Assessing the Problem: Quality, Safety, and Cost Considerations
With Alzheimer’s, quality care requires early diagnosis, evidence-based medical management, psychosocial support, education on disease progression, and advanced care planning. Promoting safety for Alzheimer’s patients is critical as cognitive impairment increases risks of self-harm, wandering, falls, and medication errors. However, quality care and safety measures can be expensive, especially in residential facilities for dementia patients’ unique needs (Werner, 2019). During my two-hour practicum with Clay, I observed firsthand the extent of his memory loss, confusion, and inability to manage activities of daily living independently. Evidence-based care guidelines emphasize patient-centered, individualized plans that preserve dignity and engagement.
Impact of Patient Problem on System
Quality of Care
Alzheimer’s disease severely impacts the quality of care for patients like Clay. Clay’s escalating cognitive deficits and functional impairments require higher levels of medical, nursing, and personal care as the disease progresses. However, Alzheimer’s patients have unique needs that challenge traditional healthcare delivery models. Evidence-based care guidelines emphasize patient-centered, individualized plans that preserve dignity and engagement. However, the fragmented nature of our healthcare system often results in reactive medicine, lack of care coordination, and insufficient training among providers in optimal dementia care techniques (Angelopoulou et al., 2022). Clay’s outcomes are further hampered by difficulties accessing specialty care, delays in diagnosis and treatment, gaps in community services, and a lack of integration between medical, social, and long-term care. Enhancing Clay’s quality of care requires systematic changes, including the adoption of integrated care models that coordinate across settings; the use of interprofessional teams and care managers; investment in workforce education on Alzheimer’s care best practices; and payment reforms to incentivize high-value patient-focused dementia care (Lees Haggerty et al., 2020).
Patient Safety
Cognitive deficits in Alzheimer’s significantly compromise patient safety for individuals like Clay. Clay’s growing memory loss, impaired judgment, confusion, and functional decline place him at high risk for medication errors, wandering/elopement, falls, malnutrition, infections, and self-harm. Caregiver stress further elevates safety risks. Evidence-based safety protocols for Alzheimer’s patients include structured routines, simplified environments, supervision during activities of daily living, tracking technologies for wandering, fall precautions, medication reconciliation, and pressure ulcer prevention (Márquez et al., 2021). However, such interventions are often inadequately implemented across real-world clinical settings due to inadequate staffing, lack of dementia-specific provider training, and challenges coordinating care across multiple venues. Improving safety outcomes for patients like Clay requires investment in Alzheimer’s-specific safety training, implementing proven safeguards by formal and informal caregivers, and integrating care to bridge safety gaps during transitions between care sites (Ward et al., 2020).
Costs to System and Individual
The exponential costs of Alzheimer’s exert tremendous strain on families like Clay’s and the healthcare system. Like Clay’s wife, informal family caregivers face high out-of-pocket costs for medical care, medications, supplies, home modifications, and paid caregiving. Indirect costs include loss of family income due to caregiving demands and health problems stemming from caregiver stress. Long-term institutionalization also incurs major expenses for families (Wong, 2020). Costs are projected to grow dramatically as prevalence increases. Addressing Alzheimer’s requires policy solutions like expanded insurance coverage for long-term care services, increased caregiver support funding, research investment to slow disease progression, and payment incentives promoting evidence-based, coordinated models that improve outcomes while reducing avoidable, costly complications (Maresova et al., 2020).
Importance of State Board Nursing Practices and Policies
Quality Care
State boards of nursing shape quality care for Alzheimer’s patients by establishing minimum education and training qualifications for licensed nurses who frequently coordinate dementia care. Expanding curricular mandates focused on evidence-based Alzheimer’s care at the pre-licensure and graduate levels equips nurses to provide individualized, dignified care grounded in up-to-date clinical guidelines. At the healthcare organization level, policies funding Alzheimer’s training for nursing staff, implementing care protocols adapted for cognitive deficits, and adopting Electronic Health Record (EHR) tools to enhance care coordination also boost care quality. Federal and state government policies like reimbursement for care planning consultations, dementia care management fees, and value-based incentives promoting evidence-based dementia models can improve patient-centered Alzheimer’s care quality (Pinzón et al., 2021).
Patient Safety
Nursing boards directly impact Alzheimer’s patient safety through regulations governing adverse event reporting, complaint investigations, and disciplinary actions against unsafe practitioners. Healthcare organizations influence safety via policies on staffing ratios, caregiver training, physical environment adaptations, and implementation of protocols addressing critical areas like wandering, falls, infections, and medication administration for dementia patients. Federal and state policies mandating provider use of care planning tools and enrollee/family caregiver education protect against safety risks arising from care fragmentation during transitions between settings. Public investment in research and disseminating evidence-based Alzheimer’s safety practices is also pivotal (Hope, 2020).
Costs
Nursing practice policies affect costs by ensuring that only practitioners with validated competencies in efficient Alzheimer’s care coordinate services. Healthcare organizations containing costs through optimized staffing models and rigorous protocols to reduce complications can lower expenses for families and payers. Governments manage Alzheimer’s costs through expanded insurance coverage for care planning and coordination, investment in integrated care models proven to reduce unnecessary utilization, and reforms tying reimbursement to value metrics and population health outcomes. A multipronged policy approach focused on improving care quality and safety while aligning incentives to deliver efficient, high-value Alzheimer’s care is critical for managing costs and achieving sustainability (Crystal et al., 2020).
Impact of Policy on Nursing Practice
State nursing board licensure and scope of practice regulations directly shape my role in Clay’s care, delineating appropriate nursing assessments, interventions, care coordination activities, and health education I can provide as a nurse. Understanding these policies and practice standards is essential to ensure I work within my defined scope to optimize Clay’s outcomes safely, efficiently, and ethically. Specifically, nursing board guidance on care coordination, care planning, and family caregiver training grants me the latitude to implement evidence-based interventions to address Clay’s multi-faceted care needs. Operating within the boundaries of nursing practice policies while leveraging my professional expertise will be essential to effectively applying an integrated care coordination approach to improving quality, safety, and costs in Clay’s Alzheimer’s care management (Hickman et al., 2022).
Strategies for Improvement of System
Several evidence-based care models have demonstrated enhanced quality of care for Alzheimer’s patients. The PACE model utilizes care protocols and decision tools to standardize care practices for common areas like behavior and medication management. Research by Chen (2021) shows that PACE (Program of All-Inclusive Care for the Elderly) improves care quality, reduces antipsychotic use, and enhances person-centeredness (Kales et al., 2015). Using interdisciplinary teams, PACE integrates and coordinates participants’ health and long-term care services. PACE participants experience lower rates of hospitalization, institutionalization, and mortality compared to other models (Kushariyadi, 2023).
Implementing safety practices tailored for Alzheimer’s patients is also essential. Educating families on home safety assessment, fall precautions, wandering prevention strategies, and evidence-based interventions shown to reduce risks. Tracking devices/alarms, simplified living environments, and medication reconciliation processes also enhance safety for dementia patients (Sabia & Singh-Manoux, 2023). Several policy strategies can improve cost-effectiveness in Alzheimer’s care. Expanding eligibility for Medicaid home and community-based care waivers increases access to affordable long-term care, lowering family costs. Value-based payment programs incentivizing care coordination services and proven dementia models will optimize resource utilization in the long term. Increased funding for Alzheimer’s research and education is critical to developing innovative, evidence-based solutions for delivering higher-value care (Makin et al., 2021).
Effectiveness of Strategies
The proposed patient-centered strategies target specific deficits in current Alzheimer’s care models across multiple domains, grounded in evidence from studies demonstrating their effectiveness. Implementing tailored protocols and decision tools enhances individualized care while reducing detrimental variations in practice. Care integration provides infrastructure for seamless coordination. Family caregiver education and home safety interventions leverage low-cost solutions with significant impact on quality and safety. Payment reforms incentivize adopting high-value practices systemwide. Targeting care delivery redesign, optimized resource use, improved safety education, and value-based financial incentives through a multifaceted approach is crucial for generating meaningful system-level improvements in Alzheimer’s care quality, safety, and costs. This combination of complementary strategies offers the potential for synergistic effects on patient outcomes (Ito et al., 2021).
Benchmark Data
Relevant national and state-level organizations that compile benchmark data to help evaluate and guide quality improvements in Alzheimer’s care include:
- The Alzheimer’s Association, through its Alzheimer’s Disease Facts and Figures reports, provides comprehensive national-level data on prevalence, costs, care settings, workforce issues, and trends that allow benchmarking across multiple Alzheimer’s care domains (Alzheimer’s Association, 2022).
- The Agency for Healthcare Research and Quality, via its National Healthcare Quality and Disparities Reports, offers Alzheimer’s care quality benchmarks in areas like prevention, patient safety, and care coordination relative to other conditions (Department of Health and Human Services, 2019).
- State public health agencies, such as the Florida Department of Health, aggregate state-specific population health data, mortality statistics, and projections that can contextualize needs and outcomes (Florida Department of Health, 2022).
- State hospital associations often track and report data on Alzheimer ‘s-related utilization, readmissions, and costs that can inform quality improvement initiatives within specific states.
Leveraging Alzheimer’s benchmark data from national organizations and state-level entities provides essential insights into current standards and gaps in quality, safety, costs, and outcomes to guide priority-setting and evaluation (Hope, 2020).
Conclusion NURS FPX 4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Considerations
In conclusion, Alzheimer’s disease presents escalating challenges to delivering quality, safe, and affordable healthcare for affected individuals like Clay and their families. Optimizing Clay’s outcomes requires evidence-based, patient-centered models coordinated across interdisciplinary teams and care settings. Strategies focused on standardized protocols, care integration, family caregiver support, tailored safety practices, and value-based payment incentives can drive systemic improvements. Policy and nursing practice changes are imperative to implement these solutions at scale. Leveraging organizational, state, and national benchmark data will facilitate targeted quality, safety, and cost initiatives. A collaborative, multifaceted approach is essential to provide the highest-value care, enhancing Clay’s quality of life and reducing the burdens of Alzheimer’s disease.
References
Alzheimer’s Association. (2022). Alzheimer’s Association . Alzheimer’s disease and dementia. https://www.alz.org/
Angelopoulou, E., Papachristou, N., Bougea, A., Stanitsa, E., Kontaxopoulou, D., Fragkiadaki, S., Pavlou, D., Koros, C., Değirmenci, Y., Papatriantafyllou, J., Thireos, E., Politis, A., Tsouros, A., Bamidis, P., Stefanis, L., & Papageorgiou, S. (2022). How telemedicine can improve the quality of care for patients with Alzheimer’s disease and related dementias? A narrative review. Medicina , 58(12), 1705. https://doi.org/10.3390/medicina58121705
Chen, L.-Y. (2021). Care for older adults with dementia: PACE day care or residential dementia care units? Archives of Gerontology and Geriatrics , 93 . https://doi.org/10.1016/j.archger.2020.104310
Crystal, S., Jarrín, O. F., Rosenthal, M., Hermida, R., & Angell, B. (2020). National partnership to improve dementia care in nursing homes campaign: State and facility strategies, impact, and antipsychotic reduction outcomes. Innovation in Aging , 4(3) . https://doi.org/10.1093/geroni/igaa018
Department of Health and Human Services. (2019). Agency for Healthcare Research & Quality . Ahrq.gov; Agency for Healthcare Research and Quality. https://www.ahrq.gov/
Florida Department of Health. (2022). Florida Department of Health . Www.floridahealth.gov. https://www.floridahealth.gov/
Hickman, S. E., Mitchell, S. L., Hanson, L. C., Tu, W., Stump, T. E., & Unroe, K. T. (2022). The design and conduct of a pragmatic cluster randomized trial of an advance care planning program for nursing home residents with dementia. Clinical Trials , 19(6), 623–635. https://doi.org/10.1177/17407745221108992
Hope, K. (2020). Role of nurses in addressing modifiable risk factors for early Alzheimer’s disease and mild cognitive impairment. British Journal of Nursing , 29(8), 460–469. https://doi.org/10.12968/bjon.2020.29.8.460
Ito, K., Chapman, R., Pearson, S. D., Tafazzoli, A., Yaffe, K., & Gurwitz, J. H. (2021). Evaluation of the cost-effectiveness of drug treatment for Alzheimer’s disease in a simulation model that includes caregiver and societal factors. JAMA Network Open , 4(10). https://doi.org/10.1001/jamanetworkopen.2021.29392
Kushariyadi. (2023). The Program of All-Inclusive Care for the Elderly (PACE) in improving medical surgical and mental health care: A literature review. Jurnal Kegawatdaruratan Medis Indonesia , 2(1), 64–73. https://doi.org/10.58545/jkmi.v2i1.53
Lees Haggerty, K., Epstein‐Lubow, G., Spragens, L. H., Stoeckle, R. J., Evertson, L. C., Jennings, L. A., & Reuben, D. B. (2020). Recommendations to improve payment policies for comprehensive dementia care. Journal of the American Geriatrics Society , 68(11), 2478–2485. https://doi.org/10.1111/jgs.16807
Makin, C., Neumann, P., Peschin, S., & Goldman, D. (2021). Modelling the value of innovative treatments for Alzheimer’s disease in the United States. Journal of Medical Economics , 24(1), 764–769. https://doi.org/10.1080/13696998.2021.1927747
Maresova, P., Komarkova, L., Kuhnova, J., Cimler, R., Pazitny, P., Kandilaki, D., Musilek, K., Truhlarova, Z., Zemek, F., & Kuca, K. (2020). Anticipated social and healthcare economic burden of people with Alzheimer’s disease in two selected regions of the Czech Republic. Healthcare , 8(4), 433. https://doi.org/10.3390/healthcare8040433
Márquez, I. C., Garcia‐Cifuentes, E., Velandia, F. R., Saavedra, A. M., Borda, M. G., Chavarro‐Carvajal, D. A., Osuna, M., Ailshire, J., & Cano‐Gutierrez, C. A. (2021). Motoric cognitive risk syndrome: Prevalence and cognitive performance. Alzheimer’s & Dementia , 17(8). https://doi.org/10.1002/alz.049718
Pinzón, M., Krainer, J., Houston, S., LeCaire, T., Green‐Harris, G., Norris, N., Walaszek, A., Johnson, S. C., & Carlsson, C. M. (2021). Quality measures in dementia care across a network of memory clinics: An implementation study. Alzheimers & Dementia , 17(8). https://doi.org/10.1002/alz.056350
Sabia, S., & Singh-Manoux, A. (2023). Healthy lifestyles for dementia prevention. BMJ , 380 , 117. https://doi.org/10.1136/bmj.p117
Ward, H., Finucane, T. E., & Schuchman, M. (2020). Challenges related to safety and independence. Medical Clinics of North America , 104(5), 909–917. https://doi.org/10.1016/j.mcna.2020.06.006
Werner, P. (2019). Reflections on quality of care for persons with dementia: Moving toward an integrated, comprehensive approach. International Psychogeriatrics , 31(3), 307–308. https://doi.org/10.1017/s1041610219000346
Wong, W. (2020). Economic burden of Alzheimer disease and managed care considerations. The American Journal of Managed Care , 26(8), 177–183. https://doi.org/10.37765/ajmc.2020.88482