Type 2 diabetes is a prevalent chronic condition that places considerable self-management demands on patients. The patient this assessment focuses on, John Smith, has struggled to maintain the lifestyle changes needed to keep his blood glucose levels controlled, as evidenced by rising HbA1c levels from 6.8% to 8.1% over the last six months. This indicates increasing risk for complications and need for interventions promoting engagement in recommended self-care behaviors. As John’s nurse, I have spent two initial practicum hours working directly with him to better understanding barriers to adherence and collaborative strategies for behavior change tailored to his needs. The impact of unmanaged diabetes on quality and safety is far-reaching, from increased healthcare utilization to devastating vascular complications. This assessment examines the influence of diabetes specifically on quality of care, patient safety and costs at both the individual and systems level, alongside evidence-based practice standards, organizational policies and leadership strategies to improve outcomes for John and similar patients.
Impact on Quality of Care
Quality of care refers to the degree health services increase desired outcomes and align with current professional knowledge for a given condition (AHRQ, 2022). For diabetes, quality markers involve evidence-based processes of care that promote self-management, monitor risk, screen for complications and control intermediate outcomes like HbA1c, blood pressure and cholesterol (Healthy People 2030, 2020). John has struggled to maintain the diet, exercise, medication adherence and testing behaviors needed to optimize glycemic control. Consequently, John’s HbA1c has risen above the target of <7%, indicating suboptimal blood glucose management over the past two to three months and increased risk for vascular complications over time (CDC, 2022). Other markers of quality like adherence to annual eye and foot exams have also dropped off for John since his initial diagnosis. At the systems level, only about 60% of diabetes patients in John’s state receive the ADA-recommended annual HbA1c testing, 35% obtain the standard for eye exams and just 65% have upcoming appointments for preventative services like nephropathy screening (CLA, 2022). Significant care gaps remain across recommended quality monitoring and early intervention processes.
Impact on Patient Safety
Diabetes profoundly impacts patient safety both directly through acute crises like hypoglycemia and hyperglycemia and indirectly via associated comorbidities and complications. As John struggles to keep his blood glucose controlled through diet, exercise and medication adherence, he faces elevated risk for hypoglycemic episodes causing confusion, seizures, loss of consciousness requiring emergency care and even death in severe cases (Mayo Clinic, 2022). John has already experienced two emergency room visits in the past year for marked hyperglycemia with blood glucose over 600 mg/dL, placing him at risk for diabetic ketoacidosis. He was hospitalized during one of these visits for two nights with an extensive recovery. Uncontrolled diabetes also indirectly threatens patient safety through cardiovascular disease, kidney dysfunction, neuropathy and impaired immunity (CDC, 2022). John’s latest lab work shows indicators of kidney damage and early nerve impairment in his lower extremities. At the organizational and community level, diabetes remains the leading cause of adult blindness, end stage renal failure and non-traumatic lower extremity amputations, compromising safety through associated comorbidities (ADA, 2022).
Impact on Costs
The cost implications of diabetes on patients and the healthcare system are astronomical. Individuals with diagnosed diabetes face over $9,000 in mean annual medical expenditures, with growing out-of-pocket costs for those like John with declining insurance coverage for supplies, medications and specialist care (ADA, 2022). Indirect costs also accumulate from missed work, reduced productivity and caregiving needs. John has already accrued nearly $5,000 in medical bills this past year between emergency visits, hospitalization, lab tests and prescription charges. This figure threatens to multiply rapidly if vascular complications escalate without improved self-management. At the systems level, the total cost of diagnosed diabetes in the U.S. reached $327 billion in 2017, including $237 billion in direct medical care and $90 billion in lost productivity (ADA, 2022). Appointment and process costs also tax practices trying to provide time-intensive DSME education and support. If current growth trends continue, researchers predict over 650 billion dollars allocated towards diabetes care by 2030 (Rowley et al., 2017). Significant potential exists to curb these alarming cost projections through improved self-management, complication prevention and population health strategies.
State Practice Standards, Policies and Evidence
Several nursing practice standards and policies exist with evidence supporting enhanced diabetes outcomes. For example, the AADE7 Self-Care Behaviors framework guides patient education and assessment using seven key components of healthy coping, taking medication, monitoring blood glucose, adopting a healthy diet, increasing physical activity, problem solving and reducing risks (Geiselman et al., 2022). DSME programs integrating AADE7 show improved HbA1c and self-efficacy compared to standard care controls, providing validated structure aligned with quality aims (Beverly et al., 2022). ADA Standards of Care also give researched practice recommendations for comprehensive management. Nurses applying these standards have achieved significantly greater patient improvements in HbA1c, blood pressure and functional status versus purely medical models (Kent et al., 2013). Evidence confirms nurse implementation of ADA guidelines positively influences quality markers and safety through risk reduction.
Translating these standards into organizational protocols and policies also promotes consistent, equitable care delivery. One way this can be achieved is by integrating DDS-2 survey into intake workflows to enable early intervention when patients like John feel unable to continue working on themselves to stick to self-care practices (ADA, 2020). Overall level strategies that include the incentive of healing include, for instance, reimbursing medical therapy nutrition or keeping group DSME class funding despite attendance changes, which enables the education that might save lives and closes the stated care gaps. Overall level strategies that include the incentive of healing include, for instance, reimbursing medical therapy nutrition or keeping group DSME class funding despite attendance changes, which enables the education that might save lives and closes the stated care gaps.
A system-wide provision of reimbursement for medical nutrition therapy or regular group DSME class funding amidst fluctuating enrollment would be a sustainable practice ensuring a community members’ life saving knowledge attainment.
System-level policies including the recognition and reimbursement for medical nutrition therapy or sustaining group diabetes stemming education even when there are fluctuations in enrollment will result in life-saving education narrowing documented gaps in care.
At the system-level, policy that retrimburses medical nutrition therapy or maintains group DSME classes with fluctuating enrollment helps bridge the gap that is proven to lead to deaths.
Life-saving education resulting from system-level policies which cover medical nutrition therapy and the DSME class costs despite low enrollment is possible to achieve with the funding.
Effective policy change does face barriers like costs, tradition and inconsistent leadership support. Yet diabetes quality improvement efforts led by nursing stakeholders emphasizing health equity have achieved broad member outreach, community partnerships and demonstrative HbA1c reductions across disadvantaged populations (Perez & Carter, 2022). State and organizational policies led by nurse contributors can profoundly shape service access and quality.
Strategies for Improvement
Specific strategies to improve quality, safety, and costs for patients like John focus on getting him more involved in managing his diabetes education and support. For example, having John complete a questionnaire about his challenges with recommended diet, exercise, taking medications, and testing his blood sugar shows where he needs more help (Johnson et al., 2018). Understanding his specific issues allows tailoring education, problem-solving, rethinking unhelpful beliefs about diabetes, and setting concrete goals he can achieve (Evert et al., 2022). Rather than general information, assessing John’s needs and providing customized support is more likely to improve his confidence in managing his condition. Adding group peer support to one-on-one education also further improves sticking to treatments and reduces distress compared to education alone over 12 months (Evert et al., 2022). Online discussion forums, text messages, and group activities focused on applying knowledge can increase John’s internal motivation.
Quality and safety markers see measurable gains with programming coordinating medical and psychosocial aspects of diabetes management (Chrvala et al., 2022). For example, multidisciplinary teams incorporating nurses, dietitians, pharmacists, certified diabetes educators and emotional health support under one roof provide seamless resource linkage matching patients’ evolving needs. On-site HbA1c testing and referrals during DSME education facilitate rapid treatment adjustment as John’s glucose control fluctuates. Embedding dental hygienists also bridges another common care gap. Coupling rich education with comprehensive screening and coordinated follow-up enhance quality standards around annual eye exams, nephropathy monitoring and disease stage prevention essential for safety gains. Targeted dashboards monitoring metrics like completed lab orders, foot checks performed and days between visits spur intervention momentum (Evert et al., 2022). Multifaceted programming coordinating diverse support and leveraging HIT systems optimizes improvement across quality, patient safety and cost aims.
Conclusion
Undiagnosed diabetic tend to have heightened risk of a complications, which can quickly aggravate already alarming outcomes and costs. Nevertheless, such issues can be dealt with by the nursing leadership setting the evidenced-based quality standards, organizational policies and patient-centred improvement strategies that will focus on the engagement of self-management. Redirecting attention to John’s needs which are particular to him and encompassing the use of positive peer support alongside a coordinated care system can pave the way for the statistic-based outcomes to be turned into functioning, resilience and the freedom from preventable harm.
References
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