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 errorsare causing harm and death to almost 45,000 Americans and costing over$29 billion every year. Other studies have indicated preventablehealthcare associated conditions (HACs) such as infections, sepsis, CHF,and pneumonia are main contributors for increasing the length ofpatient 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 whospeaks both Spanish and English fluently. She is retired, lives alone,and has Medicaid as her primary insurance. Ms. Spinner-Ramirez wasscratched by a stray cat that she feeds on her back porch daily. She hasbeen cleaning the wound daily; however, after 2 days she went to herlocal ER for increased pain, redness, and swelling in her left lower legwound where she was scratched by the stray cat. Ms. Spinner-Ramirezexplained she recently had her left knee replaced about 6 months ago andverbalized new difficulty with baring weight on that extremity to thepoint that she was having to use her cane again. Her vital signs at theER visit were stable. Her left leg wound was cleaned and redressed.After 5 hours in the ER, Ms. Spinner-Ramirez was discharged to home onoral Keflex for her left lower leg infection and was instructed to callher primary care physician for a follow-up appointment. Five days laterMs. Spinner-Ramirez was taken back to the same ER via ambulance. Herneighbor found her lethargic, short of breath, and was experiencingdifficulty being able to move. A CT scan and blood work revealed thatMs. Spinner-Ramirez’s knee replacement in her left leg was infectedsecondary to the cat scratch. She was admitted as an inpatient forsepsis. She needed to have a second left knee replacement surgery withwound irrigation and debridement, which extended her inpatient stay to 3weeks. Once she was discharged to home, she required six weeks of IVantibiotics, 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 notpay (reimburse) for injuries, extended costs, readmissions, or death(mortality) from a hospital-acquired infection or medical error. Supportyour 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 (healthcareorganizations) can improve quality and reimbursements (payments) forservices/care.Resources:Understanding Health Insurance https://www.consumerreports.org/health-insurance/guide-to-health-insurance/What’s Behind the Health Insurance Rankings https://www.consumerreports.org/cro/2012/09/what-s-behind-the-health-insurance-rankings/index.htmHospitals will have to Pay for their Mistakes https://www.consumerreports.org/cro/news/2008/08/hospitals-will-have-to-pay-for-their-mistakes/index.htmMedical Errors: Focusing More on What and Why, Less on Who https://ascopubs.org/doi/full/10.1200/jop.0723501National Business Coalition on Health: Health Care Purchaser Toolkit https://www.nationalalliancehealth.org/homeAgency for Healthcare Research and Quality https://www.ahrq.gov/patient-safety/quality-measures/21st-century/index.htmlRubricFully explainswhy insurancecompanies shouldor should not pay(reimburse) forinjuries, extendedcosts,readmissions ordeath (mortality)from a hospitalacquiredinfection ormedical error
Fully describestwo ways(initiatives)healthcare qualitycan be improvedto help reduceerrors andimprove patientsafety.
Fully discusseshow creatingincentives forproviders(healthcareorganizations)can improve quality andreimbursements(payments) forservices/care.