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Improving Chronic Hypertension Among Underserved Ambulatory Patients

Julia Childress, Brooke Myers, Sydney Muller, Stephanie Mwesigwa, & Morgan Tyner
Bon Secours Memorial College of Nursing

Description of the Issue Analysis of the Issue Solution

❖ Macro: Healthcare systems are financially impacted by Hypothesis: Implementation of a standardized education flow sheet that is
❖ Time Restraint disease/condition specific will improve the continuity and quality of
the improper use of resources due to repeat patient visits
➢ Per Care-A-Van, MDs & NPs are allotted a certain patient education.
with uncontrolled medical conditions, such as
number of patients to see in a day’s time but the Evidence: According to Care-A-Van representatives:
number of patients waiting exceeds the provider’s ➢ No method used to determine what education has been implemented in
➢ “This is the level where overall values, principles, and
capacity to care past visits.
strategies for health care develop, and where decisions
➢ Chronic care clinic only offers 30 minute ➢ No time effective method to determine the number of patient visits.
concerning resource allocation occur. Without overall
appointments one day a month for specialty and ➢ Progress notes searching is ineffective time management.
coordination at this level, health services are likely to be
complicated cases
wasteful and fragmented” (WHO, 2018). ➢ Patients cannot properly absorb all information for their chronic
❖ Consistency/Continuity of Care
➢ Government policies condition in one visit.
➢ No stability in patient-provider relationship
➢ Medicaid reimbursement/ Expansion of resources Evidence of research to support the hypothesis:
➢ Ineffective documentation of discharge teaching
❖ Micro: On a micro-level, the issue is broken down into ➢ Chicago Primary Care Group- 15 month quality improvement study
➢ Lack of review of self-management education
points such as, health behaviors, like diet, exercise, ○ Their goal was to increase the amount of patients with controlled HTN.
❖ Literacy Level & Content of Teaching Materials
smoking, alcohol use, drug use, and stress levels.
➢ Materials are provided at a sixth grade reading level ○ 64% of the patients had controlled HTN compared to only 34% before
➢ Access
when most of the population reads at a lower level the project was conducted (Gunter, 2017).
➢ Socioeconomic status
➢ No standardization of the teaching content
➢ Patient-Provider relationship
❖ Culture ❖ Staff training on new ConnectCare flowsheet
➢ Health literacy Logistics ❖ New flowsheet
➢ Physical activity and cost are not the primary barriers ❖ New education fact sheet for handout to patients
in self-management
❖ IT specialist--assist with new addition to software and
➢ Diet and the types of food eaten are directly linked to technical assistance
Root Cause a person’s culture (i.e., highly processed, canned ❖ Care-A-Van-- potential to deliver more care to more

food) Stakeholders patients through effective time management

❖ Care-A-Van administration--to ensure implementation
❖ Medical staff-- provide direct implementation of care
❖ Patient-- help improve self management of their chronic
Ineffective teaching due to condition
❖ time restraints References
Epping-Jordan, J. (2002). Innovative care for chronic conditions: Building ❖ Training of staff
❖ consistency/continuity of care blocks for action (pp. 35-40). Geneva, Switzerland: World Health Cost ❖ Creation of flowsheet by IT
❖ literacy level of teaching materials & content Organization. ❖ New printed education material
❖ culture
Gunter, K., Weyer, G., Vinci, L., Chin, M., & Peek, M. (2017). Estimated implementation time: 18 months
According to Marcus (2014), communication is often ❖ 0-6 months: Design and build
Hypertension control in the University of Chicago Primary
misunderstood when considering the factors that may Care Group. Clinical Diabetes Journals, 35(3). Timeline ❖ 6-12 months: Implementation
affect patient comprehension. The Joint Commission ❖ 13-18 months: Continuous monitoring to include
outcomes evaluation
identified the root cause of sentinel events and poor Marcus, C. (2014). Strategies for improving the quality of
verbal patient and family education: a review of the literature
patient outcomes to be related to inadequate
and creation of the EDUCATE model. Health Psychology & Behavioral ❖ Objective data collection of blood pressure
patient-provider communication. Medicine, 2(1), 482-495. Data Collection ❖ Baseline/final assessment questionnaire