Identify a clinical issue within the healthcare system that could be addressed by performing an in-depth research literature review.

Clinical Issue Article Analysis -Step 4

Summary of Article Findings
Our team was asked to identify a clinical issue within the healthcare system that could be addressed by performing an in-depth research literature review.  The first step was to associate a problem with factual evidence that it exists.  Our team decided that heart failure readmission was an issue we were familiar with, so the process began.  One of the first articles we reviewed stood out with a statement by Elixhauser as cited by Hilbert, Zasadil, Keyser, and Peele (2014) that stated, “Table 1 lists the 30 most frequently treated conditions in U.S. hospitals, with their 30-day readmission rates.  Among these most frequent conditions, the highest readmission rates were seen for congestive heart failure (24.7%)…” (p. 2).  This article, supported by numerous others including the Centers for Medicare and Medicaid Services website, demonstrated that heart failure readmission was a real problem in the United States.  Our team also wanted to demonstrate that there was an inherent cost factor to the health care system as it relates to this readmission dilemma, so our literature search continued.  A report by Hernandez et al. as cited by McClintock, Mose, and Smith (2014) states, “Approximately 90% of the readmissions attributed to HF are not planned and potentially preventable, translating into $17 billion or nearly 20% of Medicare’s hospital payments” (p. 430).  Further findings like the Center for Medicare and Medicaid Services (CMS) Readmissions and Reduction program, which place penalties that are now as high as 3% of the total charge for admissions deemed excessive, gave final support to the validity of our initial question (CMS, 2014).
Solution. The next aspect of our search was to determine if there were acceptable practices that had been proven to reduce hospital readmission rates in the heart failure population.  In an article by the Veterans Administration, results of a quantitative study demonstrated a significant reduction in admissions using a nurse practitioner team in the first year, but not in year 2 (Lowery et al., 2012).  Numerous reasons were given, including disease progression in the second year versus the first.  Mortality rates were diminished between the intervention and the control group in both year 1 and year 2, which is a significant finding as well.  Overall, the use of trained NP staff demonstrated a reduction in overall admissions and bed days over the first year, which would represent financial savings for a healthcare facility.  Another study from the UK looked at non-medical prescribing nursing staff in the care of heart failure patients.  According to Shannon and Spence (2011), “This qualitative study employed focus group and one-to-one interviewing” p. (450).  Other studies that were reviewed prior the implementation of this project found that patients were satisfied or very satisfied with NMP (non-medical prescribers) since they were easier to get in touch with and demonstrated great compassion.  The conclusion of the study found that the HFNS (heart failure nurse specialist) could be beneficial but that communication and training were needed to ensure the success of the nurse.
As our team continued to review literature, we discovered a study that examined certain discharge criteria that health care providers could take to ensure patients are discharged appropriately and that health care does not end there.  These instructions include medication use, diet and exercise adherence, what to do if heart failure symptoms are noted, and the need for compliance with their future physician appointments (Feltner et al., 2014).  The problem we discussed would be that it will take close follow-up with the patient and family to ensure these measures are met.  Patients who are non-compliant and have multiple chronic health conditions will need extra assistance from skilled professionals.  The research article revealed that a high-intensity home visiting program prevented 30 day readmits of all the trial studied.  Finally, a study that explored current approaches to management of CHF and their challenges in Uzbekistan was reviewed. The article discussed the challenges and factors that affect the implementation of quality care about CHF, both physician and patient perspectives.  One barrier mentioned that could be overcome in the CHF population included hospitalization of CHF patients every 6 months on average.  This process did not show evidence of clinical effectiveness and posed a financial burden to patients and their families as well as the health care system (Ahmedov et al., 2013).  Multiple barriers were noted in Uzbekistan and included a lack of general overall consensus towards managing this disease.  As a result of the study, it was concluded that data collection would be needed to improve overall quality factors.  The study of these results would allow their health care systems to produce national standards that address multiple aspects of this care process.

Ahmedov, M., Green, J., Azimov, R., Avezova, G., Inakov, S., & Mamatkulov, B., (2013). Addressing the challenges of improving primary care quality in Uzbekistan:  A qualitative study of chronic heart failure management. Health Policy and Planning, 28(5), 458-466. doi:10.1093/heapol/czs091
Centers for Medicare & Medicaid Services.  (2014).  Readmissions reduction program.  (CMS FY 2015 IPPS Final Rule).  Retrieved from
Feltner, C., Jones, C. D., Cene, C. W., Zheng, Z., Sueta, C. A., Coker-Schwimmer, E. J.,…Jonas, D. E. (2014).  Traditional care interventions to prevent readmissions for persons with heart failure:  A systematic review and meta-analysis.  Annals of Internal Medicine, 160, 774-784.  doi:  10.7326/M14-0083
Hilbert, J. P., Zasadil, S., Keyser, D. J., & Peele, P. B. (2014).  Using decision trees to manage
hospital readmission risk for acute myocardial infarction, heart failure, and pneumonia.  Applied Health Economics and Health Policy, 12(6), 573-585.  doi:  10.1007/s40258-014-0124-7
Lowery, J., Hopp, F., Subramanian, U., Wiitala, W., Welsh, D. E., Larkin, A.,…Vaitkevicins, P. (2012).  Evaluation of a nurse practioner disease management model for chronic heart failure:  A multi-site implementation study.  Congestive Heart Failure (Greenwich, Conn.), 18(1), 64-71.  doi:  10.1111/j.1751-7133.2011.00228.x
McClintock, S., Mose, R., & Smith, L. F. (2014).  Strategies for reducing the hospital readmission rates of heart failure patients.  Journal For Nurse Practioners, 10(6), 430-433.  doi:  10.1016/j.nurpra.2014.04.005
Shannon, E., & Spence, W. (2011).  The attitudes and views of GPs and physicians to     prescribing by heart failure nurse specialists.  British Journal of Cardiac Nursing, 6(9),     450-455.  Retrieved from  (AN 2011326281)

Are you looking for a similar paper or any other quality academic essay? Then look no further. Our research paper writing service is what you require. Our team of experienced writers is on standby to deliver to you an original paper as per your specified instructions with zero plagiarism guaranteed. This is the perfect way you can prepare your own unique academic paper and score the grades you deserve.

Use the order calculator below and get started! Contact our live support team for any assistance or inquiry.