NR 506 Quality Healthcare week 3 : Measuring NP Performance CASE STUDY | GRADED A

Quality Healthcare: Measuring NP Performance Chamberlain University: Family Nurse Practitioner Track NR506NP Healthcare Policy and Leadership QU ...

Quality Healthcare: Measuring NP Performance Chamberlain University: Family Nurse Practitioner Track NR506NP Healthcare Policy and Leadership QUALITY HEALTHCARE: MEASURING NP PERFORMANCE The National Committee for Quality Assurance (NCQA) was formed in 1990 with the goal of improving the quality of health care for millions of people (National Committee for Quality Assurance, 2020). The NCQA created HEDIS, a performance measurement tool, used by health insurance plans, to improve patient care and improve overall health (National Committee for Quality Assurance, 2020). HEDIS focuses on measures that can make a meaningful difference in patient’s lives (National Committee for Quality Assurance, 2020). One in eight women will be diagnosed with breast cancer during their lifetime and it is the second most common cancer among women (Susan G. Komen, 2020). The CDC recommends yearly or bi- annual mammography for patients between the age of 50-74 (Centers for Disease Control and Prevention, 2020). One HEDIS measure assesses the percentage of women within this age range who have had their recommended bi-annual mammogram (National Committee for Quality Assurance, 2020). The Nurse Practitioner as the primary care provider has an integral role in breast cancer prevention, detection, and treatment. In many cases, a patient’s primary care provider is the first to address concerns for cancer, including symptoms and risk assessment. In addition, the primary provider will continue to coordinate care with the breast cancer patient throughout their treatment, recovery, and beyond. In one year, there is an estimated 268,600 new cases of female breast cancer and 41,760 deaths attributed to breast cancer (Centers for Disease Control and Prevention, 2020). One of the greatest indicators for breast cancer survival is early detection (Centers for Disease Control and Prevention, 2020). Mammography is the only test shown to reduce breast cancer deaths due to their ability to detect cancer in early stages (National Cancer Institute, 2020). Following recommendations for mammography studies, can lead to better patient outcomes and increased chance of survival, as well as lower healthcare costs which lead to a successful practice (Susan G. Komen, 2020). As a primary care NP, implementing strategies to increase compliance with biannual mammography studies, is key to improving patient care while increasing the survival rate of breast cancer. Patient Interventions Intervention One: Patient Reminders One strategy to increase the number of patients getting their biannual mammogram is through patient reminders. A quality improvement project on breast cancer and mammography compliance in a primary care clinic, found that patients who were reminded of their need for a mammogram by phone, letters, and in-person care, were more likely to follow through with their tests (Kemper, 2019). By utilizing different ways to communicate with patients, the likelihood of getting vital information to them and stressing the importance of the information is reassured. Patients who are due to have a mammogram within 6 months charts could be flagged. Many electronic health record software’s have tools that can create patient reminders as well. This running list of patients allows the NP and other staff members to monitor which patients to contact. Data about how the patient was reminded, how many times the patient was reminded, and if they followed through with their mammogram or not can be collected and analyzed to see if the intervention was successful in increasing compliance with mammograms. Intervention Two: Mobile Mammography Units Another strategy to improving rates of mammography is through the use of a mobile mammography unit. Not only would mobile mammogram vans benefit the patients of the practice, but it could also influence the community as a whole. Mobile programs can reach urban and rural areas of the country where access to healthcare or resources may be limited. A mobile program can also serve as a reminder and way to educate the community in the importance of biannual mammograms and early detection. A study by Stanely et al., “The Effectiveness of a Mobile Mammography Program”, found that mobile mammogram vans increased screening rates and follow-up rates among underserved populations (Stanely et al., 2017). Another study by Hardesty et al., explains that mobile programs increase compliance by minimizing travel time to clinics and increasing convenience (Hardesty et al., n.d.). The mobile clinic could be stationed at the primary care office or could travel throughout the community. Working with local and state outreach programs, the mobile clinics hours, future locations, and amenities can be advertised to ensure the greatest number of people are reached. Data would be collected and organized to decipher if the program is successful in increasing mammogram compliance. It would be important to record several important pieces of data. This includes, the patients age, when their last mammogram was, where the mobile clinic was stationed, and if cancer was detected. Other data could include if the patient had an appointment or walked in. Analyzing the percentage of patients who chose to utilize the mobile unit versus the inpatient services can determine if the mobile vans are useful in increasing compliance with tests. In addition to this data, a post screening satisfaction survey can be provided to the patients to assess their experience. In the study titled “Improving Compliance with Screening Mammography Guidelines in an Insured Population by Initiating a Mobile Mammography Program to Increase Access in a Metropolitan Area”, by Hardesty et al., a satisfaction survey filled out by participants of their mobile program showed high levels of satisfaction of care (Hardesty et al., n.d.). Furthermore, the survey’s revealed many patients were inspired to get their biannual mammogram due to the ease of the mobile unit who may have not gotten screened otherwise (Hardesty et al., n.d.). Surveys are a great tool when reflecting on ways to improve care. Patient perspectives are extremely valuable to quality improvement. Intervention Three: Patient Education The third strategy to improve patient compliance with routine mammograms would be through patient education. This can be done through multimedia, pamphlets, and direct patient interaction. A study published in the Journal of Cancer Education concluded that the use of multimedia education improved patient satisfaction and lead to more positive treatment experiences (Dawdy et al., 2018). The practice waiting area can be the perfect opportunity to begin educating patients. A TV in the clinic waiting area can provide multimedia material on several topics, including the importance of mammography and early detection. Pamphlets have been utilized by healthcare providers and clinics for years. Educational pamphlets have been proven to be valuable tools in improving patient knowledge time and time again (Donald et al., 2018). In addition, patients have expressed that written educational materials are appreciated and helpful (Sajjad et al., 2016). Pre-printed handouts can be readily available to patients in the waiting area or in the patient rooms. Handouts can not only provide patients with new information, but they can also reinforce topics that are discussed during visits. Direct patient education can be one of the most useful educational tools. Through every direct patient interaction there is an opportunity for patient education (Marcus, 2014). A literature review by, Cara Marcus, shows that a large majority of patients report that they receive the most valuable and effective education through direct verbal interactions with their provider (Marcus, 2014). In order to determine if the patient education was successful a patient survey can be conducted. Patients will report how they rate the educational material, which material they were exposed to, if they felt it was helpful, and if they followed through with their mammogram. Education through multiple avenues has proven to be most effective in improving patient knowledge and compliance in treatment (Dawdy et al., 2018). Improved Patient Outcomes Each of these intervention strategies can improve patient outcomes and lead to larger compliance with routine mammograms. Patient reminders, mobile mammography units, and patient education are proven methods of increasing a patient’s adherence with the CDC recommendations for biannual mammograms after the age of 50 (Centers for Disease Control and Prevention, 2020). Cost Savings The total annual medical cost of breast cancer care tops 16.5 billion dollars (Kaiser Family Foundation, 2019). Widespread use of mammography has improved breast cancer prognosis (Kaiser Family Foundation, 2019). More than 96% of women diagnosed with breast cancer by mammogram survive, while only 86% not diagnosed by mammogram survive (Maiz et al., 2020). Recommended mammography usage has also contributed to sustaining a 1%-2% increase in breast cancer survival yearly over the last 30 years in developed countries (Maiz et al., 2020). Mammography screening costs when compared to the cost of a cancer diagnosis in later stages without routine mammogram, have been proven to be more cost effective (Özmen et al., 2017). When cancer is found in early stages more treatment options may be available and the treatment length may be shorter leaving the patient to incur less costs (Özmen et al., 2017). Patient Ratings These intervention methods can also strengthen the patient-provider relationship. Taking the time to educate patients throughout each visit builds trust and results in positive interactions (Paterick et al., 2017). Additionally, individualized approaches to education, access to care, and care reminders can also lead to collaboration between provider and patient which is shown to further improve patient compliance and outcomes (Paterick et al., 2017). Better relationships with patients lead to increased trust, which ultimately will result in improved Nurse Practitioner ratings. Conclusion Mammography has been shown to dramatically improve early detection rates while aiding in improving overall breast cancer survival rates (Susan G. Komen, 2020). Strategies to improve patient compliance with CDC recommendations for biannual mammography include patient reminders, mobile mammography units, and patient education. These interventions can lead to earlier detection rates in patients, decreased mortality, and lower costs. In addition, through implementation of these interventions a more trusting provider-patient relationship can develop which can lead to further compliance and improved patient health outcomes. References Centers for Disease Control and Prevention. (2020, September 29). Cost-effectiveness of breast cancer Interventions. CDC. https://www.cdc.gov/chronicdisease/programs- impact/pop/breast-cancer.htm Dawdy, K., Bonin, K., Russell, S., Ryzynski, A., Harth, T., Townsend, C., Liu, S., Chu, W., Cheung, P., Chung, H., Morton, G., Vesprini, D., Loblaw, A., Cao, X., & Szumacher, E. (2018). Developing and evaluating multimedia patient education tools to better prepare prostate-cancer patients for radiotherapy treatment (randomized study). Journal of Cancer Education. 33. 551–556. https://doi.org/10.1007/s13187-016-1091-5 Donald, R., Arays, R., Elliott, J., & Jordan, K. (2018). The effect of an educational pamphlet on patient knowledge of and intention to discuss screening for obstructive sleep apnea in the acute ischemic stroke population. Journal of Neuroscience and Nursing. 50(3). 177-181. https://10.1097/JNN.0000000000000361 Hardesty, L., Glueck, J., Lind, K., Lambert, J., & Knapp, D. (n.d.) Improving compliance with screening mammography guidelines in an insured population by initiating a mobile mammography program to increase access in a metropolitan area. Radiological Society of North America. https://www.rsna.org/uploadedFiles/RSNA/Content/Science/Quality/Storyboards/2014/H ardesty-QSE116.pdf Kaiser Family Foundation. (2019, September 28). Coverage of breast cancer screening and prevention services. KFF.org. https://www.kff.org/womens-health-policy/fact- sheet/coverage-of-breast-cancer-screening-and-prevention-services/ Kemper, M. (2019). Improving mammography adherence in the primary care setting. Capstones & Scholarly Projects. 59. https://digscholarship.unco.edu/capstones/59 Maiz, C., Silva, F., Dominguez, F., Galindo, H., Camus, M., Leon, A., Oddo, D., Villarroel, J., Razmiic, D., Navarro, M., Medina, L., Merino, T., Vines, E., Pena, J., Maldonado, D., Pinto, M., Acevedo, F., & Sanchez, C. (2020). Mammography correlates to better survival rates in breast cancer patients: a 20-year experience in a University health institution. E Cancer Medical Science. 14(1005), 17. https://10.3332/ecancer.2020.1005 Marcus, C. (2014). Strategies for improving the quality of verbal patient and family education: a review of the literature and creation of the EDUCATE model. Health Psychology and Behavioral Medicine, 2(1). 482–495. https://doi.org/10.1080/21642850.2014.900450 National Cancer Institute. (2020, March). Breast Cancer Screening. https://progressreport.cancer.gov/detection/breast_cancer#field_most_recent_ estimates National Committee for Quality Assurance. (2020, July 22). Breast cancer screening. NCQA. https://www.ncqa.org/hedis/measures/breast-cancer-screening/ Özmen, V., Gürdal, Ö., Cabioğlu, N., Özcinar, B., Özaydın, A., Kayhan, A., Arıbal, E., Sahin, C., Saip, P., & Alagöz, O. (2017). Cost-effectiveness of breast cancer screening in Turkey, a developing country: results from Bahçeşehir mammography screening project. European Journal of Breast Health, 13(3). 117–122. https://doi.org/10.5152/ejbh.2017.3528 Paterick, T., Patel, N., Tajik, J., & Chandrasekaran, K. (2017). Improving health outcomes through patient education and partnerships with patients. Baylor University Medical Center Proceedings. 30(1).112-113. https://10.1080/08998280.2017.11929552 Sajjad, S., Asho, A., Gul, R., Mateen, A., & Rozi, S. (2016). The effect of individualized patient education, along with emotional support, on the quality of life of breast cancer patients - A pilot study. European Journal of Oncology Nursing. 21. 75-82. https://doi.org/10.1016/j.ejon.2016.01.006 Stanley, E., Lewis, M., Irshad, A., Ackerman, S., Collins, H., Pavic, D., & Leddy, R. (2017). Effectiveness of a mobile mammography program. American Journal of Roentgenology, 209(6), 1426- 1429. https://doi.org/10.2214/AJR.16.17670 Susan G. Komen. (2020, December). Mammograms - What you should know. https://www.komen.org/breast-cancer/screening/mammography/