Write a report on the application of population health improvement initiative outcomes to patient-centered care, based on information presented in an interactive multimedia scenario.

In this assessment, you have an opportunity to apply the tenets of evidence-based practice in both patient-centered care and population health improvement contexts. You will be challenged to think critically, evaluate what the evidence suggests is an appropriate approach to personalizing patient care, and determine what aspects of the approach could be applied to similar situations and patients.

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By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Apply evidence-based practice to plan patient-centered care.
  • Evaluate the outcomes of a population health improvement initiative.
  • Develop an approach to personalizing patient care that incorporates lessons learned from a population health improvement initiative.
• Competency 2: Apply evidence-based practice to design interventions to improve population health.
  • Propose a strategy for improving the outcomes of a population health improvement initiative, or for ensuring that all outcomes are being addressed, based on the best available evidence.
• Competency 3: Evaluate outcomes of evidence-based interventions.
  • Propose a framework for evaluating the outcomes of an approach to personalizing patient care and determining what aspects of the approach could be applied to similar situations and patients.
• Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision.
  • Justify the value and relevance of evidence used to support an approach to personalizing patient care.
• Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions.
  • Write clearly and logically, with correct grammar and mechanics.
  • Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

 Evidence-Based Practice

• Devine, D. A., Wenger, B., Krugman, M., Zwink, J. E., Shiskowsky, K., Hagman, J., . . . Reeves, C. (2015). Part 1: Evidence-based facility design using transforming care at the bedside principles [PDF]. JONA: The Journal of Nursing Administration, 45(2), 74–83.
• Jeffs, L., Beswick, S., Lo, J., Campbell, H., Ferris, E., & Sidani, S. (2013). Defining what evidence is, linking it to patient outcomes, and making it relevant to practice: Insight from clinical nurses. Applied Nursing Research, 26(3), 105–109.
• Krugman, M., Sanders, C., & Kinney, L. J. (2015). Part 2: Evaluation and outcomes of an evidence-based facility design project. JONA: The Journal of Nursing Administration, 45(2), 84–92.
• Rice, M. J. (2013). Evidence-based practice: A model for clinical application. Journal of the American Psychiatric Nurses Association, 19(4), 217–221.
• Evidence-Based Practice in Nursing & Health Sciences: Review Levels of Evidence.
• Evidence-Based Practice in Nursing & Health Sciences.
• Research Guides
• Nursing Masters (MSN) Research Guide.
• Database Guide: Ovid Nursing Full Text PLUS.
• Kaplan, L. (n.d.). Framework for how to read and critique a research study. Retrieved from https://www.nursingworld.org/~4afdfd/globalassets/practiceandpolicy/innovation–evidence/framework-for-how-to-read-and-critique-a-research-study.pdf
• Assessment InstructionsPreparation
  In this assessment, you will base your Patient-Centered Care Report on the scenario presented in the Evidence-Based Health Evaluation and Application media piece. Some of the writing you completed and exported from the media piece should serve as pre-writing for this assessment and inform the final draft of your report. Even though the media piece presented only one type of care setting, you can extrapolate individualized care decisions, based on population health improvement initiative outcomes, to other settings.
  Requirements
  Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance level descriptions for each criterion to see how your work will be assessed.
  Writing, Supporting Evidence, and APA Style
  • Write clearly and logically, using correct grammar and mechanics.
  • Integrate relevant evidence from 3–5 current scholarly or professional sources to support your evaluation, recommendations, and plans.
    • Apply correct APA formatting to all in-text citations and references.
    • Attach a reference list to your report.
  • Report Content
    Address the following points in a 4–6 page report:
  • Evaluate the expected outcomes of the population health improvement initiative that were, and were not, achieved.
    • Describe the outcomes that were achieved, their positive effects on the community’s health, and any variance across demographic groups.
    • Describe the outcomes that were not achieved, the extent to which they fell short of expectations, and any variance across demographic groups.
    • Identify the factors (for example: institutional, community, environmental, resources, communication) that may have contributed to any achievement shortfalls.
  • Propose a strategy for improving the outcomes of the population health improvement initiative, or ensuring that all outcomes are being addressed, based on the best available evidence.
    • Describe the corrective measures you would take to address the factors that may have contributed to achievement shortfalls.
    • Cite the evidence (from similar projects, research, or professional organization resources) that supports the corrective measures you are proposing.
    • Explain how the evidence illustrates the likelihood of improved outcomes if your proposed strategy is enacted
  • Develop an approach to personalizing patient care that incorporates lessons learned from the population health improvement initiative outcomes.
    • Explain how the outcomes and lessons learned informed the decisions you made in your approach for personalizing care for the patient with a health condition related to the population health concern addressed in the improvement initiative.
    • Ensure that your approach to personalizing care for the individual patient addresses the patient’s:
      • Individual health needs.
      • Economic and environmental realities.
      • Culture and family.
    • Incorporate the best available evidence (from both the population health improvement initiative and other relevant sources) to inform your approach and actions you intend to take.
  • Justify the value and relevance of evidence you used to support your approach to personalizing care for your patient.
    • Explain why your evidence is valuable and relevant to your patient’s case.
    • Explain why each piece of evidence is appropriate for both the health issue you are trying to correct and for the unique situation of your patient and their family.
  • Propose a framework for evaluating the outcomes of your approach to personalizing patient care.
    • Ensure that your framework includes measurable criteria that are relevant to your desired outcomes.
    • Explain why the criteria are appropriate and useful measures of success.
    • Identify the specific aspects of your approach that are most likely to be transferable to other individual cases.
  • Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.

Has to be based on the scenario below:

Introduction

Public health improvement initiatives (PHII) provide invaluable data for patient–centered care, but their research is often conducted in a context different from the needs of any individual patient. Providers must make a conscious effort to apply their findings to specific patients’ care.

In this activity, you will learn about a PHII, and explore its application to a particular patient’s care plan.

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Overview

You continue in your role as a nurse at the Uptown Wellness Clinic. You receive an email from the charge nurse, Janie Poole. Click the button to read it.

Good morning!

At last week’s conference I spoke with Alicia Balewa, Director of Safe Headspace. They’re a relatively new nonprofit working on improving outcomes for TBI patients, and I immediately thought of Mr. Nowak. At his last biannual cholesterol screening he mentioned having trouble with his balance. This may be related to his hypertension, but he believes it’s related to the time he was hospitalized many years ago after falling out of a tree, and expressed distress that this might be the beginning of a rapid decline.

Ms. Balewa will be on premises next week, and I’d like to set aside some time for you to talk.

— Janie

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Alicia Balewa

Director of Safe Headspace

Overview

Interview Alicia Balewa to find out more about a public health improvement initiative that might apply to Mr. Nowak’s care.

Interview:

I have a patient who might benefit from some of the interventions for TBI and PTSD you recently studied. What populations did your public health improvement initiative study?

My father came home from Vietnam with a kaleidoscope of mental health problems. That was the 1970s, when treatment options for things like PTSD, TBI, and even depression were very different. Since then there has been a lot of investment in treatment and recovery for combat veterans. That’s excellent news for veterans in treatment now, but they’re not looking at my dad, and how his TBI and PTSD have affected him through mid–life and now as a senior. That’s why I started Safe Headspace: to focus on older patients who are years or decades past their trauma, and find ways to help them.

Which treatments showed the strongest improvement?

Exercise. We were able to persuade about half of our participants — that’s around 400 people, mostly men ages 45–80 — to follow the CDC’s recommendations for moderate aerobic exercise. Almost everyone showed improvement in mood, memory, and muscle control after four weeks. After that a lot of participants dropped out, which is disappointing. But of the 75 who stuck with it for another three months, muscle control improved 15%, mood improved 22%, and short–to–medium term memory improved 61%. We didn’t specify what kind of exercise, but we did ask them to record what they did every week, so that data is available.

Second was medication and therapy. Most of our participants didn’t receive any kind of psychotherapy in the years immediately following their trauma, so we had everyone assessed by a team of psychotherapists. As a result of those assessments, 40% of participants started on anti–depressant medication and 9% started taking anti–psychotics. Those who started taking medications now have regular contact with a therapist to manage that care. With some help at home to stick to the regimen, all but a few have successfully followed their treatment plans. They’ve reported a 26% improvement in mood over six months, and a 6% improvement in memory.

The third treatment I want to mention is meditation. We only had a small group interested in trying it, but the results were dramatic. We prescribed daily meditation at home, just 10 to 15 minutes, with a weekly hour–long guided group meditation for all 23 participants. After three weeks we lost two to disinterest, but the other 21 showed improvements of over 70% in mood and memory, and 32% in muscle control.

Have you tried anything that hasn’t worked?

Sure. There are memory exercises for patients in elderly care, and things like Sudoku and crossword puzzles. We didn’t see any gains with those. Some of our participants preferred strength training to aerobic exercise, and the only improvement we saw in that group was in muscle control, but only 4%, which is significantly less than the aerobic group.

I should also say that we were working with a willing group of participants. They knew they needed help, and were motivated to get it. One of the hurdles we see with veterans, especially in older generations, is an unwillingness to acknowledge that they have a problem. We haven’t had to wrestle with that because everyone who volunteers to participate wants to be there.

Your organization is intervening with people who have TBI and PTSD simultaneously. We have a patient with moderate TBI suffered almost 40 years ago, but no history of PTSD. Have you separated your population and studied each separately?

We haven’t, no. In some cases we could, for those who come in with previous diagnoses and medical records. But we have participants who either weren’t diagnosed, were under–diagnosed at the time, or don’t have records to show us.

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Conclusion

As you’ve seen, a PHII can apply to a patient under your care. But it’s not always a perfect fit, and it’s important to think carefully about how your patient’s condition, symptoms, background, and experience compare to that of participants in a PHII.