Scholarly Theory Paper topic Self-Management heart failure Toolkit for homecare patients to reduce hospitalizations and readmission rates.

EXAMPLE OF the type of paper Background and Significance Problem Identification and evidence/justification/rationale Review of Literature Theoretical Framework Heart failure (HF) is a deliberating chronic disease that will increase by 46% from 2012-2030 (Heidenreich et al., 2013). According to the American Heart Association (AHA), the prevalence of heart failure will rise to over 6.5 million people in the United States (Benjamin et al., 2017). Annually there are an estimated 900,000 new HF patients reported (Benjamin et al., 2017). Based on the historical data of the number of new HF patients reported per year, it is assumed the prevalence of HF will continue to climb. Heart Failure is costly because of hospitalizations, readmission rates, and emergency room visits. Heidenreich et al. (2013) report Projections show that by 2030, the total cost of HF will increase almost 127% to $69.7 billion from 2012. According to Gupta et al. (2017), HF is the leading cause of hospital readmissions for the Medicare patient population. Twenty-five percent of those admitted to the hospital for HF have a readmission within 30 days (Fritz & McKenzie, 2014). The medical and financial burden of heart failure hospitalizations has led to a substantive body of research characterizing the timing and etiology of readmissions. Many surveys of HF patients indicate that 30% of readmissions occur during the first 2 months after hospital discharge (Gorthi, Hunter, Mooss, Alla, & Hilleman,2014). Hospital readmissions remain a continued challenge in the care of the heart failure patient. The federal Hospital Readmissions Reduction Program (HRRP), implemented in October 2012 by Medicare, reduced payments to hospitals with excess readmissions for HF, myocardial infarction, and pneumonia (Center of Medicare and Medicaid Services [CMS], 2017). Consequently, effective interventions to reduce avoidable readmissions must be implemented as soon as possible, not only to improve the quality of patient care, but also to save financial resources. There are so many aspects of the healthcare system that make it unclear what is causing readmissions. There is a level of uncertainty regarding whether acute care facilities are doing enough in terms of preventing readmissions. Specific interventions being put in place by each individual hospital administration are not well known and it is unclear if such interventions are reducing readmissions. On the staff level, it is unknown how well nurses and other healthcare professionals provide pre-discharge education and how effective that education is. Additionally, it is unclear whether that nurse to patient ratio affects the readmission rate and patient outcomes. From the perspective of the government, it is difficult to determine if Medicare, Medicaid, ACA, and HRRP are effective in preventing readmissions and the effects on the hospital. Both Medicare and Medicaid have been put in place to help the patient financially based upon specific circumstances. Most patients admitted and readmitted into the hospital setting are on Medicare and as a result, Medicare has a large impact on the hospital financially. The puzzling aspect of HRRP is the thought process behind the policy. It is unclear why the government sector is penalizing hospitals that dont have full control over preventing an individual being readmitted into the hospital. As a result, it is not clear if HRRP is creating a generally positive or negative impact on the hospital. References Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., Muntner, P. (2017). Heart disease and stroke statistics2017 update: A report from the American Heart Association. Circulation Vol. 135. https://doi.org/10.1161/CIR.0000000000000485 Center for Medicare and Medicaid Services. (2017). Readmissions Reduction Program. Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/Readmissions-ReductionProgram.html Fritz, D., & McKenzie, P. (2014). Avoiding emergency department visits for COPD, Pneumonia, & Heart Failure. Home Healthcare Nurse 32(10) 578-586. DOI:10.1097/NHH.0000000000000152 Gorthi, J., Hunter, C. B., Mooss, A. N., Alla, V. M., & Hilleman, D. E. (2014). Reducing heart failure hospital readmissions: A systematic review of disease management programs. Cardiology Research, 5(5), 126138. https://doi.org/10.14740/cr362w Gupta, A., Allen, L. A., Bhatt, D. L., Cox, M., DeVore, A. D., Heidenreich, P. A., Fonarow, G. C. (2017). Association of the hospital readmissions reduction program implementation with readmission and mortality outcomes in heart failure. JAMA Cardiology, 3(1), 4453. https://doi.org/10.1001/jamacardio.2017.4265 Heidenreich, P.A., Albert, N.M., Allen, L.A., Bluemke, D.A. Butler, J., Fonarow, G.C. Trogdon, J. G. (2013). Forecasting the impact of heart failure in the United States A policy Statement from the American Heart Association. Circ Heart Failure. 6:606-619. Retrieved from https://circheartfailure.ahajournals.org DOI: 10.1161/HHF.0b013e318291329a Mozaffarian, D., Benjamin, E.J., Go, A.S., Arnett, D.K., Blaha, M.J., Cushman, M. Turner, M.B. (2015). Heart disease and stroke statistics2015 update a report from the American Heart Association. Circulation 131:e29-e322. Retrieved from https://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000152

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