NHS FPX 6004 Assessment 2 Policy Proposal

Student Name

Capella University

NHS-FPX 6004 Health Care Law and Policy

Prof. Name

Date

Policy Proposal

A healthcare setting is a dynamic setting where ups and downs are common. Finding and addressing performance shortfalls helps ensure patients deliver high-quality care, consistently promoting patient safety. This paper is a policy proposal and practice guidelines to improve performance benchmarks identified in previous assessments for Mercy Medical Center (MMC). The shortfalls were identified in the declining rate of HgbA1c level and foot exam for efficient diabetes management. 

Addressing Shortfalls: Creating Policy & Practice Guidelines

The benchmarks are set for HgbA1c and foot exams by various local and federal healthcare agencies, notably the American Diabetes Association (ADA), Centers for Medicare & Medicaid Services (CMS), and the National Healthcare Quality and Disparities Report (NHQDR) (ADA, 2019; CMS, 2023). It states that a foot exam is once a year, and an HgbA1c level test is at least twice yearly. These benchmarks are aligned with the federal health goal of enhancing patient health outcomes and reducing diabetes-related complications in the country (ADA, 2019). 

However, the data from the MMC dashboard in the previous assessment demonstrated a notable benchmark shortfall in both HgbA1c and foot exams. For instance, fluctuations in all four Quarters (Q) of 2019 and 2020 are visible in both factors (HgbA1c and foot). The HgbA1c test rate declined from 78(Q3) to 64(Q4) in 2020. Similarly, the foot exam rate also shows fluctuations in all four quarters but a concerning decline from (Q1)70 to (Q3) 48 in 2020. The uneven trend highlights the underperformance, encouraging addressing these to improve and enhance diabetes management at MMC. 

The underperformance compared to local, state, or national set benchmarks seriously impacts patient health outcomes and the standard of care at MMC. The impact of missed diagnosis of high HgbA1c in diabetes patients can lead to neuropathy and nephropathy (Eyth & Naik, 2023). Damaged nerves due to high blood glucose level tingling, numbness, and pain, while damage to heart vessels risking heart attack and stroke. The impact on the kidney can also lead to its diminished functioning in filtering waste from the blood. To avoid such implications, regular monitoring is essential.

NHS FPX 6004 Assessment 2 Policy Proposal

Similarly, missed diagnosis of foot exams in diabetic patients can cause an escalation in food injuries by slowing the healing process; it can also cause nerve damage and ulcers, which need to be prevented by regular monitoring (Song & Chambers, 2021). The organization is also under the impact of underperformance in a legal, financial, and competitive manner. The increased complications in diabetic patients due to high blood glucose levels or foot complications increase the economic burden of providing care. For instance, $1096.21 was spent on each patient in 2017-2020 to treat diabetes (Birinci & Simten Malhan, 2023). MMC can also suffer from legal penalties due to non-compliance with national standards of diabetes prevention and management. The organization damages its reputation in the community due to poor quality of care and risks losing a competitive advantage in the health industry (Tomic et al., 2022). 

Various studies align with the conclusions mentioned above. For instance, Song & Chambers (2021) state the role of regular foot exams in preventing lower limbs. Casadei et al. (2021) also mention that controlled HgbA1c levels help manage diabetes and avoid complications. This research aligns with the proposed measures for enhanced patient outcomes at MMC for implementing policies and practice guidelines in managing diabetes. 

Proposed Organizational Policy and Practice Guidelines

Reputable agencies like ADA, CMS, and NHQDR set benchmarks to address underperformance in MMC’s HgbA1c level and foot exams. Following are proposed policies to enhance diabetes patient health outcomes by emphasizing factors:

• HgbA1c test at least twice a year is required for monitoring blood glucose levels, which is crucial for diabetes management. The policy aligns with CMS to enhance diabetes management and prevent complications in diabetes patients (CMS, 2023).
• A foot exam once a year is necessary to avoid amputation and to improve the wound-healing process. Diagnosing and preventing foot-related complications is possible with one comprehensive text in a year, aligning it with ADA guidelines (ADA, 2019). 

Proposed Practice Guidelines

1. A personalized diabetic plan is essential for managing glucose levels and foot health effectively. Healthcare professionals can set patient scheduling techniques to develop a personalized plan that includes lifestyle modification and medicine adherence guidelines for effective patient outcomes (Sugandh et al., 2023).  
2. Staff training on comprehensive foot exams and regular HgbA1c level tests is essential to manage diabetes. This training includes educating patients and enhancing skills and knowledge to diagnose and treat diabetes-related issues and prevent complications. Training on sensory assessment, vascular evaluation, and skin inspection for early diagnosis of abnormalities (Memon et al., 2021). 
3. Educating patients is on self-management of blood glucose levels through dietary and physical modifications. It should highlight the importance of annual and bi-annual examinations of blood glucose levels and foot conditions. Appropriate footwear, self-inspection, and hygiene practices for foot health should be integrated into education plans through visuals and text on a pamphlet to help increase awareness (Ahmad & Joshi, 2023).

The proposed policies align with standardized protocols and benchmarks set forth by ADA, CMS, and NHDQR, highlighting at least annual and bi-annual examinations of foot and blood glucose levels in high-quality diabetes care (ADA, 2019; CMS, 2023). The guidelines keep the audience in mind: healthcare professionals, administration personnel at MMC, and most importantly, patients. Healthcare professionals help diagnose, prescribe, and develop personalized care plans. Administration plays a role in policy implementation by analyzing logistics and patients benefiting from these policies. 

Environmental Factors and Regulatory Considerations

To successfully implement policies and suggested guidelines at MMC for diabetes management and enhance care quality standards, it is necessary to stay updated with regulatory changes. The current policies are the basis for the proposed policies suggested by the ADA, CMS, and NHDQR to prevent diabetes-related complications (ADA, 2019; CMS, 2023). These institutions change policies with changing trends in the community, for instance, demographics or disease prevalence. MMC must stay up-to-date with the regulatory policies to save itself from legal or ethical repercussions due to non-compliance with diabetes standards.

The staffing level also impacts the implementation of policies and suggested guidelines. Low staffing levels will create burnout, misdiagnosis, and medication errors while conducting HgbA1c and foot (Thorsen et al., 2020). So, it is essential to implement adequate staffing levels at MMC to manage diabetes effectively. Lastly, financial factors are another factor that can hinder policy implementation or guidelines. Resource allocation for recruiting new staff, training, education, and conducting tests requires monetary funds (Birinci & Simten Malhan, 2023).   

Specific solutions should be considered to address these potential issues in successful implementation. Administration can help in priority setting, while effective resource allocation and logistical aspects like scheduling and maintaining records can be beneficial (Seixas et al., 2021). The financial budget for MMC recruitment, training, and educational programs should be provided. A support system should be developed for patients to manage follow-ups and educational aspects for long-term improved health outcomes and patient empowerment to self-manage diabetes-related factors (Lowden, 2021). 

Ethical, Evidence-Based Practice: Strategies from Literature

The literature provides evidence to conduct regular blood glucose and foot exams for timely intervention. It allows for early diagnosis and prevents any irreversible damage to diabetic patients. World Health Organization (WHO) emphasizes that the prevalence of diabetes and its related complications can be avoided through early diagnosis, and it can be done in primary care settings (WHO, 2023). It also highlights regular blood glucose testing to prevent complications in diabetic patients.

All proposed policies and guidelines are to abide by CMS, ADA, and NHQDR standards. MMC can enhance the quality of care and abide by legal and ethical regulations through training and education. Training for primary healthcare providers like physicians, nurses, and allied health staff for diabetes tests. The impact of training on healthcare staff will upskill their practices through learning and improvement. It will enhance the productivity of staff and patient satisfaction as well. Patient-centered care plans for diabetes patients and education to self-manage symptoms allow for autonomous, beneficiary, and maleficence ethical principles (Asadi et al., 2023).

The training provides for practices that are applicable to diverse populations coming to MMC for diabetes treatment; it aligns with the justice principle of ethics through multi-language or simple language to educate patients effectively (Asadi et al., 2023). Consequently, aligning with evidence-based ethical standards will enhance patient health outcomes, maintain a positive reputation of MMC in the health community, and benefit financially. 

Stakeholder Involvement in Policy and Practice Guidelines

Stakeholders’ involvement is crucial for implementing suggested policies and guidelines at MMC. Different stakeholders play different parts in successful implementation. Three stakeholders are significant in implementation: healthcare providers, administrators, and patients. Healthcare providers are responsible for everyday diagnosis, and nurses assist in conducting tests or guiding patients regarding their personalized plans for diabetes management (Nurchis et al., 2022).

Administration sets priorities and smooth operations (Seixas et al., 2021). They can help implement policies seamlessly through careful modifications in operation like resource allocation, recruitment, training, and providing tools for regular blood glucose and foot tests at MMC. Lastly, patients are crucial stakeholders and can give feedback on the processes related to diabetes treatment (Evans et al., 2023). 

MMC’s modification allows stakeholders’ participation, resulting in various benefits. For instance, stakeholders’ involvement develops ownership and shared responsibility among health personnel, which increases adherence to policy standards. Administration allows streamlining processes for diabetes management at MMC. Through shared decision-making, an effective and required resource allocation is implemented. The positive and productive environment due to collaborative participation ensures the policies’ effectiveness and enhances quality care for diabetic patients, preventing adverse events (Racine et al., 2023). 

Conclusion

Summarizing the proposal document, it is clear that implementing evidence-based policies and instructions at MMC for diabetes control fosters improved patient, health staff, and organizational outcomes. It happens due to compliance with regulatory standards and collaboration among stakeholders for regular HgbA1c and foot exams, twice and once a year, respectively. 

References

ADA. (2019). Standards of medical care in diabetes—2019 abridged for primary care providers. Clinical Diabetes, 37(1), 11–34. https://doi.org/10.2337/cd18-0105

Ahmad, F. J., & Joshi, S. H. (2023). Self-care practices and their role in the control of diabetes: A narrative review. Cureus, 15(7). https://doi.org/10.7759/cureus.41409 

Asadi, M., Zahedi, F., Ebrahimpur, M., & Larijani, B. (2023). Ethical challenges in gestational diabetes. Journal of Medical Ethics and History of Medicine. https://doi.org/10.18502/jmehm.v16i6.13470 

NHS FPX 6004 Assessment 2 Policy Proposal

Birinci, S., & Simten Malhan, B. (2023). Distribution and economic burden of diabetes-related microvascular complications in Türkiye. Anatolian Journal of Cardiology, 27(10), 597–607. https://doi.org/10.14744/AnatolJCardiol.2023.3762 

Casadei, G., Filippini, M., & Brognara, L. (2021). Glycated hemoglobin (HbA1c) as a biomarker for diabetic foot peripheral neuropathy. Diseases, 9(1), 16. https://doi.org/10.3390/diseases9010016

CMS. (2023). Medicare Diabetes Prevention Program (MDPP) expanded model. Www.cms.gov. https://www.cms.gov/priorities/innovation/innovation-models/Medicare-diabetes-prevention-program

Evans, K., Williams, A. G., Pearson, M., Kotera, Y., & Enston, C. (2023). Health service improvement using positive patient feedback: Systematic scoping review. ProQuest, e0275045. https://doi.org/10.1371/journal.pone.0275045 

Eyth, E., & Naik, R. (2023, March 13). Hemoglobin A1C. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549816/ 

Lowden, A. R. P. (2021). Clinical decision support for diabetes care in the hospital: A time for change toward improvement of management and outcomes. Journal of Diabetes Science and Technology, 193229682098266. https://doi.org/10.1177/1932296820982661 

NHS FPX 6004 Assessment 2 Policy Proposal

Memon, R., Levitt, D., Salgado Nunez Del Prado, S. R., Munir, K., & Lamos, E. (2021). Knowledge of hemoglobin A1c and glycemic control in an urban population. Cureus, 13(3), e13995. https://doi.org/10.7759/cureus.13995 

Nurchis, M. C., Sessa, G., Pascucci, D., Sassano, M., Lombi, L., & Damiani, G. (2022). Interprofessional collaboration and diabetes management in primary care: a systematic review and meta-analysis of patient-reported outcomes. Journal of Personalized Medicine, 12(4), 643. https://doi.org/10.3390/jpm12040643 

Racine, E., O Mahony, L., Riordan, F., Flynn, G., Kearney, P. M., & McHugh, S. M. (2023). What and how do different stakeholders contribute to intervention development? A mixed methods study. HRB Open Research, 5, 35. https://doi.org/10.12688/hrbopenres.13544.2 

Seixas, B. V., Dionne, F., & Mitton, C. (2021). Practices of decision making in priority setting and resource allocation: A scoping review and narrative synthesis of existing frameworks. Health Economics Review, 11(1). https://doi.org/10.1186/s13561-020-00300-0 

Song, K., & Chambers, A. R. (2021). Diabetic foot care. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553110/ 

Sugandh, F. N. U., Chandio, M., Raveena, F. N. U., Kumar, L., Karishma, F. N. U., Khuwaja, S., Memon, U. A., Bai, K., Kashif, M., Varrassi, G., Khatri, M., Kumar, S., Sugandh, F., Chandio, M., Raveena, F. N. U., Kumar, L., Karishma, F. N. U., Khuwaja, S., Memon, U. A., & Bai, K. (2023). Advances in the management of diabetes mellitus: A focus on personalized medicine. Cureus, 15(8). https://doi.org/10.7759/cureus.43697 

Thorsen, M., McGarvey, R., & Thorsen, A. (2020). Diabetes management at community health centers: Examining associations with patient and regional characteristics, efficiency, and staffing patterns. Social Science & Medicine, 255, 113017. https://doi.org/10.1016/j.socscimed.2020.113017 

Tomic, D., Shaw, J. E., & Magliano, D. J. (2022). The burden and risks of emerging complications of diabetes mellitus. Nature Reviews Endocrinology, 18(9), 525–539. https://doi.org/10.1038/s41574-022-00690-7 

WHO. (2023, November 14). Diabetes. Www.who.int. https://www.who.int/health-topics/diabetes?gad_source=1&gclid=CjwKCAiArLyuBhA7EiwA-qo80DQ1lEfovXrcllwgXDsXUhFQ4bBjP9rlz06ENm4eOcs_NdA7yAxoiBoC1hMQAvD_BwE#tab=tab_3