Assignment: Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
• Consider the best method of disseminating the results of your presentation to an audience. 

The Assignment: (Evidence-Based Project)

Part 4: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

HA4070D – Regulatory Environment in Health Care

Assignment 06: Appealing Decisions

 

Directions

Complete the questions below based on the problem identified. Your written response should be no less than two to three pages in length.

Problem: Mr. H. was a diabetic and had severe ulcers on his feet. He was a member of an HMO, and his primary care physician had prescribed a treatment regimen that was proving ineffective. In response, the primary care physician offered Mr. H. an amputation below the knee that was his only option. Mr. H. went out of plan to a local wound care center that specialized in diabetic wound treatment where he was advised that vein by-pass surgery would likely take care of his problem. The HMO denied such surgery because Mr. H. referred himself to the specialist without permission. The HMO advised Mr. H.’s family that its utilization review department was reviewing the case, but that it would take at least a month to review. Subsequently, the HMO agreed to approve such surgery, but only if done by Mr. H.’s current medical group, which did not have any physician who had ever performed vein by-pass surgery. Mr. H.’s family asked for him to be transferred to a primary care physician at the medical group that staffs the wound care center. The HMO responded that although they sometimes approve such requests, they would not do so in Mr. H.’s case and that they had already granted enough of his requests. They gave as their reason a provision in the plan documents that prevent referrals outside the plan’s network when the network’s physicians have the capability to perform the required procedure.

This problem is adapted from a real case history developed by the Center for Health Care Rights in California.

• What procedural remedies does the patient likely have under private insurance and under Medicare or Medicaid?

• Are they adequate?

Be sure to include the following based on the criteria below:

Student examines legal issues related to healthcare rationing and medical necessity.

Student identifies remedies the patient would have under private insurance and if they are adequate.

Student identifies remedies the patient would have under Medicare and if they are adequate.

Student identifies remedies the patient would have under Medicaid and if they are adequate.

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HA4070D – Regulatory Environment in Health Care

Discussion 06: Selecting a Plan

Base this discussion on the Problem on page 261 of your text labeled “Choosing Health Insurance”. Defend your plan selection with material from the text.

From what you have learned so far, which of the following insurance plans listed below do you personally prefer, assuming each one costs the same? Defend your choice (both your selection and rejections) with reasons drawn from these readings:

.Plan A: Covers the full range of medical care, subject to standard medical necessity or experimental exclusions, without any deductibles or copayments, but you must receive all care at an HMO clinic where doctors are paid a bonus for saving money.

.Plan B: Excludes mental health and preventative care, and the rest is subject to a $200 deductible and 20 percent copayment up to a maximum of $1,500 per year. Your choice of doctor, but all expensive treatments must be submitted for prior approval by the insurer to determine medical appropriateness.

.Plan C: Covers the full range of medical care, with no major exclusions and your choice of doctor, and no prior authorization requirement, but subject to a $3,000 deductible.

.Plan D: Coverage is defined in an approach similar to the Oregon plan, only using 5,000 specific categories of inclusion and exclusion taken from the latest practice guidelines based on medical research, as selected by a national panel of politically appointed experts. No other restrictions or financial limitations.

Base your discussion on material from the text and your own experience. Cite sources when necessary. Remember to write 150 words in complete sentences.

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A healthcare organization allows for mandatory overtime in the case of staffing shortages. You are the supervisor on shift and there is a staffing shortage for one RN for 4 hours into the next shift. There are five RNs currently working. What factors do you take into account in deciding which RN will be required to remain to cover the shift? 

word count 300 APA format references within 5 years.