Heart failure among adults calls for re-designing care systems to improve evidence-based practice and seamless transitions through the care continuum. Through the years, heart failure has been known to have significant impacts on the quality of care, patient safety, and healthcare costs for the systems, individuals, and their families. According to Tromp et al. (2021), one in five people is likely to develop heart failure during their lifetime, and the incidence increases as they age. Given the poor prognosis, it is significant to assess how heart failure can impact the cost of healthcare for the system and individual patients, quality of care, and patient safety while noting the influence of state board nursing practice standards and/or organizational or governmental policies to propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
How Heart Failure in US Adults Impacts Quality of Care, Patient Safety, and Costs to the System and Individual.
As patients take the natural course of heart failure (HF), they will experience acute episodes that call for urgent medical treatment and hospitalization. Considering heart failure admissions are projected to rise over the next few years, the following events will increase pressure on the healthcare system because the healthcare costs associated with HF would have also risen dramatically. Therefore, the race for quantity rather than quality will likely occur as many patients will need medical attention and follow-up. When all are coupled up, i.e., the quality of care, patient safety, and costs to the system and individual, the impacts lean more on the negative outcomes than the positive. However, the positives cannot be ignored.
Heart failure can reduce the blood flow to the kidneys, which means that failure to get treatment is subject to kidney failure. On the other hand, HF contributed to about 5% of hospital readmissions in Europe and USA, which is a life-threatening medical emergency. Given the dependency on self-care maintenance and management, HF poses a significant risk to patient safety. With proper management, such that patients transition smoothly with follow-up care and the right medications with the right doses, the issue of patient safety would have been addressed to contribute to improved quality of care (Zhu, Gu, and Xu, 2020). Moreover, HF patients will need support and education to help them practice self-care while reducing future deterioration scenarios.
Hospital inpatient costs and additional emergency department services can be overwhelming as the numbers of HF patients grow. The economic burden of HF on healthcare systems is alarming, as Urbich et al. (2020) explain that it is considerable and will likely increase as its prevalence grows. As of 2020, the total care cost with direct and indirect costs accounted for was $43.6 billion in the USA, with 70% of that directed to medical costs (Urbich et al., 2020). Again, Urbich et al. state that the annual cost of care for HF in the USA is projected to rise to $69.7 billion by 2030 if there won’t be significant improvements in HF outcomes. Thus, with the current and predicted influx, the system has to provide the appropriate infrastructure to ensure the HF patients’ needs are catered to sufficiently. The concept of social determinants of health also plays a part in the costs for the system as it works towards meeting the needs of HF patients from lower socioeconomic backgrounds.
As a condition associated with older age, the possibility of other comorbidities apart from HF should not be ignored. Individuals spend quite a number on hospitalization following through admissions and readmissions subject to the exacerbation of symptoms in individual patients (Urbich et al., 2020). At the same time, they cater to their post-discharge costs, outpatient care, and other medical costs like medication, and even with insurance, they are likely to pay a lot as the clinical burden also remains high. Therefore, it is advisable that such individuals be armed with additional healthcare resources related and unrelated to HF. Besides, HF can aggravate other conditions totally unrelated to it, which means the patients will have to spend to cater to the induced illnesses.
When HF creates such attention that the systems are aware of how much is needed to meet the impacts caused to the costs and the patients, the systems will seek to design evidence-based healthcare appropriate for each healthcare setting. Moreover, there will be high standards of HF care which will be made universal. Therefore, HF, plus the attention it draws, leads to improved quality of care. According to Seferovic et al. (2019) and Zhu, Gu, and Xu (2020), the emerging information technology can support existing measures that patients can be monitored while in their homes, i.e., remote monitoring and medical records sharing across professionals.
Influence of Standards and Policies on Quality of Care, Patient Safety, and Costs to the System and Individual.
State board nursing practice standards guide organizational policies to some extent to ensure that a desired quality of care is achieved. One of the goals included in the practice standard is ensuring patient safety throughout the nursing processes like assessment and documentation. Through the state Board of nursing practice standards, the Nursing Practice Act (NPA) is born to ensure that hospitals, clinics, and nursing schools work collaboratively to ensure patient safety (Huynh and Haddad, 2020). In the process, standards are set to ensure nurses are accountable for providing and improving safe client care, i.e., the NPA guides the standards of practice that prioritize patient safety for improved quality of care. In the case of HF, the licensing and regulation allow professionals to perform specific duties, from symptom assessment to patient education on self-care management and maintenance practices.
On the other hand, different organizations work towards risk management, medicines management, and ensuring a safe environment and equipment through internal policies (Vaismoradi et al., 2020). Implementing these policies requires input through human and financial resources to aid the small and complex processes involved. For instance, organizations work towards following up with patients in remote settings, which requires interprofessional collaboration that utilizes financial resources. This, in turn, will increase the costs for the organizations and individual patients. Subsequently, the resources directed to patient education and participation in their care can ensure patient safety as they will be able to manage themselves to avoid symptom exacerbation. Hence, individual organization policies ensure patient safety for overall quality care outcomes through leadership, teamwork, research for knowledge development, accountability, and reporting practice errors (Vaismoradi et al., 2020).
Government policies are related to coverage expansion to ensure that patients can cater to their medication, admission, and readmission costs. For instance, the Affordable Care Act (ACA) has positive elements that can positively affect HF patients. For example, it ensures HF clinicians are aware of how the legislation can affect practice, which in turn reflects on patient care outcomes. According to Wolfe and Joynt Maddox (2019), ACA affects access to healthcare through legislative policies contained within their constituents, like the annual and lifetime caps on spending that were consequently eliminated. Additionally, ACA led to the elimination of regulations in insurance companies that deny coverage due to pre-existing conditions and pulling out financial support when policyholders get sick (Wolfe et al., 2019). Such a regulation impacts patient safety positively as they can be admitted, hospitalized, and get their medication costs covered without stretching out-pocket.
Other government policies, like the expansion of Medicaid, have seen improvements, especially in reducing the number of deaths related to heart failure and other cardiovascular diseases like hypertensive heart disease. Despite the shortcoming in determining outcomes related to cardiovascular deaths (it is a challenge to attribute heart failure as a cause of death), the confounding findings, according to Khan et al. (2020), indicate that Medicaid has contributed to improvements in deaths.
Strategies to Improve the Quality of Care, Enhance Patient Safety, and Reduce Costs to the System and Individual
Strategic intervention to achieve desired results as framed require input from individual patients, the healthcare system, and providers. For instance, healthcare professionals provide recommendations to patients on how to follow guideline-directed medical therapy and self-care, where adherence would lead to improved care outcomes and quality. On the other hand, the system and providers enact policies that focus on preventing system exacerbation at the population level through healthcare policies and minimize risks likely to occur when patients transition from in-hospital care to their home settings (Piña, Allen, and Desai, 2021).
The most recommended strategy to improve the quality of care is adopting a multidisciplinary or team approach to ensure the patient is cared for in-hospital and remotely. According to Driscoll et al. (2020), the transition period that involves the patient moving from the hospital to home following admission is a vulnerable period. This vulnerability can be explained by challenges in communication since healthcare professionals may not be in sync with the community care team. Besides, caregivers and patients find visits to the emergency sudden and planned, and they are often not prepared. As a response, the caregivers and patients call for healthcare policymakers to intervene in the transition such that there are resources for communication after patients are discharged. Therefore, seamless care between remote care and inpatient settings through multidisciplinary collaboration can improve outcomes in patients by contributing to their safety in case of emergencies.
Collaboration can also extend to insurance providers who are expected to provide coverage for patients during their admissions, readmissions, and emergency visits to take some load off the individual patients’ backs. Moreover, the aspect involved in government policies like the ACA should be less ambiguous with regard to the delivery system reform of hospital readmissions reduction program to ensure that the same applies to HF patients. Again, placing HF as high-risk in insurance policies is a major hindrance that needs to be looked at. For instance, there could be a strategy involving a higher purchase cost for the health problem, considering the denial of coverage due to pre-existing conditions has been scrapped (Wolfe and Joynt Maddox, 2019). Such an approach will ensure HF patients have fewer expenses to cater to as they navigate admissions and readmissions. For the system, expansion of coverage can reduce costs related to increasing life expectancy to lead to better health outcomes. At the same time, the systems can reduce spending and utilization of resources by adopting other strategic approaches like eHealth for value.
Lastly, systems should seek to adopt significant eHealth in the care of HF patients remotely. This strategy will ensure patients are admitted immediately if their symptoms prove dangerous for their health, hence ensuring their safety while addressing the quality of care. As stated earlier, technology is developing rapidly to complement healthcare processes in various sectors of cardiovascular health (Zhu, Gu, and Xu, 2020). The government can also be involved by ensuring providers have access to technology by ensuring sufficient funding and keeping a close watch on policies involving funding in community care settings. These technologies will ensure patients receive relevant and effective information regarding their self-care management.
Conclusion
Re-designing care systems for the improvement of evidence-based practice seems like an ideal for improved quality and outcomes of care. The state board of nursing standards and organizational and governmental policies work towards ensuring patient safety and improved quality of care for various healthcare providers. While some policies may be controversial, they lean towards reducing risks and symptom management. As stated, with a multidisciplinary approach and the adoption of eHealth, the patient’s safety stays a priority as increased and regulated insurance coverage reduces costs for individuals and the system. Notwithstanding, heart failure challenges in all populations are still lagging and need to be addressed with policies as soon as possible to reduce associated mortality rates.
References
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