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4 pages/β‰ˆ1100 words
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Health, Medicine, Nursing
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Health care Delivery and Quality Case Study Health, Medicine Essay

Essay Instructions:

Activity 4
Healthcare Delivery and Quality Case Study
Landmark studies To Err is Human (1999) and Crossing the Quality Chasm (2001) from the Institute of Medicine (IOM) identified medical errors are causing harm and death to almost 45,000 Americans and costing over $29 billion every year. Other studies have indicated preventable healthcare associated conditions (HACs) such as infections, sepsis, CHF, and pneumonia are main contributors for increasing the length of patient stays, the cost of care, and the likelihood of mortality (death).
Consider the below case study:
Margret Spinner-Ramirez is a 66 y/o female Hispanic-American who speaks both Spanish and English fluently. She is retired, lives alone, and has Medicaid as her primary insurance. Ms. Spinner-Ramirez was scratched by a stray cat that she feeds on her back porch daily. She has been cleaning the wound daily; however, after 2 days she went to her local ER for increased pain, redness, and swelling in her left lower leg wound where she was scratched by the stray cat. Ms. Spinner-Ramirez explained she recently had her left knee replaced about 6 months ago and verbalized new difficulty with baring weight on that extremity to the point that she was having to use her cane again. Her vital signs at the ER visit were stable. Her left leg wound was cleaned and redressed. After 5 hours in the ER, Ms. Spinner-Ramirez was discharged to home on oral Keflex for her left lower leg infection and was instructed to call her primary care physician for a follow-up appointment. Five days later Ms. Spinner-Ramirez was taken back to the same ER via ambulance. Her neighbor found her lethargic, short of breath, and was experiencing difficulty being able to move. A CT scan and blood work revealed that Ms. Spinner-Ramirez’s knee replacement in her left leg was infected secondary to the cat scratch. She was admitted as an inpatient for sepsis. She needed to have a second left knee replacement surgery with wound irrigation and debridement, which extended her inpatient stay to 3 weeks. Once she was discharged to home, she required six weeks of IV antibiotics, extensive rehab, and home health.
If you were in charge of a healthcare insurance company:
Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs, readmissions, or death (mortality) from a hospital-acquired infection or medical error. Support your why or why not?
Describe two ways (initiatives) healthcare quality can be improved to help reduce errors and improve patient safety.
Discuss how creating incentives for providers (healthcare organizations) can improve quality and reimbursements (payments) for services/care.
Resources:
Understanding Health Insurance
What's Behind the Health Insurance Rankings
Hospitals will have to Pay for their Mistakes
Medical Errors: Focusing More on What and Why, Less on Who
National Business Coalition on Health: Health Care Purchaser Toolkit
Agency for Healthcare Research and Quality
HERE IS THE ATTACHED LINK OF RUBRIC https://learn(dot)americansentinel(dot)edu/pluginfile.php/736716/mod_resource/content/9/SIM410_Comp4_rubric.pdf
please refer to the rubric

Essay Sample Content Preview:

Health Care Delivery and Quality Case Study
Name
Institutional Affiliate
Health Care Delivery and Quality Case Study
Introduction
The delivery of quality health care services to patients or consumers makes for one of the primary objectives of health care systems in the United States and around the world. The achievement of the said outcome is dependent on the ability of a given health care system to provide safe and affordable patient care to its wide range of consumers. The rising cost of health care witnessed in the United States and around the globe poses a great challenge towards the delivery of quality healthcare. The underlying factors contributing to the rising costs of health care include the rising cases of chronic diseases among the populace as well as extended lengths of patient stays across the diverse health care facilities. The prolonged patient stays in hospitals may be as a result of the severity of a patient’s condition or stem from the occurrence of medical incidents while in the hands of care providers within health care facilities. Medical errors account for a higher percentage of medical incidents recorded in health care facilities in the United States. According to a report by the Institute of Medicine (IOM), for instance, medical errors account for the annual expenditure of approximately $29 billion in the mitigation of preventable harm and other adverse effects on patients due to the administration of medical errors. Healthcare insurance providers such as Medicare and Medicaid as well as a wide range of private health insurance covers often end up paying for such expenses due to the lack of accountability on the part of the care providers in the United States health care system. Provided herein in is an evaluation of a health care delivery and quality case study to highlight some of the concerns for health insurance providers towards the rising costs of health care as a result of preventable harm on patients and other hospital-acquired conditions.
Scope of the Problem
According to the National Alliance of Healthcare Purchaser Coalition, American employers and health insurance policyholders spend an annual amount of approximately $300 billion on health care CITATION Min20 \l 1033 (Minnesota Health Action Group, 2020). The rising cost of healthcare due to the occurrence of medical errors in health care facilities, on the other hand, affects over 45,000 people in the United States who incur additional health care costs amounting to over $29 billion in a year. Healthcare-associated conditions and the adverse effects of medical errors affect over 2.4 million people annually in the United States CITATION Con08 \l 1033 (Consumer Reports, 2008). The occurrence of preventable harm on patients often differ in severity with the extreme cases leading to prolonged patient stays in healthcare facilities as well as death. Healthcare insurance cover providers and policyholders are at the receiving end of the rising costs of health care in the country. Collaborative efforts between the federal and state governments to cushion the low-income earners against the burden of the rising cost of health care takes the form of the Medicare and Medicaid programs CITATION Con14 \l 1033 (Consumer Reports, 2014)....
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