Health Care Quality
Healthcare quality is how healthcare services improve patient outcomes (Selvin et al., 2021). Patients diagnosed with diabetes require high healthcare quality to prevent diabetes progression. Patients also require prevention-focused treatment to reduce the risk of cardiovascular diseases and death (Selvin et al., 2021). The goals of diabetes treatment include achieving hemoglobin A1c (HbA1c) levels, controlling blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) level treatment targets (Kazemian et al., 2019). Healthcare providers emphasize beneficial interactions and care coordination among patients diagnosed with diabetes, interdisciplinary team members (nurse, dietitian, psychotherapist, physiotherapist, diabetes educator), and the community. The rationale is that care coordination promotes high-quality care and a continuum of patient management.
According to Selvin et al. (2021), the degree of population health services increases the likelihood of desired patient outcomes. However, racial minorities and low-income populations in the United States experience disproportionate health care services. This population has limited access to quality diabetes care, thus resulting in poor health-related quality of life (Selvin et al., 2021). For instance, racial minorities are less likely to receive A1c testing and diabetes and retinopathy screening services than whites. According to Selvin et al. (2021), these racial disparities persist in populations with equal access to healthcare services. Individuals with low income also have limited access to nutritious food. Minority populations (African Americans) have poor glycemic, lipids, and blood pressure control and a high disease burden. Additionally, the population has low utilization of eye and foot examination services. These disparities indicate a significant gap in healthcare quality among United States residents diagnosed with diabetes.
The measures of diabetes healthcare quality include reported patient satisfaction, eye and foot examination rates, rate of albuminuria test, and level of glycemic control (Selvin et al., 2021). These measures indicate significant progress in improving diabetes care (Ba-Essa et al., 2018). It is essential to monitor trends in diabetes quality indicators. The rationale is that monitoring quality measures help evaluate the effectiveness of implemented interventions and identify gaps in care that impair population health outcomes.
Patient satisfaction is expressed as hospital waiting time and the effectiveness of technology used during healthcare interaction and patient evaluation (Selvin et al., 2021). Advanced technology, such as telehealth, enables patients to receive high-quality and timely healthcare services. Remote patient monitoring also improves healthcare utilization. Telehealth promotes remote patient monitoring, which involves digital tracking of patient data on glycemic levels, thus improving patient management by reducing unnecessary hospital visits (Lee et al., 2018). These aspects improve healthcare quality and patient satisfaction. In addition, advanced technology has decreased the proportion of underdiagnosed cases of diabetes and delayed treatment initiation over the past 20 years (Selvin et al., 2021). High healthcare quality and early treatment promote more prolonged patient survival and high health-related quality of life.
Patient Safety
Patient safety focuses on reducing the risk of harm by promoting high-quality care and preventive interventions (Selvin et al., 2021). Patients diagnosed with diabetes have a high risk for cardiovascular complications, renal and hepatic complications, lower limb amputation, and vision loss (Reed et al., 2021). Therefore, delayed treatment and poor management of diabetes symptoms increase the risk of terminal diseases and premature death. Patients diagnosed with diabetes have minimal safety due to immune dysfunction. This population is prone to infection and prolonged healing, especially of wounds (Reed et al., 2021). Additionally, this population is susceptible to depression due to poor coping skills and increased distress. Therefore, healthcare providers should focus not only on diabetes care but also on psychological support.
According to Selvin et al. (2021), the availability of new medications and changes in clinical recommendations improve risk factor control, thus improving patient safety. Elderly patients diagnosed with diabetes have high morbidity and impaired cognition. Additionally, the elderly population has pervasive polypharmacy. These aspects complicate the treatment and management of diabetes (Selvin et al., 2021). Therefore, the patients experience a high disease burden and mostly die due to diabetes-associated heart attacks and hypertension. Therefore, caregivers should coordinate patient care to improve patient outcomes and life expectancy and protect elderly patients from harm and infections. Caregivers can also increase patient education and training to empower patients in self-care practices (Dhatariya et al., 2020). Patient education improves health literacy and promotes self-management.
Healthcare Cost
Diabetes is a significant public health burden in the United States. Patients diagnosed with diabetes require medication and psychotherapy. The patients incur high healthcare costs attributed to continuous insulin therapy, regular screening, hospitalization, and hospital visits. These patient needs account for direct healthcare costs, which can deter patients from seeking healthcare services due to low income (Riddle & Herman, 2018). The indirect cost of diabetes care includes reduced productivity, early retirement, work absence, and loss of employment due to disability. Disability-adjusted lives and early retirement deplete labor, thus affecting the economy and growth (Riddle & Herman, 2018). Patients also incur the cost of preventive interventions such as nutritional, physical fitness, and hospital travel costs. These high-cost result in the economic barrier of medication utilization. According to Kazemian et al. (2019), diabetes prevalence is expected to increase to 54 million by 2030. This prediction indicates that the healthcare cost of diabetes management will increase dramatically.
The American Diabetes Association (ADA) reports an increasing trend in healthcare costs associated with diabetes care. The total direct cost of diabetes care in the U.S. was $116 billion in 2007, $176 billion in 2012, and $237 billion in 2017 (Riddle & Herman, 2018). The increasing cost of healthcare is attributed to the increasing prevalence of diabetes, insulin expenditure, and medication supply. Healthcare for one person costs $16,752 annually (2.3 times the average expenditure of a person without diabetes) (Brown et al., 2018). Approximately 1 in every four healthcare dollars is spent on diabetes management in the U.S (Riddle & Herman, 2018). This evidence instigates the implementation of safe, efficient, and cost-effective treatment plans such as lifestyle interventions.
Caregivers can improve access to diabetes care by targeting the highly prevalent populations to reduce hospitalization and other healthcare costs. Most importantly, public health nurses can focus on community programs that educate people about healthy lifestyles, healthy diets, and the health consequences of diabetes (Riddle & Herman et al., 2018). Creating public awareness can help people adhere to diabetes prevention recommendations.
Effect of State Board Nursing Practice Standards and Governmental Policies on the Impact of Diabetes on Quality of Care, Patient Safety and Costs
The State Board Nursing Practice Standards focus on nurse qualifications. State boards of nursing require nurses to meet professional qualifications, skills, and knowledge for authorization to practice nursing. The Board of Nursing protects the integrity of the nursing profession and the quality of healthcare delivery (Beck et al., 2017). Qualified nurses are granted practicing licenses and must adhere to the nursing code of ethics by protecting patients from harm, maleficence, and injustice. According to Lawler et al. (2019), qualified nurses provide high-quality diabetes care and coordinate patient care to improve patient outcomes, patient experience, and satisfaction. Quality healthcare also reduces patient length of stay in the hospital, readmission, unnecessary hospital visits, and patient harm and diabetes-related complications. Therefore, recruiting qualified nurses is cost-effective and improves healthcare quality.
One governmental policy that influences the impact of diabetes on patient safety, healthcare quality, and the cost is the Affordable Care Act (ACA). ACA improves the affordability of healthcare services among vulnerable populations. This policy has increased the number of insured Americans by expanding Medicaid, providing a subsidized health insurance marketplace, and decreasing insurance disparity for populations affected with chronic diseases such as diabetes. According to Riddle & Herman (2018), ACA increased the health coverage of adults younger than 65 diagnosed with diabetes from 84.7 to 90.1% (Riddle & Herman, 2018). Additionally, many families with low income and less than a high school education had health insurance coverage. This data shows that the ACA reduced healthcare costs and improved healthcare quality and access. ACA covers type 2 diabetes screening, diet counseling, and psychotherapy expenses (Brown et al., 2018). Therefore, patients have reduced out-of-pocket expenditure, high medication use, and diabetes management.
The Americans with Disabilities Act (ADA) policy influences patient safety by protecting patients from discrimination in workplaces, schools, healthcare facilities, and living environments (American Diabetes Association, 2022). This policy recognizes patients diagnosed with diabetes as disabled individuals that require quality care and physical and social support. These policies improve patient safety, healthcare quality, and cost-effectiveness of diabetes healthcare.
The state board of nursing standards and the governmental policies guide nurses’ actions in promoting health care quality, patient safety, and costs. Nursing standards provide insights into protecting patients from harm and discrimination. The standards also guide nurses in making informed and ethical clinical decisions for patient beneficence. The governmental policies require nurses to enforce the laws at the local level and improve healthcare access. I gained insights into conducting public health promotion and patient advocacy to improve the utilization of diabetes care. I plan to provide high-quality, evidence-based care and collaborate with interdisciplinary team members to monitor patients and implement patient-tailored diabetes care plans.
Effects of Local, State, and Federal Policies on Nursing
Scope of Practice
Local, state and federal policies limit the nursing scope of practice. These policies restrict nurses from providing only the healthcare services they are qualified and authorized to provide (Schumer et al., 2020). For instance, endocrinologists diagnose patients with diabetes, and nurse educators educate patients diagnosed with diabetes about self-care practices and the management of diabetes symptoms. Similarly, dietitians educate patients bout healthy diets and develop meal plans, while psychotherapists help patients cope with distress. Generally, nurses can prescribe patient medication and monitor health progress. The scope of practice policies aims to protect patients from sub-standard care, which compromises patient safety resulting in poor patient outcomes and high healthcare costs.
Strategies to Improve Healthcare Quality, Patient Safety, and Reduce Costs
Strategies that can improve healthcare quality, patient safety and reduce diabetes care cost focus on preventing the exacerbation of diabetes, reducing risk factors for diabetes-related complications, and addressing barriers that deter patients from accessing diabetes care (Reed et al., 2021). These strategies include encouraging lifestyle changes, providing patient education, promoting diabetes screening, and adopting telehealth. Public health nurses can conduct community outreach programs to create public awareness about lifestyle changes, risk factors of diabetes, and the importance of physical exercise and healthy diets (Reed et al., 2021). Nurse dietitians can also educate patients diagnosed with diabetes about self-care practices, coping skills, and self-glucose monitoring. Promoting diabetes screening improves early diagnosis and initiation of diabetes care.
Patient education enables patients to make informed decisions and provides insights into patient engagement in care coordination (Powers et al., 2020). Nurses can reduce risk factors for diabetes-related complications such as cardiovascular diseases, obesity, hyperlipidemia, stroke, and heart attack by emphasizing physical activity, Mediterranean diets, and insulin and pharmacotherapy adherence. The telehealth approach can help patients overcome healthcare barriers such as transportation costs. According to Lee et al. (2018), telehealth supports timely care and readily available patient consultation, and remote monitoring of blood glucose levels. These strategies can improve healthcare quality, access, and utilization, thus promoting patient safety and health outcomes and reducing healthcare costs. The American Diabetes Association (2021) provides evidence supporting the implementation of these interventions to improve diabetes care outcomes. This resource emphasizes the provision of quality healthcare services based on standards of care.
References
American Diabetes Association. (2021). Standards of Medical Care in Diabetes- 2021. Diabetes Care, 44, S1-S232. doi.org/10.2337/dc21-Sint
American Diabetes Association. (2022). Is Diabetes a Disability? https://diabetes.org/tools-support/know-your- rights/discrimination/is-diabetes-a-disability
Ba-Essa, E. M., Abdulrhman, S., Karkar, M., Alsehati, B., Alahmad, S., Aljobran, A., … & Alhawaj, A. (2018). Closing gaps in diabetes care: From evidence to practice. Saudi journal of medicine & medical sciences, 6(2), 68. doi.org/10.4103/sjmms.sjmms_86_17
Beck, J., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., … & Wang, J. (2017). 2017 National standards for diabetes self-management education and support. Diabetes Care, 40(10), 1409–1419. doi.org/10.1177/0145721719897952
Brown, D. S., & Delavar, A. (2018). The Affordable Care Act and insurance coverage for persons with diabetes in the United States. Journal of hospital management and health policy, 2. Doi: 10.21037/jhmhp.2018.04.07
Dhatariya, K., Mustafa, O. G., & Rayman, G. (2020). Safe care for people with diabetes in hospital. Clinical Medicine (London, England), 20(1), 21–27. https://doi.org/10.7861/clinmed.2019-0255
Kazemian, P., Shebl, F. M., McCann, N., Walensky, R. P., & Wexler, D. J. (2019). Evaluation of the cascade of diabetes care in the United States, 2005-2016. JAMA internal medicine, 179(10), 1376–1385. doi:10.1001/jamainternmed.2019.2396
Lawler, J., Trevett, P., Elliot, C., & Leary, A. (2019). Does the Diabetes Specialist Nursing workforce impact the experiences and outcomes of people with diabetes? A hermeneutic review of the evidence. Human Resources for Health, 17(1), 65. https://doi.org/10.1186/s12960-019-0401-5
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Riddle, M. C. & Herman, W. H. (2018). The cost of diabetes care—the elephant in the room. Diabetes Care, 41(5), 929–932. doi.org/10.2337/dci18-0012
Selvin, E., Narayan, K. V., & Huang, E. S. (2021). Quality of care in people with diabetes. https://www.ncbi.nlm.nih.gov/books/NBK568015/
Schumer, R. A., Guetschow, B. L., Ripoli, M. V., Phisitkul, P., Gardner, S. E., & Femino, J. E. (2020). Preliminary experience with conservative sharp wound debridement by nurses in the outpatient management of diabetic foot ulcers: Safety, efficacy, and economic analysis. The Lowa Orthopedic Journal, 40(1), 43–47. PMCID: PMC7368523
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