Response one ms-06

"Heart failure (HF) is a condition that affects the heart ability to push blood through the body, with the decline of the heart muscle, the life expectancy and quality of life is getting short and worse. Heart failure is a leading cause of hospitalization, also the rate of readmissions due to HF is also high." (Aidemark & Askenas, 2016, page 216)

Heart failure patients often present with the same symptoms, such as dyspnea (trouble breathing), weight gain and/or swollen joints, new or increased oxygen requirement, or chest pain. Medication adherence and daily weights are a critical part in maintaining good health when a patient has heart failure.

"Common signs and symptoms of heart failure include exertional dyspnea, orthopnea, peripheral edema, reduced exercise tolerance, paroxysmal nocturnal dyspnea, and weight gain." (Shah, Simms, Barksdale, & Wu, 2015, page 87)

Doctors and nurses should be able to predict what will happen to the patient when he or she decides not to take their medicines, track their weight, or maintain communication with their doctors. The idea of feed-forward speaks to the doctors and nurses being able to say "if you don't take your medications, you will have further issues with water retention, which can lead to trouble breathing", based on previous experiences with other patients.

"A patient's ability to perform self-care is crucial to the overall management of heart failure and is needed at all stages of the disease.7 Self-care behaviors help decrease all-cause hospital admission and readmission for heart failure exacerbations.8 Medication adherence is the most important self-care behavior to prevent acute exacerbations of heart failure." (Shah, Simms, Barksdale, & Wu, 2015, page 88)

When a medication regimen is followed, it can reduce the risk of multiple hospitalizations, improve survival rates, and controlling symptoms. When educating a patient regarding their medication regimen, and whatever else needs to be discussed, is to invite the patient to participate in the teach back process.

This is when a patient will repeat back to the nurse what had been discussed, and will demonstrate the proper way to do something, if necessary. "Utilization of an interdisciplinary team can be effective in delivering education about medication adherence. The interdisciplinary team could consist of a nurse, pharmacist, registered dietician, social worker, and a physician.

The interdisciplinary team would assist the patient in understanding the relationship between medication, diet, and symptoms." (Shah, Simms, Barksdale, & Wu, 2015, page 93)

KPJ Aidemark, J., & Askenäs, L. (2016). Flexible Self-care Solution Portfolio: Adaptive Support for Patient Centered Heart Failure Care. Procedia Computer Science, 100(International Conference on ENTERprise Information Systems/International Conference on Project MANagement/International Conference on Health and Social Care Information Systems and Technologies, CENTERIS/ProjMAN / HCist 2016), 215-220.

Response two ms-06

Reducing healthcare errors, providing a high quality of care that is cost effective and increased patient satisfaction are all areas that are being monitored in healthcare. Not treating a chronic disease to the point where the patient is failing to reach established evidence based goals throws a red flag up in all areas.

The healthcare team needs to identify patterns in behaviors to predict the future and determine actions against those poor behaviors. Feedback uses data results of past actions to guide treatment decisions, while feed-forward makes treatment decisions based on anticipated future states.

In feedback strategies the physician uses previous blood glucose values to adjust the dosing of medications. The patient and healthcare team should meet every ninety days to discuss management and monitor A1c to see how it related to the goal. This allows the physician to make any necessary changes to the medications and monitor another goal: diet, exercise, are preventing further health deterioration.

Feed-forward estimates the current data and behavior to predict the risk of comorbidity and complications. The healthcare team uses this data to educate on prevention and behavior modification.

Diabetes has a large vascular effects on the body causing an increased risk morbid and mortality. More resources may be needed as the patient gets older to help them maintain a quality of life. Nutrition, exercise, occupational therapy can help by providing alteration and strengthening so the patient can be compliant with treatments.

Nelson, E. C., Batalden, P. B., Godfrey, M. M., & Lazar, J. S. (2011). Value by design: Developing clinical microsystems to achieve organizational excellence. San Francisco: Jossey-Bass

Using Data Mining to Predict Errors in Chronic Disease Care

Shah, D., Simms, K., Barksdale, D., & Wu, J. (2015). Improving medication adherence of patients with chronic heart failure: challenges and solutions. Research Reports In Clinical Cardiology, Vol 2015, Iss Default, Pp 87-95 (2015), (default), 87.

Response three ms-06

With my patient population, VA patients with head and neck cancer using active duty military microsystems for care, implementing a feed-forward like method would enrich not just my population, but all VA patients that are in need of a surgical procedure.

My rationale for this method is because of my experience working at a joint VA-active duty military facility in Alaska. In this environment, VA patients requiring a surgical speciality (i.e. thyroid surgery) would see their VA primary care provider and then get referred over to an active duty surgical clinic like mine (Ear, Nose and Throat).

Now if both of our facilities used the feed-forward method, we would be able to share important data like surgical utilization and availability. Active duty surgical clinics can have extensive wait times for surgery, even with just the active duty population. Also, medical personnel change periodically sometimes creating manning shortages in both the operating room and specialty clinics.

With feed-forward "...to use this information to improve care processes so future patients will get the right treatment in the right way, efficiently, safely and effectively." (Nelson, Batalan, Godfrey & Lazar, 2011) future VA patients that may need surgery, could get sent away from the active duty facility and sent to another facility that can accommodate their procedure with less of a wait time.

With certain surgeries related to cancer, timing is critical and some VA patients that I have seen usually feel that they are a burden on the system and therefore wait to seek treatment. By the time they come to my clinic, surgery may be needed as soon as possible. This causes my clinic to reschedule patients already consulted for surgery, creating a longer wait for existing and new patients.

Nelson, E. C., Batalan, P. B., Godfrey, M. M., & Lazar, J. S. (2011). Value by Design:

Developing clinical microsystems to achieve organizational excellence (1st ed.). San Francisco, CA: Jossey-Bass.