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TASK

Post your initial response to one of the two topics below

The ACA or the AHCA: Imperfect Solutions to Increasing Access to Health Care?

This week’s discussion focuses on the federal government’s role in protecting the public’s health using the ACA and current efforts to “repeal and replace” the ACA. Please note that the government’s role in protecting the public’s health did not begin with the ACA. In the late 1800s, Lilian Wald brought health care to the community. And in 1965, Congress passed bills authorizing Medicare and Medicaid. Since 1965, Congress has expanded government-sponsored health care to pregnant women and children.

Topic 1

• Compare the current provisions in the ACA with those in the failed first version of the AHCA. 
• Share your opinions about why the AHCA failed in the first attempt at passage.

APA format. MUST BE  1 SEPERATE RESPONSE TO EACH QUESTION. 1 paragraph per response. Use only scholar authors only. References needed

Discussion 1:

According to Spath (2018), FOCUS PDCA is a frequently used quality improvement model used to improve processes. This change model has two phases. The first phase, FOCUS, consists of finding a process needing improvement, organizing a team, clarifying the current process and areas needing change, understanding why improvement is needed, and selecting actions to adjust the process (Spath, 2018). The second phase, PDCA, includes planning through investigation, identification, and brainstorming ways to improve the measure, do or incorporate the process improvement on one unit, check the process to make sure changes are improving the measure, and acting to maintain improvements (Spath, 2018).  This model provides the structure through analysis, planning, outcomes, and feedback.

          FOCUS PDCA is a change model that can be used to decrease falls. Falls during toileting is one safety concern that needs improvement. The quality team, along with other care team members, were organized to clarify current practices and policies and noted care team members are not staying within arms-reach of patients that trigger high fall risk. It is imperative to keep an open line of communication between the team and frontline staff (Godlock, Christiansen, & Feider, 2016).  Understanding the policy deviations and brainstorm to select appropriate interventions to decrease falls during toileting. Interventions that need to be changed requires education to all care team members about the falls policy and how important it is to stay within arms-reach of patients that trigger high fall risk. Education also needs to be provided to CNA’s on certain medications that would make patients higher risk like blood pressure-lowering medications, and diuretics. These interventions will be rolled out to one unit to determine the efficacy of changes. These interventions need to be reviewed for improvement and modified if necessary. Once improvement has been met, it is crucial to maintain these improvements. Maintaining improvements can be accomplished through monthly quality improvement meetings.

Discussion 2:

I selected the quality improvement model of FOCUS-PDCA. This model is split up into two separate phases the FOCUS phase and the PDCA phase. F is for finding a problem that need improvement. Falls can be a detrimental occurrence than can affect patients and staff that is involved. Nursing times stated that as many as 20% of hospitalized patients experience a fall at some point during their stay (Grant, 2013).  Even though falls are not always preventable they can be decreased with proper staff and patient education. If one fall can be prevented by a changed policy that can be one less patient that avoids an extended hospitalization or additional injury. O if for organizing a team. The team I have selected for the improvement project is my nurse manager and mentor as well as some floor nurses from both shifts and our patient care techs. C is to clarify the current policy and changes that need to be made. Our current policy is a yellow falling star sign that can sometimes be confusing to patients and family members. U is for understanding the causes of variation. Variations from standard fall precautions could be patient confusion or patient noncompliance. Another variation could be that staff coming in to assist your patient may not be aware they are on fall precautions if the proper prevention measures are not in place. S is for selecting the actions needed to improve the process. There needs to be something more in depth for each patient not just something generic. In the next phase, P is for plan to change the process. In a study by Lipsett patients falls were decreased by color coded mobility cards being placed in each patient room depending on how they required assistance (Lipsett, 2019). This would be much easier to see and associate with then just a generic fall risk or no fall risk. D is to do the change on a small scale. We will pilot the fall risk mobility cards on our unit. We have a mix of post op, post-partum, and medical surgical patients. C for checking the data to determine its effectiveness. We will compare the falls for the next months after the implementation with the fall rate prior to implementation. Lastly is A to act to maintain the gains.  Randomly compliance should be monitored to make sure that falls risk mobility cards are being used. With this model we will put plans into place and follow up to make sure the best plan possible is put into place.

Assignment:

Healthcare Coverage Gap

The  ACA was meant to provide quality health care coverage for all yet a  coverage gap for some populations especially in states that oppose  Medicaid expansion. Based on what you have learned so far in this  course, create a PowerPoint presentation that addresses the coverage gap  problem, who is impacted by the coverage gap, the role the ACA plays in  the coverage gap, why the coverage gap should be closed, and solutions/  recommendations for closing the gap. Address the following in your  PowerPoint: 

• Select  one state opposed to Medicaid expansion and describe why. Then,  consider your own state. What are the benefits and drawbacks to Medicaid  expansion in your state?
• Define what the coverage gap is (problem/issue)
• Discuss how the coverage gap impact low income healthcare consumers population.
• What role does the ACA have in widening or closing the coverage gap?
• Why is it important to close the gap (implications for positive social change)?
• What  are some solutions to closing the coverage gap and how can healthcare  equity help close the gap? Include recommendations and/or solutions.

Your PowerPoint presentation should include/address:

• Title Slide (1 slide)
• Objectives Slide (1 slide)
• Medicaid expansion (1-2 slides)
• Coverage gap – define/problem/issue (1-2 slides)
• Coverage gap impact on low income healthcare consumers (2-3 slides)
• Role ACA has in widening or closing the coverage gap (1-2 slides)
• Close the gap (1-2 slides)
• Solutions to closing the coverage gap and how can healthcare equity help close the gap? (2-3 slides)
• Reference slide (1-2 slides).

Assignment Expectations

Length: 9-14 slides (in addition to the title slide and reference slides) 

Structure:  Include a title slide and reference slide in APA format.  These do not  count towards the minimum slide count for this assignment.  Your  presentation must include an objectives slide.  Be sure to fully explain  all slides in the Speaker Notes.

References:  Use the appropriate APA style in-text citations and references for all  resources utilized to answer the questions. A minimum of three (3)  scholarly sources are required for this assignment. 

Format: Save your assignment as a Microsoft PowerPoint document (.pptx) or a PDF document (.pdf). 

Case Study 1: Gastrointestinal Function

Constipation and its risk factors

Constipation occurs when bowel movements become less frequent and stools become difficult to pass. It happens most often due to changes on the diet, routine, or because the inadequate intake of fiber (Sumida et al., 2017). It is a common condition because almost every individual goes through it at some point in their lives. Though, it is not severe at some point, still causes discomfort to people because everyone feels better and relieved when their bowel movements are back on the right track. Some of the risk factors of developing constipation includes a change of diet. When a person changes abruptly from one diet to another, the body takes quite some time to adapt to new foods. This, therefore, causes constipation. Another risk factor is the lack of enough water in the body. Notably, the presence of dehydration makes the bowel movement much tougher, which is a clear symptom of constipation. Another risk factor is the tendency to reject the urge to poop. When an individual rejects the call to poop, it can result in the accumulation of stool in the body, and simultaneously causes constipation.

According with W. G. (2019), other risk factors we can also mention are:

• Being an older adult.
• Being a woman.
• Being dehydrated.
• Eating a diet that’s low in fiber.
• Getting little or no physical activity.
• Taking certain medications, including sedatives, opioid pain medications, some antidepressants or medications to lower blood pressure.
• Having a mental health condition such as depression or an eating disorder.

Recommendations that can be given to a patient who is suffering from constipation are:

• Include plenty of high-fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals and bran.
• Eat fewer foods with low amounts of fiber such as processed foods, and dairy and meat products.
• Drink plenty of fluids.
• Stay as active as possible and try to get regular exercise.
• Try to manage stress.
• Don’t ignore the urge to pass stool.
• Try to create a regular schedule for bowel movements, especially after a meal.
• Make sure children who begin to eat solid foods get plenty of fiber in their diets.

Symptoms of constipation present in H.R case study and those that are not present

Symptoms of constipation present in the H.R case study are; delay of bowel movements where she went a whole week with a single bowel. Another symptom is the presence of hard stool, which comes out with a lot of strain, it often takes her 10 minutes at a minimum to initiate a bowel movement, and she’s feeling bloated. Patient’s suffering from constipation usually have hard stools like in this case. There are some symptoms not present in this case study as of; the feeling of fullness even after having a bowel movement, presence of rectal blockage, incomplete stool emptiness from the rectum, while needing help doing so using your hands to press the abdomen  inserting a finger to remove the stool from the rectum (Hawkins, 2016).

Is there a possibility of anemia?

From the case presented by H.R., there is no proof of anemia because no single symptom is given that resembles those of anemia. But patients with constipation can develop anemia; how? due to the presence of anal or rectum fissures.  This condition is most commonly caused by constipation when passing hard stools. In addition, bleeding from the rectum is present and anal fissures may also cause pain during and immediately after bowel movement; symptoms the patient does not refers at this time (W. G., 2019).

Another way that the anemia could be present in the patient, but is not related to the constipation, it’s the fact that she is taking over the counter medications; like aluminum hydroxide tablets to help with the relieve of the heartburn. One of the effects of this medication is to decrease PH in the stomach, relieving heartburn, but if taken for long time periods could cause anemia due to a decrease in the absorption of vitamin B12 and iron (W. G., 2019). Hence, constipation appear to be present due to the aluminum ions causing the relaxation of the gastrointestinal track smoothing the muscle, which can postpone the gastric emptying and cause constipation.

Case Study 2: Endocrine Function

The race and ethnic group where diabetes mellitus is common and its symptoms in C.Bs case

There are 17 million Americans (5.9% of the population) who have diabetes mellitus (DM), with up to 6.4 million not yet diagnosed and almost 1 million new cases added yearly. Of these cases, 90% to 95% of the cases are type 2 diabetes. At every age group, African Americans have one of the highest incidences of diabetes in the United States, with over 20% of African Americans between 60 and 74 years old having the disease. Therefore, is most prevalent among Native Americans in the southeastern United States, with 27.8% of the population affected. On average, Native Americans, including Alaska Natives, are 2.2 times as likely to have diabetes as non-Hispanic whites of similar age (Bergenstal, 2017).

In the case of C.B, she has some symptoms which are comparable with diabetes mellitus type 2. Patient has a history of having high blood sugar levels three years ago with not follow-up; also, an elevated fasting blood sugar of 141 mg/dL (Fasting blood sugar test; If it’s 126 mg/dL or higher on two separate tests, you have diabetes). Another symptom she reported is the fact of been very thirsty lately and getting up more often at night than usual to urinate. She has gained weight and finally as a result of her uncontrolled diabetes, she has suffered of a multiple genitourinary infection.

How would C.Bs glycemic values be if she develops a bacterial pneumonia?

I will expect for glycemic values to be high. Infection in this case pneumonia; causes a stress response in the body by increasing the number of certain hormones such as cortisol and adrenaline. These hormones work against the action of insulin and, therefore the body’s production of glucose increases, resulting in high blood sugar levels. When the blood sugar is high, white cells are unable to “mop up” bacteria because they cannot move around at their normal speed, and do not reach the infection site quickly enough to engulf and kill the present bacteria (Pippitt et al., 2016). Hence, some of the reasons of an uncompensated diabetes is the infection. 

Initial therapy non-pharmacologic and pharmacologic

In my opinion the best initial non-pharmacological therapy could be:

• Dietary interventions: Nutritional interventions are important in achieving optimal glycemic control in patients with DM. Most patients with this condition become obese overweight and the weight loss achieved through dietary restriction of energy, helps them with the diabetes management. Blood glucose response to individual food items varies according to glycemic index (GI) and the glycemic load (GL) in the diet.
• Physical activity: This one improves insulin sensitivity, bodyweight, cardiovascular risk factors, physical fitness, lipid level, blood pressure and overall their wellbeing, reducing the risk of cardiovascular morbidity and mortality.
• Restorative sleep: Sleep deprivation and poor quality of sleep results in an altered metabolic and hormonal function, leading to the development of DM. People who sleep less than 6 hours per night are at risk of developing diabetes, therefore it is advised having at least 7 hours of uninterrupted sleep per night. Various mechanisms are described in the development of diabetes in people with sleep deprivation. During this stage brain glucose use is reduced, causing a hormonal deregulation, resulting overall in higher Growth Hormone (GH) levels and evening cortisol levels that may contribute to the development of DM (Pippitt et al., 2016).
• Diabetes education: Patients with newly diagnosed diabetes should participate in a comprehensive diabetes self-management education program, which includes individualized instruction on nutrition, physical activity, optimization of metabolic control, and prevention of complications.

            Pharmacologic therapy should be initiated along with consultation on lifestyle modifications, focusing on dietary changes and other lifestyle contributors to hyperglycemia. Weight loss and maintenance underpins are effective diabetes therapies that can reduce the risk of weight gain, associated with sulfonylureas and insulin.

 In the absence of specific contraindications, I will suggest metformin as an initial therapy; it can be given beginning with 500 mg a day with the evening meal and, if tolerated, add a second 500 mg dose at breakfast time. The dose can be increased slowly (one tablet every one to two weeks) as necessary reaching a total dose of 2000 mg per day. Metformin is the medication preferred as initial therapy, because of the glycemic efficacy, absence of weight gain and hypoglycemia, together with general tolerability, and the favorable cost (Pippitt et al., 2016).

References

Bergenstal RM, Gal RL, Connor CG, et al., (2017) Exchange Racial Differences Study Group. Racial differences in the relationship of glucose concentrations and hemoglobin A1c levels. Ann Intern Med; 167:95–102

Hawkins, A. T., Olariu, A. G., Savitt, L. R., Gingipally, S., Wakamatsu, M. M., Pulliam, S., … & Bordeianou, L. (2016). Impact of rising grades of internal rectal intussusception on fecal continence and symptoms of constipation. Diseases of the Colon & Rectum, 59(1), 54-61.

Marín-Peñalver, J. J., Martín-Timón, I., Sevillano-Collantes, C., & del Cañizo-Gómez, F. J. (2016). Update on the treatment of type 2 diabetes mellitus. World journal of diabetes, 7(17), 354.

Pippitt, K., Li, M., & Gurgle, H. E. (2016). Diabetes mellitus: screening and diagnosis. American family physician, 93(2), 103-109.

Sumida, K., Molnar, M. Z., Potukuchi, P. K., Thomas, F., Lu, J. L., Matsushita, K., … & Kovesdy, C. P. (2017). Constipation and incident CKD. Journal of the American Society of Nephrology, 28(4), 1248-1258.

1. G. (2019). Who Gets Constipation? What Are the Causes? What Is an Evidence-Based. Gastrointestinal Emergencies: Evidence-Based Answers to Key Clinical Questions, 185.

Statistical application and the interpretation of data is important in health care. Review the statistical concepts covered in this topic. In a 750-1,000 word paper, discuss the significance of statistical application in health care. Include the following:

1. Describe the application of statistics in health care. Specifically discuss its significance to quality, safety, health promotion, and leadership.
2. Consider your organization or specialty area and how you utilize statistical knowledge. Discuss how you obtain statistical data, how statistical knowledge is used in day-to-day operations and how you apply it or use it in decision making.

Three peer-reviewed, scholarly or professional references are required.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

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