Assignment: Clinical outcomes Exercises Paper 2: The measurement of outcomes: • • Identify at least 2 metrics (or measures) that are useful in measuring outcome progress including describing the data sources and critically analyzing strengths and limitations to data sources 2-3 References- within 7 years, peer-reviewed professional journals, government/foundation, or professional association publication and websites. Grading rubric for paper 2 (20 points, 10% of your total grade) Graded element Identifies at least 2 metrics used to quantify clinical outcome/issue Describes sources of data that can provide performance metrics Identifies and critically analyzes strengths and limitations to data sources and available metrics or measures Proper use of grammar, sentence structure and APA format Proper References Three-page limit excluding title page and references Total points Potential points 5 4 8 3 20 Page 1 of 1 1 Introduction The clinical problem that requires immediate attention and action is postpartum hemorrhage, a preventable health issue that affects women around the world to varying degrees. While this issue is detrimental to women everywhere, in the United States it is especially concerning for African American women, who have a significant disparity in maternal morbidity and mortality rates (Small et al., 2017). While research has shown that protocol-driven care is associated with improved health outcomes, not many hospitals are implementing these protocols regularly (Kacmar et al., 2014). One clinical outcome that should be measured around this issue is maternal death in African American women in the United States. First Metric for Outcome Progress One of the most important metrics used to evaluate maternal death is the maternal mortality ratio (MMR). According to the World Health Organization (WHO), the MMR is “the number of maternal deaths during a given time period per 100,000 live births during the same time period” (World Health Organization [WHO], 2020). Maternal deaths are defined as any death related to or aggravated by pregnancy or childbirth or within 42 days after the end of the pregnancy (WHO, 2020). To measure the outcome of African American maternal deaths in the United States, the MMR is essential to tracking and understanding preventable causes of maternal death such as postpartum hemorrhage. The data for the MMR comes from a variety of sources, including vital registration systems and surveys (WHO, 2020). One strength of this data source is that it is a commonly used metric to easily compare maternal deaths across different settings, including different countries. However, there can be problems with data collection for the MMR, particularly related to underreporting and misclassification of maternal deaths (WHO, 2020). 2 Second Metric for Outcome Progress A different metric that should be used to evaluate maternal death of African American women related to postpartum hemorrhage is from a study in which they developed a survey titled “The Use of Postpartum Hemorrhage Protocols in United States Academic Obstetric Anesthesia Units” (Kacmar et al., 2014). This survey includes questions about hospital characteristics, availability of postpartum hemorrhage protocols or plans to develop a protocol soon (Kacmar et al., 2014). The source of data for this survey was from “104 directors of United States academic obstetric anesthesia units,” and their responses can help determine the percentage of hospitals that are implementing strategies to reduce maternal deaths (Kacmar et al., 2014). One strength of this metric is that it directly asks hospitals in the United States to evaluate their protocols in place, which determines the hospital settings that may be lacking and may require incentives to implement proper protocols to help decrease maternal mortality. However, one limitation to this metric is that the first survey did not receive a high response rate (only 58%), which severely impacts the data that can be collected and indicates there may be a response bias. Conclusion To best evaluate maternal death in African American women related to postpartum hemorrhage, metrics including the MMR and the survey developed in 2014, can help determine areas of high need. While these metrics are not perfect, in conjunction together they can provide a clearer picture of health care disparities in the United States and determine a way forward to decrease maternal death in African American women. Addressing this care outcome will change the health of individual women and families but also reach beyond to entire populations of women inside and outside of the United States. 3 References Kacmar, R. M., Mhyre, J. M., Scavone, B. M., Fuller, A. J., & Toledo, P. (2014). The use of postpartum hemorrhage protocols in United States academic obstetric anesthesia units. Anesthesia & Analgesia, 119(4), 906–910. https://doi.org/10.1213/ane.0000000000000399 Small, M. J., Allen, T. K., & Brown, H. L. (2017). Global disparities in maternal morbidity and mortality. Seminars in Perinatology, 41(5), 318–322. https://doi.org/10.1053/j.semperi.2017.04.009 World Health Organization. (2020). World health data platform/GHO/Indicator metadata registry list: Maternal mortality ratio (per 100 000 live births). https://www.who.int/data/gho/indicator-metadata-registry/imr-details/26 1 Introduction The clinical problem that requires immediate attention and action is postpartum hemorrhage, a preventable health issue that affects women around the world to varying degrees. While this issue is detrimental to women everywhere, in the United States it is especially concerning for African American women, who have a significant disparity in maternal morbidity and mortality rates (Small et al., 2017). While research has shown that protocol-driven care is associated with improved health outcomes, not many hospitals are implementing these protocols regularly (Kacmar et al., 2014). One clinical outcome that should be measured around this issue is maternal death in African American women in the United States. First Metric for Outcome Progress One of the most important metrics used to evaluate maternal death is the maternal mortality ratio (MMR). According to the World Health Organization (WHO), the MMR is “the number of maternal deaths during a given time period per 100,000 live births during the same time period” (World Health Organization [WHO], 2020). Maternal deaths are defined as any death related to or aggravated by pregnancy or childbirth or within 42 days after the end of the pregnancy (WHO, 2020). To measure the outcome of African American maternal deaths in the United States, the MMR is essential to tracking and understanding preventable causes of maternal death such as postpartum hemorrhage. The data for the MMR comes from a variety of sources, including vital registration systems and surveys (WHO, 2020). One strength of this data source is that it is a commonly used metric to easily compare maternal deaths across different settings, including different countries. However, there can be problems with data collection for the MMR, particularly related to underreporting and misclassification of maternal deaths (WHO, 2020). 2 Second Metric for Outcome Progress A different metric that should be used to evaluate maternal death of African American women related to postpartum hemorrhage is from a study in which they developed a survey titled “The Use of Postpartum Hemorrhage Protocols in United States Academic Obstetric Anesthesia Units” (Kacmar et al., 2014). This survey includes questions about hospital characteristics, availability of postpartum hemorrhage protocols or plans to develop a protocol soon (Kacmar et al., 2014). The source of data for this survey was from “104 directors of United States academic obstetric anesthesia units,” and their responses can help determine the percentage of hospitals that are implementing strategies to reduce maternal deaths (Kacmar et al., 2014). One strength of this metric is that it directly asks hospitals in the United States to evaluate their protocols in place, which determines the hospital settings that may be lacking and may require incentives to implement proper protocols to help decrease maternal mortality. However, one limitation to this metric is that the first survey did not receive a high response rate (only 58%), which severely impacts the data that can be collected and indicates there may be a response bias. Conclusion To best evaluate maternal death in African American women related to postpartum hemorrhage, metrics including the MMR and the survey developed in 2014, can help determine areas of high need. While these metrics are not perfect, in conjunction together they can provide a clearer picture of health care disparities in the United States and determine a way forward to decrease maternal death in African American women. Addressing this care outcome will change the health of individual women and families but also reach beyond to entire populations of women inside and outside of the United States. 3 References Kacmar, R. M., Mhyre, J. M., Scavone, B. M., Fuller, A. J., & Toledo, P. (2014). The use of postpartum hemorrhage protocols in United States academic obstetric anesthesia units. Anesthesia & Analgesia, 119(4), 906–910. https://doi.org/10.1213/ane.0000000000000399 Small, M. J., Allen, T. K., & Brown, H. L. (2017). Global disparities in maternal morbidity and mortality. Seminars in Perinatology, 41(5), 318–322. https://doi.org/10.1053/j.semperi.2017.04.009 World Health Organization. (2020). World health data platform/GHO/Indicator metadata registry list: Maternal mortality ratio (per 100 000 live births). https://www.who.int/data/gho/indicator-metadata-registry/imr-details/26 1 Introduction The clinical problem that requires immediate attention and action is postpartum hemorrhage, a preventable health issue that affects women around the world to varying degrees. While this issue is detrimental to women everywhere, in the United States it is especially concerning for African American women, who have a significant disparity in maternal morbidity and mortality rates (Small et al., 2017). While research has shown that protocol-driven care is associated with improved health outcomes, not many hospitals are implementing these protocols regularly (Kacmar et al., 2014). One clinical outcome that should be measured around this issue is maternal death in African American women in the United States. First Metric for Outcome Progress One of the most important metrics used to evaluate maternal death is the maternal mortality ratio (MMR). According to the World Health Organization (WHO), the MMR is “the number of maternal deaths during a given time period per 100,000 live births during the same time period” (World Health Organization [WHO], 2020). Maternal deaths are defined as any death related to or aggravated by pregnancy or childbirth or within 42 days after the end of the pregnancy (WHO, 2020). To measure the outcome of African American maternal deaths in the United States, the MMR is essential to tracking and understanding preventable causes of maternal death such as postpartum hemorrhage. The data for the MMR comes from a variety of sources, including vital registration systems and surveys (WHO, 2020). One strength of this data source is that it is a commonly used metric to easily compare maternal deaths across different settings, including different countries. However, there can be problems with data collection for the MMR, particularly related to underreporting and misclassification of maternal deaths (WHO, 2020). 2 Second Metric for Outcome Progress A different metric that should be used to evaluate maternal death of African American women related to postpartum hemorrhage is from a study in which they developed a survey titled “The Use of Postpartum Hemorrhage Protocols in United States Academic Obstetric Anesthesia Units” (Kacmar et al., 2014). This survey includes questions about hospital characteristics, availability of postpartum hemorrhage protocols or plans to develop a protocol soon (Kacmar et al., 2014). The source of data for this survey was from “104 directors of United States academic obstetric anesthesia units,” and their responses can help determine the percentage of hospitals that are implementing strategies to reduce maternal deaths (Kacmar et al., 2014). One strength of this metric is that it directly asks hospitals in the United States to evaluate their protocols in place, which determines the hospital settings that may be lacking and may require incentives to implement proper protocols to help decrease maternal mortality. However, one limitation to this metric is that the first survey did not receive a high response rate (only 58%), which severely impacts the data that can be collected and indicates there may be a response bias. Conclusion To best evaluate maternal death in African American women related to postpartum hemorrhage, metrics including the MMR and the survey developed in 2014, can help determine areas of high need. While these metrics are not perfect, in conjunction together they can provide a clearer picture of health care disparities in the United States and determine a way forward to decrease maternal death in African American women. Addressing this care outcome will change the health of individual women and families but also reach beyond to entire populations of women inside and outside of the United States. 3 References Kacmar, R. M., Mhyre, J. M., Scavone, B. M., Fuller, A. J., & Toledo, P. (2014). The use of postpartum hemorrhage protocols in United States academic obstetric anesthesia units. Anesthesia & Analgesia, 119(4), 906–910. https://doi.org/10.1213/ane.0000000000000399 Small, M. J., Allen, T. K., & Brown, H. L. (2017). Global disparities in maternal morbidity and mortality. Seminars in Perinatology, 41(5), 318–322. https://doi.org/10.1053/j.semperi.2017.04.009 World Health Organization. (2020). World health data platform/GHO/Indicator metadata registry list: Maternal mortality ratio (per 100 000 live births). https://www.who.int/data/gho/indicator-metadata-registry/imr-details/26 4 Clinical Outcomes: Metrics for Racial Bias towards African Americans regarding Pain Tolerance in Hospitals October 24th, 2021 5 When it comes to measuring racism within the healthcare system, there are a couple of methods that would be best. It is important to take into account all aspects of the job. It is also important to try to eliminate biases that may be found in the workplace.The outcome that should be measured to evaluate racism in regards to the prescription of opoids in hospitals is the type of instances that have occurred. For example, what the providers said, the color of the patient and the medication that perosn was described should be documented. Using metrics like quality measurement and performance measurements would allow the researchers to fully understand and grasp how racism is not only impacting the workforce, but also impacting the patients. Quality measurement is a very important metric because it can be a powerful motivator to help push system execution advancement. Quality measurement not only lets patients see the care that that one hospital has provided, but it also helps providers know where they could use some improvements. Quality indicators can be used for summative causes to increase the level of responsibility of hospitals as well as formative reasons which could help providers monitor and measure the provided levels of quality. Furthermore, it can help provide insights to why healthcare professionals think a certain way or why they prescribed a certain medication to a patient. (Hashji, et.al 2014). One type of quality measurement is surveys. They are a very good metric that can help researchers identify teamwork failures. It could help show the impact of hierarchical and cultural factors upon providers behavior. These surveys are beneficial because they can involve ratings of treatments and it can help pinpont weaknesses that fellow providers may see in others in regards to patient satisfaction, interpersonal and communication skills and team and culture safety. These surveys could also show where some healthcare providers were miseducated. One negative aspect of this measurement is that the implementation process of writing down what the 6 providers do regularly. Providers may want to lie about the care they are giving and they may not want to do the measurement all together just because of the risk of possibly being labeled as racist. (Kash, 2018) Another metric measurement can be video analysis. Video analysis is going through past video footage of a particular place in the hospital to monitor hospital staff. This would allow researchers and providers themselves to view current care and anlyze mental processes (Thought leadership, 2020). One positive to this type of measurement is that it would take out the biased answers or lies that could be given in a survey. One negative would be that the public may then get access to these videos and it could lead to some social challenges for the hospital. That one clinicians views could damage the publics view of the hospital as a hole. Futhermore, it could have been a mistake by the providers but the public will always take things out of context and this one mistake could ruin this providers career. Ultimately, using Quality metrics such as surveys or looking at video analysis would allow researchers to get a well-rounded view of whats actually happening in regards to patientprovider interactions. These metrics not only give a personal testimony of the treatment in hospitals, but they also provide factual data. This data could be graphed or even charted to see the myriad of racial instances in full view. This data will expose the current issues and will be a motivaitng factor for providers. Especially ones who do not know nor understand what they are doing to people of Color. The goal of this data is not to necessarily critisize those providers but to open their eyes so they can see that imporvements need to be made so that everyone who comes in for care feels treated equally. 7 References Aghaei Hashjin A, Ravaghi H, Kringos DS, et al. Using quality measures for quality improvement: the perspective of hospital staff. PLoS One. 2014;9(1):e86014. Published 2014 Jan 23. doi:10.1371/journal.pone.0086014 Brasher, C. (2020). Simple Guide to Measuring Your Healthcare Teams’ Performance. Blog.cortexhc.com. https://blog.cortexhc.com/simple-guide-to-measuring-your-healthcareteams-performance Kash BA, Cheon O, Halzack NM, Miller TR. Measuring Team Effectiveness in the Health Care Setting: An Inventory of Survey Tools. Health Serv Insights. 2018;11:1178632918796230. Published 2018 Aug 24. doi:10.1177/1178632918796230 1 Patient Wait Times and Understaffing Of Nurses Name Professor Course Date 2 Patient Wait Times and Understaffing Of Nurses Quality health care is the provision of effective, safe people-centered health services that increase the possibility of achieving desired health outcomes (WHO, 2021). The latest records indicate that there are currently 369 diseases, 286 causes of death and 87 factors of risks globally (GBD, 2019). Health centers have the most considerable burden for ensuring that they improve services to reduce the death rates globally. However, health facilities should handle core issues such as patient wait times and nurses' understaffing for health centers to achieve the desired aim. Patient Wait Times Patient wait times are important indicators in the determination of quality healthcare by various health facilities. Patient wait times can be defined as the time a patient spends before receiving any health services, ranging from consultation, admission, surgery, and even discharge. In most health facilities, long waiting times have been evident in most outpatient facilities and emergency departments. Healthcare Customer Relationship System (CRM) can now easily monitor patient wait times, which provides daily metrics for analysis (Prayitno and Astuty, 2017). (How do they monitor )The average waiting time in most emergency departments across various health facilities is one and a half hours for admission and two and a half hours for discharge. Some of the significant causes for long waiting times in most health facilities are slow check-ins, emergencies, understaffing and overscheduling, poorly trained staff, among many other factors. Health facilities can control most aspects. However, some are beyond human control, such as the emergence of covid-19, which caused an influx in most hospitals. However, the integration of healthcare CRMs in various health care facilities reduced patient wait time by 3 82% in most facilities and subsequently enhanced better hospital management and customer satisfaction (Prayitno and Astuty, 2017). (TALK ABOUT HOW THEY DID SO) Understaffing of Nurses Understaffing of nurses has been a significant concern in most healthcare facilities, affecting the overall patient quality of care. The most widely used metric to measure nurse staffing is the nurse-patient ratio. California State was the first to introduce a mandatory nursepatient balance which was 1:5 on average (Allen, 2018). Currently, nurses experience more workloads than any other time in history, with one nurse administering to more than 15 patients. Inadequate nurse supply, patient stay reduction and increased work demand are some of the causes for extreme workloads for nurses. Budget costs are the main reason for understaffing. (how did they find out? Did they look at overall budget cuts? And where were those cuts made to have an effect on the nurses) Overworked nurses often experience burnout which impairs their focus, eventually contributing to most medical errors. In the United States alone, medication errors rank sixth in the causes of death in American citizens (Salar et al., 2020). A case of a 71-year-old male who went into a coma as a result of the administration of the wrong injection due to a poorly marked syringe (Akkerman et al., 2020). The issue came from the pharmacy, but the nurses in charge could have noticed and salvaged the situation. Sadly this is the situation in most health centers whereby there is understaffing of nurses. Most nurses are usually not able to give it 100% job concentration, therefore, salvaging some hopeless situations. It is, therefore, necessary for health facilities to put up strategies that will ensure there is adequate staffing of nurses, which will eventually reduce medication errors and increase the life expectancy rates. ( what metric/ strategycould be used to ensure adequate nursing? How to apply those strategies in that setting? 4 Conclusion All health facilities need to adhere to suitable staffing for nurses and reduce the patient wait time to ensure quality health care. With current performance metrics such as the integration of health CRMs, ensuring customer satisfaction and management of workload becomes easy for any health facility. Despite providing quality health care, the initiatives would lead to reasonable customer satisfaction, and customer experiences increased mortality rate and suitable working environments for all health care facilities. 5 References Akkerman, R., Nguyen, T., Dekkers, A., & de Haas, J. (2020). Opiate Intoxication Caused by Epidural Infusion of Morphine: A Case Report of a Near-Fatal Medication Error. Pain Practice, 20(3), 321-324. https://doi.org/10.1111/papr.12837 Allen, M. (2018). Nurse to Patient Ratios Greater than 1: 5 and the Effects on Nurse Satisfaction and Retention (Doctoral dissertation, University of Mount Olive). Prayitno, E., & Astuty, N. A. (2017, November). Positive impact of Customer Relationship Management (CRM) implementation to improving the services of animal polyclinics customers. In 2017 International Conference on Sustainable Information Engineering and Technology (SIET) (pp. 246-250). IEEE. Salar, A., Kiani, F., & Rezaee, N. (2020). Preventing the medication errors in hospitals: A qualitative study. International Journal Of Africa Nursing Sciences, 13, 100235. https://doi.org/10.1016/j.ijans.2020.100235
Purchase answer to see full attachment