NR 506 NP Week 3 Quality Healthcare-Measuring NP Performance

1 Quality Healthcare: Controlling Hypertension Amber Holliday Bryant Chamberlain University College of Nursing NR506NP: Healthcare Policy and Leadership Dr. Michelle Keating-Sibel March 22, 2020 2 Quality Healthcare ...

1 Quality Healthcare: Controlling Hypertension Amber Holliday Bryant Chamberlain University College of Nursing NR506NP: Healthcare Policy and Leadership Dr. Michelle Keating-Sibel March 22, 2020 2 Quality Healthcare: Controlling Hypertension Hypertension is known as the silent killer and often goes undetected. With the potential risk of causing kidney damage, myocardial infarction, congestive heart failure, or cerebrovascular accident, having an elevated blood pressure should not be taken lightly. Given the significance of managing adequate blood pressure levels, it is no surprise that the National Committee for Quality Assurance (NCQA) included controlling high blood pressure into the Healthcare Effectiveness Data and Information Set (HEDIS) under the effectiveness of care category (National Committee for Quality Assurance, 2020). By examining patient interventions for controlling high blood pressure and evaluating methods family nurse practitioners (FNP) can use to measure outcomes, one can begin to understand how these primary care interventions result in improved patient outcomes and cost savings for the practice, as well as result in improved patient ratings. Patient Interventions and Measuring Outcomes Patients play an important role in their health and must be conscientious of actions that can affect their overall wellbeing. Patient interventions are essential to improve the patient’s condition and are a necessary part of care. Hypertension affects one billion adults worldwide and 30% of adults in the United States (Liyanage-Don, Fung, Phillips, & Kronish, 2019). With such a staggering number of individuals affected by hypertension, patients must also do their part to improve their health. When a patient is working to control high blood pressure, patient interventions will be crucial to their success. Three patient interventions that would have a positive effect on controlling elevated blood pressure include home monitoring of the blood pressure and keeping a log, eating a heart-healthy diet, and increasing physical activity levels with exercise. 3 Home blood pressure monitoring and keeping a log allows the patient and the clinician to gain a better understanding of how the blood pressure readings are trending. It can show if the blood pressure is elevated at a certain time of the day or if the readings remain consistently high and would require medication interventions or a change in medication dosages. According to Liyanage-Don, Fung, Phillips, and Kronish (2019), home blood pressure readings are often more accurate than those taken at a medical office due to “white coat hypertension”. Anxiety from having to visit a medical office can temporarily raise an individual’s blood pressure and potentially result in them being prematurely put on blood pressure medication or having their medication dose adjusted without a need. Taking home blood pressure readings and keeping a log of said readings can allow providers to gain a better overall picture of the patient’s cardiovascular health. A heart-healthy diet is also an important factor in controlling elevated blood pressure and is an intervention that patients can actively engage in. According to Dinu, Pagliai, and Sofi (2017), the occurrence and mortality rate from cardiovascular disease can be avoided with proper dietary choices and simple lifestyle modifications. A heart-healthy diet is one that includes reduced calories, increased intake of fruits and vegetables, reduced consumption of fresh and processed meat, limited sodium and sugar intake, and increased consumption of omega-3 fatty acids (Dinu, Pagliai, & Sofi, 2017). While this diet can help aid in reducing hypertension, it can also help the individual maintain a healthy weight to decrease their risk of developing other health problems. Increasing activity levels and exercising is another intervention that patients can perform to ensure that they are aiding in lowering their elevated blood pressure. A study detailed by Kristanti and Prihartono (2019) found that patients who were obese were 1.84 times more likely 4 to develop hypertension compared to those who were not. Given that being overweight significantly increases the incidence of hypertension, increasing activity levels and exercising is crucial. It is recommended that individuals engage in moderate-intensity aerobic exercise for 30 minutes a day at least 5 days a week, but need clearance from their clinician before beginning to ensure the patient is healthy enough for exercise (Deka, Pozehl, Williams, & Yates, 2017). Patients need to be aware that it is not expected for them to be able to tolerate 30 minutes of moderate-intensity exercise right away. Most individuals have to gradually work their way up to that intensity and timeframe. Family nurse practitioners can measure the outcomes of these patient interventions by using certain tools. In the case of controlling high blood pressure, the most appropriate tools are self-reporting outcomes measurements and performance-based outcome measurements. Self- reporting outcomes are subjective data and rely on the progress the patient believes they are making. A patient involved in the heart-healthy diet plan will present subjective data to self- report their outcome. This would involve how the diet made them feel and if they thought they were successfully following the diet. The FNP can take the subjective data supplied by the patient and determine if the patient intervention appeared effective. On the other hand, daily blood pressure readings and activity endurance deal with objective data that can be measured. The family nurse practitioner can review the blood pressure log to determine if vitals have been satisfactory and could also have the patient engage in physical activity to see if the patient can tolerate it. If the patient is unable to tolerate the activity, it could be an indicator that the patient has not been exercising to control their high blood pressure. The FNP could also measure exercise endurance and vitals at the beginning when the intervention was implemented and then again at follow-ups to determine if the exercise program has improved heart health. Through the 5 use of self-reporting outcome measurements and performance-based outcome measurements, the FNP can gain a better understanding of how the patient interventions are affecting the patient’s health and if they are attempting to control their hypertension. Improved Patient Outcomes and Cost Savings for the Practice Patient interventions are a way of involving patients in their care, promoting compliance, and ensuring patients are knowledgeable about ways to manage their healthcare problems. Educating the patient on interventions to improve their outcomes will not only help them improve their current health but will aid in improving their health for years to come. Many clinicians, including family nurse practitioners, incorporate the Institute for H ealthcare Improvement Triple Aim framework into practice in an attempt to strive to improve the health of populations, enhance patient care experience, and reduce costs within the practice (Verma & Bhatia 2016). Patient interventions are a way to help achieve this. When patients are motivated to control their high blood pressure and are willing to monitor their blood pressure at home, eat a heart-healthy diet, and increase physical activity, they not only are working to impr ve their overall health but can also help the nurse practitioner save money within the practice. When patients are able to control high blood pressure, it eliminates unnecessary, unscheduled clinic visits, allowing the providers to focus on other patients. While one knows that more office visits equals more money, if patients are left sitting long wait times in the lobby to see a provider, they are more likely to seek medical attention elsewhere with shorter wait times. Losing patients to other clinics not only results in money loss for that clinic, but also can affect the patient’s health since they are not seeing their established primary care provider. When hypertension is controlled, it also saves the practice money in terms of insurance reimbursement versus services provided. If a patient keeps presenting to the clinic for elevated blood pressure, 6 insurance reimbursement is traditionally not as high as an initial visit. While the FNP may have to spend as much time with the patient for the follow-up visit as they would an initial visit, insurance reimbursement is not the same. Patient interventions can decrease the amount of follow-up visits needed and therefore help eliminate the risk of low reimbursements from insurance. Improved Patient Ratings While patient interventions have the ability to save money in practice, they can also improve patient ratings which can bring even more money into the clinic. Medicare and other insurance companies now choose reimbursement amounts based on patient ratings and satisfaction (Lindsay, 2017). While all providers should do their best to provide competent care, sometimes patients are still unsatisfied with the care they receive. This is an example of why patient interventions should be incorporated into care. There are times that provider interventions are not enough, and the patient must also aid in improving their condition through the use of patient interventions. Ultimately, patients just want to be treated for their ailment and live life as normally as possible while managing their condition. If FNPs and other clinicians can provide the patient with information and steps that can be taken at home to improve their condition, many patients are satisfied that the provider is trying to help. The satisfaction remains once the patient starts noticing an improvement in their condition resulting from changes they are making at home. Consistent blood pressure readings, a heart-healthy diet that could potentially lead to weight loss, and an increase in physical activity all contribute to a healthier lifestyle and make the patient feel as though they are part of their care. Both the benefits of the patient interventions and the fact that the patient is involved in their treatment plan can lead to improved satisfaction and patient 7 ratings. Improved patient ratings can then, in turn, bring in new patients who have heard positive feedback about the provider and/or clinic. Conclusion Hypertension is a problem for individuals throughout the world. With risks of kidney failure, myocardial infarction, cerebrovascular accident, and congestive heart failure, it has become evident as to why the NCQA has included controlling high blood pressure in the HEDIS. Interventions must be placed into patients’ daily lives to ensure that they can experience optimal outcomes. By examining three patient interventions for controlling high blood pressure, explaining how family nurse practitioners can measure the outcomes for the interventions, detailing how the patient interventions can save money in practice, and investigating how the overall outcome improves patient ratings, it becomes apparent that patient interventions to control hypertension are beneficial and essential to the health of our patients. With the help of FNPS and other providers, patients have the opportunity to positively influence their health and stop the silent killer in its tracks. 8 References Deka, P., Pozehl, B., Williams, M. A., & Yates, B. (2017). Adherence to recommended exercise guidelines in patients with heart failure. Heart Failure Reviews, 22(1), 41–53. Kristanti, D., & Prihartono, N. (2019). Obesity as a predictor of hypertension in adult population: A 14-years retrospective cohort study. Indian Journal of Public Health Research & Development, 10(6), 491–497. Lindsay, R. W. (2017). Linking reimbursement to patient satisfaction: Is the tail wagging the dog? JAMA Facial Plastic Surgery, 19(3), 173–174. Liyanage-Don, N., Fung, D., Phillips, E., & Kronish, I. M. (2019). Implementing home blood pressure monitoring into clinical practice. Current Hypertension Reports, 21(2), 14. National Committee for Quality Assurance. (2020). HEDIS measures. Retrieved from http://www.ncqa.org/hedis/measures/ Verma, A., & Bhatia, S. (2016). A policy framework for health systems to promote triple aim innovations. HealthCarePapers, 15(3), 9-23.