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Quality Healthcare: Measuring NP Performance...

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Quality Healthcare: Measuring NP Performance

2 Quality Healthcare: Measuring NP Performance Productivity plays a big part in the success of practicing APNs. Productivity serves as a measurement for practices in regulating reimbursement and determining salaries for Nurse Practitioners. However, nursing productivity is measured for many reasons. Measuring productivity can aid in determining quality of care, decreasing healthcare costs for patients and healthcare organizations, and overall increase patient satisfaction in regards to care received (Balderrama & Smith, 2018). The Healthcare Effectiveness Data and Information Set (HEDIS) is a performance improvement tool used that is frequently used within healthcare. For the purpose of this paper, the performance measure of controlling high blood pressure, as listed within HEDIS, will be discussed. Roughly 80 million adults in the United States, those 20 years of age and older, have hypertension (Schub & Marcel, 2018). When comprehending this number, it is clear that Nurse Practitioners everywhere can expect to be involved in the treatment of this condition. In the following literature, patient interventions concerning controlling hypertension and the measurement of resulting outcomes will be discussed as well as how those In the United Staainterventions result in improved patient outcomes, cost savings and improved patient ratings. Patient Interventions Intervention One: Weight Monitoring While there are many risk factors for the development of hypertension, obesity is one of the most prominent. There is a direct correlation between increasing body mass index (BMI) and elevated systolic and diastolic blood pressure. Hypertension and obesity can lead to organ damage, heart failure, chronic renal failure, and ultimately death (Schub

3 & Boling, 2018). This is why weight management is so important in the treatment of hypertension and why clinicians often monitor weight in hypertensive patients. When clinicians prescribe weight monitoring to patients, the main goal is for the patient to lose weight, or at least cease to gain more weight. Nurse Practitioners and other providers may recommend that patients take their weight daily, at the same time every day, and record the weight in a journal. The most common way providers then track and monitor weight loss progress is through follow-up appointments. It is very important that patients present for follow-up appointments so that providers can take accurate weights in order to determine BMI and assess blood pressure in order to measure patient progress (Schub & Boling, 2018). Intervention Two: Prescribe Lifestyle Changes A poor diet including high levels of saturated fats, cholesterol, and sodium as well as inactivity can also increase an individual’s risk for hypertension. Hypertension is a leading contributor to cardiovascular disease. CVD accounts for over 17 million deaths per year, making it the leading cause of death worldwide. Additionally, it is estimated that 80% of premature deaths associated with CVD could be avoided with lifestyle changes involving a health diet regimen and/or physical activity (Schub & Marcel, 2018). It is clear that lifestyle changes can play a key role in decreasing blood pressure or preventing hypertension altogether. Some commonly recommended lifestyle changes not only include a healthy diet such as the DASH (Dietary Approaches to Stop Hypertension) diet and exercise but also smoking cessation and stress management. It is important to assess which lifestyle changes each individual patient believes will affect his or her blood pressure personally. Follow-up appointments are an

4 essential piece in measuring the success of lifestyle changes so that clinicians can communicate with the patient regarding their thoughts and how the lifestyle changes have been implemented and assess their success. In recommending lifestyle changes a clinician may also recommend that the patient journal their diet and exercise habits on a daily basis in order to have some way of measuring the interventions. If specifically assessing adherence to a low sodium diet, a 24-hour urinary salt excretion sodium level can be taken. When lifestyle changes are the only intervention being utilized in hypertensive treatment, an associated decreasing blood pressure can confirm progress through direct correlation (Schub & Marcel, 2018). Intervention Three: Prescribe Anti-Hypertensive Medications Clinicians often attempt to prescribe lifestyle changes before prescribing medications. However, when lifestyle changes and weight management alone do not adequately decrease blood pressure, many patients require the addition of a medication regimen to treat hypertension. There are a variety of different antihypertensive medications that have been proven successful when taken on a regular schedule including diuretics, angiotensin-converting enzyme inhibitors (ACE inhibitors), calcium channel blockers, vasodilators, β-blockers, and more (Uribe & Oji, 2018). Many patients may require combination therapy including more than one medication. Medications seem to be the most reliable method for decreasing blood pressure, but it is important to assess patients individually in regards to co-morbidities and preferences before prescribing. Medications have side effects and an important aspect in measuring their success lies in follow-up with patients regarding any side effects in order to support adherence. Follow-up appointments provide opportunity to

5 discuss whether the patient has regularly been taking prescribed medications and review any complications experienced due to medications. Also during follow-up appointments, an accurate blood pressure can be taken to determine if the medications are adequately treating the hypertension (Uribe & Oji, 2018). For a few specific medications such as thiazide or loop diuretics, a serum chemistry can indicate treatment adherence through abnormal potassium levels, (Schub & Boling, 2018). Improved Patient Outcomes Each intervention discussed leads to improved patient outcomes. Weight monitoring and management not only helps treat and prevent hypertension, but many other serious death-causing diseases (Schub & Boling, 2018). Life-style changes can also help prevent a wide variety of related health issues. Exercise is a generally healthy action that contributes to good health. Smoking cessation can decrease risk of cancer and other health issues. Each intervention, if carried out successfully, can lead to successful treatment and management of hypertension and lead to an overall healthier life and prevent premature death. Every intervention mentioned involves a close patient-provider relationship in order to adequately measure outcomes and progress. An effective patient-provider relationship ultimately leads to increased adherence to blood pressure decreasing interventions and positive patient outcomes (Schub & Boling, 2018). Cost Savings When considering treatment for any disease or condition it is important to ensure that treatment is cost effective and affordable. Moran et al. (2015) states, “In the United States, more deaths from cardiovascular causes are attributed to elevated

6 blood pressure than to any other risk factor” (Moran et al., 2015). With thousands of hospitalizations and deaths related to hypertension every year, it is clear that there is room for improvement in the treatment of high blood pressure. In hopes of providing cost-effective care it is crucial that clinicians attempt to implement interventions involving weight management and lifestyle changes as a first line of treatment. These interventions involve minimal financial involvement from the patient. When medications are needed it is important that providers assess each patients insurance and ability to pay for medication. Some medications may be more affordable to specific patients. All in all, by providing preventative treatment for high blood pressure, complications resulting from hypertension as well as hospitalizations and fatalities can be prevented, thus reducing the costs of treating the condition (Moran et al., 2015). Patient Ratings Patient satisfaction is a primary focus for health care services. Positive patient ratings serve as an indicator of quality care and impact successive health service operations. Each intervention discussed requires practitioners to engage with individuals and assess patient -specific needs in regards to treating hypertension. In providing patient-centered care, patients are more likely to feel involved in the treatment process and develop a strong relationship with the provider. Subsequently, a strong patient-provider relationship often leads to better health outcomes (Balderrama & Schiebel, 2018). When patients can adequately treat clinical hypertension with the help of a clinician, they are able to trust that practitioner’s expertise resulting in an overall positive outlook on the care received and positive patient ratings.

7 Conclusion As productivity plays an important role in salary and reimbursement for practicing NPs, the HEDIS serves as an important resource for performance measures. Controlling high blood pressure is only one of many performance measures listed within HEDIS, but a very important one due to the prevalence of hypertension worldwide (Schub & Marcel, 2018). Measuring outcomes of implemented interventions can aid in determining productivity of given care. Each of the interventions discussed, including weight monitoring, lifestyle changes, and medication administration, result in improved patient outcomes, cost savings for individuals and the practice, and improved patient satisfaction.

References Balderrama, D. R. M., & Schiebel, D. F. (2018). Patient-centered care: An overview. CINAHL Nursing Guide. https://search.ebscohost.com/login.aspx? direct=true&db=nup&AN=T707729&site=eds-live&scope=site

8 Balderrama, D. R. M., & Smith, N. R. M. C. (2018). Nursing productivity: Measuring. CINAHL Nursing Guide. https://search.ebscohost.com/login.aspx? direct=true&db=nup&AN=T903264&site=eds-live&scope=site Moran, A.E., Odden, M.C., Thanataveerat, A., Tzong, K.Y., Rasmussen, P.W., Guzman, G., Williams, L., Bibbins-Domingo, K., Coxson, P.G., Goldman, L. (2015). Costeffectiveness of hypertension therapy according to 2014 guidelines. New England Journal of Medicine. http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.1056/NEJMsa1406751 Schub, T. B., & Boling, B. R. D. C.-C. (2018). Hypertension and obesity. CINAHL Nursing Guide. https://search.ebscohost.com/login.aspx? direct=true&db=nup&AN=T703326&site=eds-live&scope=site Schub, T. B., & Marcel, C. B. (2018). Hypertension: Diet therapy. CINAHL Nursing Guide. https://search.ebscohost.com/login.aspx? direct=true&db=nup&AN=T703166&si t e=edsl i v e&scope=si t e Uribe, L. P. M., & Oji, O. D. A. F.-B. (2018). Hypertension: Combination Therapy. CINAHL Nursing Guide. https://eds-b-ebscohostcom.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=3&sid=6970cade-38d2-437eade7-d86de75f4ae2%40pdc-v-sessmgr06...