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Medicare nonpayment, hospital falls, and unintended consequences

Part 1

Review several of the descriptions of “big pictures” from others in the class. Are those big pictures missing anything?

· Find the posts that you are going to reply to.

· Always construct your responses in a word processing program like Word. Check for grammar, spelling, and mechanical errors.  Make the corrections and save the file to your computer.

· Submit your peer responses.

I live in Broward County, Florida, where a diverse group of patients, particularly Afro-Caribbean and African-descent female patients, reside and are seen in the private practice where I worked.  However, I have encountered a high prevalence of obesity among black female patients regardless of socioeconomic status. 65% of black female patients seen have expressed hairstyle practices and management, and chronic stress as a barrier to physical activity in their lives. According to Ogunniyi et al., (2021), racial minority groups have a higher burden of mortality and morbidity due to cardiovascular-related complications brought on by persistent hypertension, obesity, and metabolic syndrome disorders. That I have researched and understood. I also understood that race should not be considered a biological construct for disparities or even differences (Ogunniyi et al., 2021) in obesity outcomes, increased physical activity, or stress but rather within the context of environmental, socioeconomic, and systemic issues such as structural racism. For 3 years, most patients identified as black females have expressed that their haircare style and management, and chronic stress in their lives are, in fact, primary contributors to their obesity and lack of physical activity.

The significance of the problem is that the population of African descent, and black racial minorities in the United States develop cardiovascular diseases earlier in life with worse disease severity than other racial groups but also develop target organ damages at a younger age than their other counterparts and higher risk of premature health (Oginniyi et al., 2021). So, I believe providers should be aware of hairstyle management, and chronic stress can also be considered as risk factor leading to obesity and, cardiovascular disorders in black female patients. Gathers and Mahan (2015) emphasized that African American women who had struggled with weight loss, and body weight maintenance have cited exercise avoidance as a conscious decision to overcome hairstyle challenges. My project aims to find culturally relevant exercises and self-care management to increase physical fitness in the black female patients being served in my practice and community and provide self-care strategies as a guideline to mitigate stress in this population.

References

Gathers, R. C. & Mahan, M. G. (2015, September 9). African American Women, Haircare and health barriers. Clinical and Aesthetic Dermatology, 7(9), 26-29.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174916/#:~:text=Hair%20care%20issues%20are%20more,and%20how%20long%20they%20exercised Links to an external site. .

 Ogunniyi, M. O., Commodore-Menseh, Y. & Ferdinand, M. C. (2021, December 14). Race, ethnicity, hypertension and heart disease: Jacc focus seminar 1/9. Journal of the American College of Cardiology, 78(4), 2460-2470.  https://doi.org/10.1016/j.jacc.2021.06.017 Links to an external site.

Part 2

Review several of the descriptions of “big pictures” from others in the class. Are those big pictures missing anything?

· Find the posts that you are going to reply to.

· Always construct your responses in a word processing program like Word. Check for grammar, spelling, and mechanical errors.  Make the corrections and save the file to your computer.

· Submit your peer responses.

What is the context or “big picture” of the problem or issue?

The number of inpatient falls differs according to the hospital and department types. However, there appears to be consensus on the problematic nature of falls in all hospitals and departments. There is also consensus among all hospitals that the major implications of falls are physical injuries to patients and substantial costs to the institutions. According to Morello et al. (2015), patients who fall and sustain serious injuries are burdened with a payment of $13,316 more than those patients who had not fallen, as well as spending at least eight additional days at the hospital. Although, as mentioned above that, one of the major implications of inpatient falls are physical injuries to patients, there are also injuries that are associated with a mental component, such as loss of confidence in oneself, anxiety, and the fear that they may fall again, to name a few. Therefore, my project will address the issue of inpatient falls in a hospital setting, and I have selected Homes Regional Medical Center (HRMC) in Central Florida, telemetry department, as the case study for this project.

What is the significance of this problem?

Inpatient hospital falls continue to be a growing healthcare problem across the care continuum and have become one of the most popular adverse events re-counted by hospitals in the United States (U.S). Unintentional falls have been associated with a myriad of injuries for individuals over 65 years. Titler (2016), noted that more than 30% of patient falls have caused severe injuries, including fractures and in some instances, death. Furthermore, hospital falls can extend the patient’s hospital stay and cause the patient to be discharged to a skilled nursing facility rather than the comfort of their home, and this can increase the healthcare cost for the patient. According to Currie (2008), at least 2% of patients experience at least one fall during their hospital stay. The author posits that approximately 700,000 to 1 million falls occur in hospitals in the U.S, and these falls have resulted in approximately 11,000 deaths and 250,000 injuries (Currie, 2008). LeLaurin & Shorr (2019) noted that hospital falls had caused significant problems to patients economically and physically since it increases mortality rates and decreases the patient’s quality of life. It also burdens healthcare institutions since it increases the cost of hospital stays and litigations. The Centers for Medicare & Medicaid Services (CMMS) intervened in 2008 to revise their policy and cease any reimbursements to hospitals submitting claims for injuries related to inpatient falls (Inouye et al., 2009). Although hospitals have been implementing interventions to address this issue, the problem continues to exist and has created extensive burdens on families and institutions.

Where does this problem “live” that is, what is the “neighborhood” like?

My project will be focused on a large 500-bed inpatient hospital with approximately 500 skilled physicians employed at the facility. The hospital is Holmes Regional Medical Center (HRMC) in Florida. The facility is equipped with a heart center that performs the highest number of cardiac procedures than its counterparts in that county. It also includes a trauma center and provides 24-hours trauma care. The hospital has been climbing annually in terms of inpatient falls, especially the units that address admission stays longer than two consecutive days in the hospital. This issue has placed a huge financial burden on the hospital and a physical burden on the patients.

References

Currie, L. (2008). Fall and injury prevention. In R. G. Hughes (Ed.),  Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US).  https://www.ncbi.nlm.nih.gov/books/NBK2653/Links to an external site.    

Inouye, S. K., Brown, C. J., & Tinetti, M. E. (2009). Medicare nonpayment, hospital falls, and unintended consequences.  The New England Journal of Medicine, 360(23), 2390–2393.  https://doi.org/10.1056/NEJMp0900963Links to an external site.   

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: State of the science.  Clinics in Geriatric Medicine, 35(2), 273–283.  https://doi.org/10.1016/j.cger.2019.01.007Links to an external site.

Morello, R. T., Barker, A. L., Watts, J. J., Haines, T., Zavarsek, S. S., Hill, K. D., Brand, C., Sherrington, C., Wolfe, R., Bohensky, M. A., & Stoelwinder, J. U. (2015). The extra resource burden of in-hospital falls: A cost of falls study.  The Medical Journal of Australia,  203(9), 367.  https://doi.org/10.5694/mja15.00296Links to an external site.

Titler, M. G., Conlon, P., Reynolds, M. A., Ripley, R., Tsodikov, A., Wilson, D. S., & Montie, M. (2016). The effect of a translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre-post implementation study in the U.S.  Applied