UCLA Post Discharge Nursing Interventions for Patients Congestive Heart Failure Case

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Svert123

Health Medical

University Of California Los Angeles

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"Introduction and Problem Statement” to state the title of your project, a purpose statement, the background and significance of your project; PICOT formatted project questions, and references. 

  • Provide a title that conveys or describes the assignment.
  • Project Purpose Statement – Provide a declarative sentence or two which summarizes the specific topic and goals of the project.
  • Background and Significance – State the importance of the problem and emphasize what is innovative about your proposed project. Discuss the potential impact of your project on your anticipated results to the betterment of health and/or health outcomes.
  • PICOt formatted Clinical Project Questions – Provide the Population, Intervention, Comparison, Expected Outcomes and timeframe for the proposed project.
  • References – Cite references using APA 7th ed format. 1500 words 

Here is my PICOT question For congestive heart failure (CHF) patients (P), how does the utilization of post-discharge nurse-led interventions such as ?? (be specific as to what this would be) (I) compared to not using follow-up interventions (C) affect 30-day hospital readmission rates (O) within three months of intervention (T) ?

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Impact of Intensive Behavioral Therapy (IBT) on Type 2 Diabetes in a Primary Care Clinic A selected topic from the approved list: The implementation of a clinical protocol to identify and manage type 2 diabetes mellitus in adults in the family practice clinic setting. PICOT question: In a group of patients between the ages of 18-65 diagnosed with type 2 diabetes without complications (P), does the implementation of intensive behavioral therapy program/protocol (I), versus standard family practice protocols (C), result in a reduction in A1C (O) within 6 months (T)? Project Purpose: Reversing the Progression of Type 2 Diabetes Through an Intensive Behavioral Therapy Program The purpose of this project is to determine if the implementation of an intensive behavioral therapy (IBT) program for working age adults diagnosed with type 2 diabetes (T2DM) will promote long term behavioral and lifestyle changes. The goal is to encourage and support patients in their adherence to the necessary lifestyle changes and to realize a reduction in glycated hemoglobin A1C levels in order to stop the progression of the disease along with its associated clinical, societal and economic burden. It will aim to illustrate a standardized outline for implementation of IBT in the primary care setting. As the burden of most routine management for chronic medical conditions, like T2DM, falls on primary care providers (PCPs), this project aims to provide a framework for PCPs which may in turn reduce that burden. Background and Significance: Type 2 Diabetes Risk Factors for Poor Quality of Life and Decreased Life Expectancy According to the Centers for Disease Control and Prevention [CDC] (2020), despite continued development of policy and availability of evidence-based guidelines demonstrating effective approaches to care, an estimated 34.2 million people in the United States are affected by T2DM. Chronic diseases, like T2DM, are among the leading causes of death in the United States. This is due to the progressive nature of the disease, driven by dysglycemia, which leads to costly and life altering complications such as heart disease, kidney disease, blindness, nerve damage and limb-amputations (CDC, 2020). According to Mechanick, et al. (2018), its progression can be categorized into four distinct stages: insulin resistance, prediabetes, type 2 diabetes and type 2 diabetes with vascular complications. Traditionally, the goal of management for insulin resistance and prediabetes is to stop the progression, while the goal of management for type 2 diabetes and type 2 diabetes with vascular complications is to both stop progression and manage complications. It is very common for people to go undiagnosed, and therefore untreated, due to the lack of symptoms present in the first three stages. According to the National Institute of Diabetes and Digestive and Kidney Diseases (2016), the most at-risk populations for T2DM are >45 years old who have a BMI >25 kg/m2, hypertension, low HDL cholesterol, high triglycerides, a family history of diabetes and are African American, Alaskan, American Indian, Asian American, Hispanic, Native Hawaiian or Pacific Islander. Regarding ethnic factors, a study by Smalls, et al. (2020) found that at risk people groups had specific biological, behavioral, social, environmental and health system contributors to this disparity which should be considered when developing preventative and treatment measures. According to the American Diabetes Association (2020), complications tend to occur in individuals who are non-compliant with medication and lifestyle interventions along with those suffering from multiple comorbidities. Early recognition and diagnosis along with subsequent adherence to the necessary lifestyle changes can lead to reduction in complications. According to the CDC (2020), the annual burden to the United States Economy from T2DM is estimated at $327 billion dollars. The American Diabetes Association (ADA) (2020) reports that the average person with diabetes spends approximately $16,752 in medical expenses per year, which is about 2.3 times more than people without diabetes spend. Therefore, the prevalence of diabetes is classified as an epidemic which imposes a substantial clinical and public health burden, as it leads to an increase in health care expenditures and a decrease in quality of life and overall life expectancy. Guidelines set by the ADA (2020) suggest that A1C should be managed as close to 7% as possible. These guidelines are supported by studies indicating that intensive medication management towards A1C targets at or around the normal range of 4.9% to 5.7%, leads to increased mortality. Unfortunately, an A1C at 7% represents a greater than normal insulin production which taxes the beta cells of the pancreas. The beta cells are destroyed faster than they are reproduced, ultimately contributing to the progressive nature of the disease (White, et al., 2016). As indicated by the ADA guidelines (2020), medication management cannot stop this progression due to the danger of hypoglycemia. Diet and exercise, however, are considered to be lifestyle interventions effective at stabilizing blood glucose and for which an IBT program could be used to increase adherence towards. Therefore, an IBT program could be used to stop the progression of T2DM without the dangers posed from antihyperglycemic medications. IBT is generally classified as a program consisting of a collaboration between a small group of healthcare providers and the patient with focus on learning individualized behavioral self-management strategies related to diabetes, nutrition and physical activity. This is accomplished through a series of frequent clinical contacts, remote patient monitoring, motivational interviewing and a network of training, feedback and clinical support (Wadden, et al., 2019). Based on the background, prevalence, cost and impact on quality of life posed by T2DM, IBT programs need to be implemented in primary care clinics. This project specifically addresses that need by creating a framework for IBT in the primary care setting which could increase the number of patients with T2DM engaged in lifestyle modifications. This will improve the quality of life for patients suffering from T2DM in a safe and cost-effective way while also decreasing the tremendous burden posed to our health care system. PICOT Formatter Clinical Projection Questions The population being studied includes working aged adults between the ages of 18 and 65, who have been diagnosed with T2DM, and are without complications. The intervention is implementation of a structured intensive behavioral therapy program which includes behavioral, dietary and exercise counseling. The comparison group will assume traditional care for T2DM as currently provided at the clinic. Assessment will be made through the recording of the glycated hemoglobin A1C both before and after the provision of the intervention. The expected outcome would be to reduce the value of the glycated hemoglobin A1C to
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The Effectiveness of Post-Discharge Nurse-Led Interventions for Patients with Congestive
Heart Failure (CHF) in Reducing 30-day Readmission Rates
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The Effectiveness of Post-Discharge Nurse-Led Interventions for Patients with Congestive
Heart Failure (CHF) in Reducing 30-day Readmission Rates
Congestive heart failure (CHF) is a major contributor to poor patient health outcomes and
deaths in the United States. The purpose of this project is to reduce the rates of readmission from
CHF and hence enhance health outcomes for patients with the health condition. Since nurses are
in charge of patient care and interact extensively with patients, they are in a position to provide
ongoing care and ensure effective care transition for the target population. Evidence-based
practice (EBP) could improve the prognosis for patients with CHF and enhance the quality of life
and health outcomes. This project seeks to implement nurse-led post-discharge interventions to
assist patients with CHF to reduce the risk of readmission.
Project Purpose: Reducing the Hospital Readmission Rates of CHF Patients through
Nurse-Led Post-Discharge Follow-Up Interventions
The purpose of this project is to determine whether nurse-led post-discharge interventions
can reduce hospital readmission rates for patients with CHF. These interventions include aspects
such as transitional care planning and provision, education programs, and telehealth follow-up.
The key aspect of the interventions is that they have to be organized and carried out by nurses.
The goal of the project, therefore, is to reduce the risk of patients being readmitted for CHFrelated complications within 30 days, a benchmark that has been used in the healthcare industry
to measure and monitor the effectiveness of transitions from the healthcare setting. The project
also aims to test the abilities of nurses in organizing and implementing post-discharge follow-up
interventions for CHF patients. Hopefully, the project will demonstrate nurses’ competence and
abilities to effectively monitor and follow up on patient health to achieve the best health

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outcomes, especially for patients with chronic conditions. This project’s purpose is to reduce the
burden of CHF readmissions and improve patient health outcomes.
Background and Significance
CHF is a common progressive chronic condition which affects millions of Americans.
According to Virani et al. (2020) more than 6 million Americans are living with CHF and around
550,000 cases are diagnosed annually. Moreover, CHF is associated with high morbidity and
mortality rates. In 2018, more than 350,000 death certificates indicated heart failure as one of the
causes (Virani et al., 2020). The chronic nature of CHF means that one of the likely prognosis is
the death of affected individuals. These high rates of death from the disease have made it one of
the leading causes of death in general in the country. The prognosis of CHF is also discouraging
since more than half of those diagnosed die within 5 years of diagnosis (Virani et al., 2020).
Maintaining a high quality life and reducing risk factors for those at risk of CHF are the main
approaches to slowing its progression and leading a high quality lifestyle for longer.
The occurrence of CHF across all ages increases its impact and relevance in the
healthcare industry. CHF can affect people from all ages although majority of the affected people
are older adults. Approximately 1.5 million of the 5 million affected people are below the age of
60 (Virani et al., 2020). Therefore, even younger people are at risk of CHF. Other risk factors
include the presence of diabetes, obesity, coronary artery disease, and high blood pressure. As
seen from this list, many patients diagnosed with heart failure have a chronic comorbidity. The
management of CHF, therefore, requires consideration of other underlying issues and may
require huge adjustments in the patient’s lifestyle as well as health maintenance.
In addition to incidence and mortality rates, CHF has a high impact on patients as well as
the healthcare system. Studies have shown that CHF patients are likely to have comorbidities and

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the presence of comorbidities adversely affects the quality of life for these patients (Bahall et al.,
2020). Therefore, being diagnosed with CHF may lead to less satisfying and quality lifestyle.
Similarly, diagnosis of any chronic condition is likely to produce mental distress in the patient.
Mental distress is associated with poor mental health and exacerbation of some of the chronic
conditions symptoms (Bahall et al., 2020). Other than impact on individuals, CHF has
significantly impacted the healthcare system. First, it is the leading cause of 30-day readmission
rates at 20.6% (Shah et al., 2018). Heart failure contributes to the highest rates of 30-day
readmission, an aspect that presents high healthcare utilization and c...

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