by saving money that's wasted in healthcare every day we could: improve health care quality and improve health of populations There are multiple types of aims we can use but we use which one? Triple aim- because we can barely get these 3 things right...why add more add more if you can but focus on the 3 dimensions first! Why do we care? US healthcare is expensive There are new demands on medical and social services related to: Aging population Increased longevity Chronic conditions How do we make this happen? o "Upstream Approach" o There are more factors in play with our patients than just seeking and getting the healthcare they need o Making smarter decisions based on long term thinking o Fixing the heart of problems, not just putting a band-aid on it Social determinants of health Non-medical factors which influence health outcomes. These factors include the conditions in which people are born, grow, work, live, and age (CDC, 2022). Health equity The state in which everyone has the opportunity to attain their full health potential and is not disadvantaged because of social position or other socially determined circumstances (CDC, 2020). Health literacy The degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves (CDC, 2023). Health disparity Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations (CDC, 2023). Aspects of the Social Determinants of Health (SDOH) People with more money the less likely they will have any... stress, health problems, etc. Examples of SDOH Quadruple Aim in healthcare adds care team well being Quintuple Aim in Healthcare Health equity affects: · Length of life · Quality of life · Rates of disease, disability, and death · Severity of disease · Access to treatment -Racial and ethnic minority groups are often disproportionately affected by health inequities. What are a few reasons why a person might not go to the doctor? can't afford- NO INSURANCE! don't trust/like doctor scheduling conflicts afraid of outcome language barriers transportation Health literacy definition the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions Clinical Decision Support System - intended to improve healthcare delivery by enhancing medical decisions with targeted clinical knowledge, patient info, and other health info - comprised of software designed to be a direct aid to clinical decision-making, in which the characteristics of an individual pt are matched to a computerized clinical knowledge base and pt-specific assessments or recommendations are then presented to the clinical for a decision Where CDSSs are Used - primarily used at the point-of-care, for the clinician to combine their knowledge with information or suggestions provided by the CDSS Administration of CDSSs - often make use of web-applications or integration with EHRs and computerized provider order entry systems - can be administered through desktop, tablet, smartphone, biometric monitoring, wearable health technology Classification of CDSSs - knowledge-based or non-knowledge based Knowledge Based CDSSs - rules (if-then statements) are created - system retrieves data to evaluate the rule and produces an action/output - rules can be made using literature-based, practice-based or patient-directed evidence Non Knowledge Based CDSSs - still require a data source, but the decision leverages AI, machine learning, or statistical pattern recognition rather than being programmed to follow expert medical knowledge Difference Between Knowledge and Non Knowledge Based CDSSs - knowledge based uses an interface engine and bases its findings on expert medical knowledge whereas non knowledge based uses an AI powered interface engine to produce an algorithm/pattern rather than expert knowledge Rules in Knowledge Based CDSSs - based on literature, practice, or patient-directed evidence Scope of Functions in CDS - diagnostics, alarm systems, disease management, prescription drug control, etc. - can manifest as computerized alerts and reminders, computerized guidelines, order sets, pt data reports, documentation templates, and clinical workflow tools Advantages of CDS - pt safety - clinical management - cost containment - administrative function/automation - diagnostic support - support with imaging, lab, and pathology - pt decision support - better documentation - workflow improvement Patient Safety Advantage - reduces incidence of med/prescribing errors and adverse events Clinical Management Advantage - promotes adherence to clinical guidelines, follow-up and treatment reminders, etc. Administrative Function/Automation Advantage - diagnostic code selection, automated documentation and note autofill Diagnostic Support Advantage - provides diagnostic suggestions based on pt data, automating output from test results Support with Imaging, Lab, and Pathology Advantage - augments the extractions, visualization, and interpretation of medical images and lab test results Patient Decision Support Advantage - decision support administered directly to pt's through personal health records and other systems Workflow Improvement Advantage - can improve and expedite an existing clinical workflow in an EHR with better retrieval and presentation of data Pitfalls of CDS - fragmented workflows - alert fatigue and inappropriate alerts - impact on user skill - computer literacy dependence - system and content maintenance - operational impact of poor data quality and incorrect content - lack of transportability and interoperability - financial challenges - user distrust of CDSS Fragmented Workflow Disadvantage - can disrupt existing workflows if they require interaction external to the EHR, or don't match the providers' real world information processing sequences Alert Fatigue Disadvantage - a phenomenon where too many insignificant alerts or CDSS recommendations are presented, and providers start to dismiss them regardless of importance Impact on User Skill Disadvantage - reliance on, or excessive trust in the accuracy of a system Computer Literacy Dependence Disadvantage - may require a very high technological proficiency to use System and Content Maintenance Disadvantage - as practice changes, there can be difficulty keeping the content and knowledge rules that power CDSS up to date Operational Impact of Poor Data Quality and Incorrect Content Disadvantage - may aggregate data from multiple sources that are not synced properly. Users may develop manual workarounds that compromise data Lack of Transportability and Interoperability Disadvantage - face challenges regarding integration with other hospitals or systems, making it inefficient for otherwise high-quality systems to be disseminated and scaled Financial Challenges Disadvantage - setup can be expensive (capital or human resource), and long-term cost-effectiveness is not guaranteed User Distrust Disadvantage - users may not agree with the guideline provided by the CDSS CDS - providing clinicians or patients with clinical knowledge and patient-related information, intelligently filtered or presented at appropriate times, to enhance patient care More Advantages of CDS - provide nurses with appropriate clinical evidence resources associated with accurate patient assessments and test results - makes data quickly available, provides ability to make the right decision at the right time within the right place and to the right person - overall provide lots of helpful resources that make the acquisition of knowledge and subsequent delivery of care that much easier Electronic Form CDS - common; can be designed to guide patient data entry - provides support when completing interviews and observations at admission, during daily care, when performing focused assessments, and implementing interventions - user can access the full scope of assessments and patient care activities; data entry is shared Electronic Form CDS Continued - supports documentation of care by using reusable templates that are available to all appropriate health care providers wherever they work