Patient Perspectives on Quality of Life - Blog 4

A recent article in the Wall Street Journal by Laura Landro entitled “The Simple Idea That is Transforming Health Care” focuses on the issue of quality of life for health care patients. In the article, Landro purports that a patient’s perception of quality of life can be swayed when he or she is focused on smaller, more specific goals for treatment. Lofty goals, such as reducing one’s cholesterol or blood pressure in an effort to treat diseases, can be stressful on a patient. When such a large task is ahead of a person, the efforts to treat symptoms can be daunting and seem impossible to accomplish.

New theories suggest that counselors who ask personal questions to patients relating to the patient’s condition, happiness, and daily struggles can have a great impact on that patient’s quality of life (Landro, 2012). In fact, with the advice of counselors on how to improve one’s life on a daily basis and how to cope with symptoms of a disease, patients have reported feeling less stressed about their conditions and struggles with treatment management. The reasoning follows that patients are daunted by seemingly innocuous tasks such as lowering blood pressure, but are better able to handle personal goals, such as performing better at work or being able to spend more time with family.

The key to this strategy is following up with patients. Unlike doctors, counselors can spend more time going over goals with patients. While a patient may see a doctor a few times a year, he or she can meet with a counselor on an ongoing basis. Many experts believe that such follow-ups are vital to helping a patient meet treatment goals (Landro, 2012). Counseling programs can help patients keep track of their symptoms and can answer questions that one might have regarding things like possible drug interactions or how to handle certain aspects of family life as related to one’s illness.

Lawmakers seem to agree with this idea, as the Affordable Care Act of 2010 included $3 billion of funding to help patients improve their quality of life throughout care (Landro, 2012). Instead of solely focusing on illness treatments, a Patient-Centered Outcomes Research Institute will use more personal measures when searching for new treatments. This will be one of the first institutes of its kind to completely incorporate patient-perceived quality of life into treatment research.

Hopefully further research can provide more in-depth insight into the benefits of patient counseling. While it has been known that patients who are followed up are readmitted less, there has not been enough research to say for certain that it is due to patient counselors (Landro, 2012). With the country’s recent move toward a focus on preventive care instead of simply treating a patient’s symptoms, counseling can be a relatively cost-effective way to keep patients on track with his or her treatment. 

Landro, L. (2012, April 16). The simple idea that is transforming health care. The Wall Street Journal. Retrieved from http://online.wsj.com/article/SB10001424052702304450004577275911370551798.html

Adverse Events in Healthcare

According to Chapter 11 of The Health Care Quality Book, the goal of patient safety in health care is for no patient to experience “unnecessary harm, pain, or other suffering” (Ransom, Joshi, Nash, and Ransom, 2008, p. 244). The book defines a patient’s personal experience of injury or harm resulting from a medical event as an adverse event. This is why the perspective of the patient is the most important determinant as to whether an adverse event has occurred.

Adverse events can be caused by human errors, such as administering to a patient the wrong type or wrong dosage of medicine, resulting in harm coming to the patient. These errors can also occur and not be adverse events in the case of the error not causing any harm to the patient. An example of an error not causing an adverse event could include the administration of the wrong medicine to a patient when the error is caught before the patient ingests the medicine. While an error was still made, no harm came to the patient and the patient still views the care as satisfactory.

Alternatively, adverse events can be caused by the nature of a surgery or procedure with widely known or common complications. For example, in a surgery with common complications that do not derive from human error, an adverse event can occur even if the surgeons, doctors, and nurses perform their duties perfectly.

When an adverse event occurs, such as the death of a patient, there is always someone who wants to assign blame. It is unfortunate that this often leads doctors to lawyer-up in preparation for a malpractice lawsuit. In class, it was discussed that very often the families of the deceased simply want an explanation and apology from those responsible, not a lawsuit; however, an explanation and apology can be seen as an admission of guilt and can potentially be used against the defendants in court. I wish there could be more of a culture of learning from mistakes instead of hiding them so that others could learn from them and hopefully decrease their frequency.

Ransom, E. R., Joshi, M. S., Nash, D. B., Ransom, S. B. (2008). The health care quality book: Vision, strategy and tools (2^nd ed.). Chicago, IL: Health Administration Press.

My Grandmother and Nursing Home Care

            After my grandmother, Estelle, broke her hip just over two years ago, it wasn’t long before talk of finding a suitable nursing home came to be a common topic of conversation between my parents. At 91 years old, she was one of the oldest inhabitants at her apartment community for “active seniors” in West Palm Beach and it was no surprise to any of her friends and neighbors that the time would soon come for her to need more help.

            Just after surgery and a few months in a rehabilitation facility, Estelle was ready to move to a long-term care nursing home. In anticipation of this move, my family had put her name on a waiting list at a few nursing homes in her area; however, when the time came for her to leave the rehabilitation center there were still no open spots available. My family panicked at the thought of Medicare ending payment to the rehabilitation facility and us having to pick up the astronomical bill for a prolonged residency while we waited for a bed to open. The wait was excruciating for both my grandmother and my parents as beds came and went due to management’s confusion and incompetent staff whose correspondence with Medicaid made the wait that much harder. 

            Finally, we decided that my grandmother should move to an Orlando nursing home so we could more easily advocate for her care from a greater proximity. While waiting for an open bed at a local nursing home, the director of the facility kept in constant contact with my family to update us on the status and presumed availability of new beds. The director’s personable nature really helped my family to see the facility as one that really cared about its patients and their families. One day, a staff member alerted my parents to a bed that would be ready in the coming week, yet when the director called to give us more information, we learned that he did not think the roommate would be a good match for my grandmother because the woman had a long history of past roommate troubles. Unlike stereotypical nursing home directors, anxious to fill beds, this director seemed to care more about my grandmother’s well-being. 

            Once a suitable bed opened up and my grandmother entered the facility, we were pleasantly surprised at the quality of care present in the nursing home. The staff always seemed to be friendly and helpful, something Estelle loves. Additionally, a nurse always responds to our calls and concerns in a timely manner. My parents have even had numerous phone conversations with my grandmother’s main doctor over our wishes to provide her with dietary supplements that were not prescribed by one of her doctors. The physician’s willingness to work with us made my grandmother’s transition into the nursing home as easy as could be. 

            What worries me, however, is the quality of care provided to patients who do not have strong advocates, such as parents like mine. Estelle’s roommate, Mercedes, is one of those patients. Although Mercedes’ daughter lives less than an hour away, she is rarely present for Mercedes’ medical appointments and to oversee treatment. Although her quality of care seems to be good, there have been instances where my father has had to step in and speak with a doctor on her behalf due to her inability to know what is best for her. It seems that there should be an advocate, independent of the nursing home, available to provide information to patients and act on their behalf on a daily basis. These advocates would provide assistance to those patients who may have trouble asking for help on their own.  

Quality in Healthcare and What it Means to Me

The concept of quality can be a tricky thing to define. An acceptable level of quality can be different for many people depending on whether they try to define it for a good or a service, and even then quality can vary. Researchers have developed six dimensions of quality that make up care: safety, effectiveness, efficiency, timeliness, patient centeredness, and equality. In a healthcare setting, these dimensions can mean something completely different to each stakeholder asked, including patients, doctors, staff, and insurance providers. Each of these groups of people may have a different idea about the level of quality that is acceptable in a healthcare environment.

            Patients, on one hand, most likely want to receive the highest possible level of quality. Due to medical advancements in recent years, patients have come to enjoy the newest procedures and tests available; however, these advancements come at a higher cost and patients often do not want to or are unable to cover the increasingly high costs of care. Doctors may have another idea of quality altogether. While a patient may feel that a long wait time is an indicator of low quality, a doctor may deem the long wait time necessary. Additionally, insurance companies may not feel that certain tests or procedures are necessary for a patient’s care and can refuse to cover them.

            There are many problems with the quality of care in healthcare organizations. Although no organization is perfect, these three problems can occur anywhere. Underuse occurs when good practices are not used as often as they are needed. An example of underuse is when a necessary test or procedure, often preventive in nature, is not provided or offered to the patient. If a patient is uninformed, as it is easy to be in the complicated healthcare world, it is up to the doctor to explain all the options for care. Overuse is another problem with quality and occurs when procedures or tests that are not necessary are used. This overuse can be invasive to the patient and can also unnecessarily drive up the cost of care. Finally, misuse is a healthcare quality problem in which the wrong care is delivered. This can occur when the wrong drug is administered to a patient or the wrong amount is given. Misuse also occurs when a doctor prescribes drugs to a patient who clearly does not need them, such as in pill-mill situations.

            To me, high quality means that the patient receives the best care possible within the six dimensions of care mentioned above and there is little to no overuse, underuse, and misuse of care. Of course, there must be a balance between the quality and cost of care as some may be able to pay a higher cost for better services. This does not mean that only those who can afford high quality care should be the people to receive it. I believe that all people deserve good medical care and all tests and procedures necessary to live a healthy life; however, there must be standards for the minimum quality of care for those who may be financially unable to afford the “best” quality care.