two replies to responses
Reflect on the triple aim and describe your role as an APRN in achieving the triple aim.
The triple aim was designed to improve health care in the United States by implementing a system that enriches the experience of care, enhances the overall health of populations, and decreases per capita costs of health care (Berwick et al., 2008). While the triple aim is ideal, it has not become a standard of practice in today’s healthcare industry, which seems to be driven by profits and the filling of hospital beds. I believe that the APRN is a vital component in implementing and achieving the triple aim. When I graduate as a future APRN, I would like to open a small practice comprised mainly of 3-4 APRNs. We would enrich the experience of patient care by centering the operation of our clinic around the patient. We would function in a manner consistent with timeliness and efficiency in scheduling and treating patients. Offering convenient services such as telehealth appointments may increase the perceived quality of care, and facilitate access to care (Polinski et al., 2016). This would enhance the overall health of populations by offering a new and more time-efficient way to receive healthcare. Per capita costs of healthcare would be reduced for providers as it would reduce the amount of office overhead that goes to waste due to patients who “no show” to appointments due to various circumstances. Not to mention the cost savings that would be passed along to the patient. Telehealth would allow the provider to offer remote visits at a lower rate than what they normally offer and may even save the patient from unnecessary emergency room visits (Cheney, 2019).
Identify a population of interest to you. This population can be broad (national) or local (community). Describe the population. How do you know what defines that population? What health outcomes would you define for this population? A population of interest to me is the geriatric population aged 65 and older. This is one of the fastest-growing populations that is projected to almost double from 52 million in 2018 to around a staggering 95 million by 2060 (Mather et al., 2019). There will likely be inconsistency in the economic and physical welfare of this population-based on gender and ethnic groups. Statistical analysis of this population group has shown us that older women are more likely to live alone and tend to be poorer, black men and women have lower life expectancies, and minorities are more likely to rely solely on Social Security for their family income (Mather et al, 2019). With the lower economic status that is prevalent in this population, I would expect there to be more health issues and roadblocks to receiving healthcare. This population would have to prioritize necessities such as shelter and food against costly healthcare and medications. I would anticipate there to be more cases of self-neglect, injuries related to falls due to limited mobility and failing eyesight, and age-related onset problems such as diabetes and arthritis.
For your chosen population, identify two or three health disparities that are common to the population. Why do these disparities exist among your population of interest?
Common health disparities in the geriatric population are diabetes, high blood pressure, heart disease, arthritis, and cancer. These disparities exist due to baby boomers (ages 51 to 69 in 2015) living longer than previous generations (Mather et al., 2019). Older adults are less active and the prevalence of obesity in the United States is skyrocketing which leads to many of the chronic health conditions mentioned.
Using the various statistical and data websites, discuss your population of interest using data. What statistics define the population? Provide background data that allow readers to understand your population of interest. What health disparity statistics can you share with the group? This would allow readers to understand the critical disparities among your population of interest.
The geriatric population is age 65 and older and is one of the fastest-growing populations that is projected to almost double from 52 million in 2018 to around a staggering 95 million by 2060 (Mather et al., 2019). One of the largest growing health disparities in this group is obesity, which leads to chronic health issues. A recent analysis of the U.S. obesity trends revealed that in the population aged 65 to 74, the number of men who were obese increased from 24 percent to 36 percent over a two-decade period; women increased from 27 percent to 44 percent (Mather et al., 2019).
The “Triple Aim” describes a set of interconnected goals that when collectively achieved, can have a positive systemic effect on health care (Berwick et al., 2008). The three goals comprised in the Triple Aim are improvement of patient care experience; optimization of the health of populations; and reduction in health care costs per capita of populations (Berwick et al., 2008). As an APRN and a future healthcare leader, I am obliged to be an active participant in the pursuit of the Triple Aim. Specifically, I must be a productive member of a team of “integrators”, or “… an entity that accepts responsibility for all three components of the Triple Aim for a specified population” (Berwick et al., 2008). According to Berwick (et al., 2008), “pursuit of the Triple Aim requires that the population served become continually better informed about both the determinants of their own health status and the benefits and limitations of individual health care practices and procedures”. As an APRN and integrator for the Triple Aim, it is my duty to thoroughly educate my patients so they may take active roles in their care. Furthermore, “a conscientious integrator would aspire to produce or contract for individual care and population-based interventions that are evidence-based and highly reliable”. Another aspect of my role as an APRN in achieving the Triple Aim is to stay abreast of the most current evidence-based practice methods in order to provide patients with the best possible outcomes.
My population of interest is women diagnosed with cervical cancer living in the state of Texas. The population is identifiable by their gender, Texas residency, and diagnosis of cervical cancer reported in the Texas Cancer Registry database (Lin et al., 2015, p. 22). The health outcomes I would define for this specific population would be either survival or mortality of their cervical cancer diagnosis. Lin et al. (2015) and his cohorts further differentiate the population’s outcomes by categorizing the women based on the grade of tumor and type of treatment used (p. 24).
Lin et al. (2015) performed a study on approximately 11,212 women who were diagnosed with cervical cancer while living in Texas between 1995 and 2005 (p. 22). The study revealed disparities among the population, specifically with race and socioeconomic status (Lin et al., 2015, p. 24). The authors “… found that African-Americans had higher overall mortality risk, which is consistent with findings of several studies conducted in the United States” (Lin et al., 2015, p. 25). In an attempt to rationalize this disparity, Lin et al. (2015) explain, “according to the Behavioral Risk Factor Surveillance System (BRFSS), African Americans had a persistently higher percentage of not having health insurance when compared to non-Hispanic whites in Texas during 2002-2010 (as cited in Center for Health Statistics, 2012). Furthermore, the study yielded evidence that suggests an inverse relationship between socioeconomic status and mortality rate; the risk of death among individuals increased the lower the SES (Lin et al., 2015, p. 24).
The screening tool used to detect HPV, a virus that can lead to cervical cancer, is the Pap smear. According to KFF.org (2020), from 2016-2018, 73% of Texas women ranging in age from 18-64 reported having a pap smear within the last three years. Therefore, 23% of the studied population was not screened for HPV, increasing the likelihood of the development of cervical cancer among these individuals (KFF.org, 2020). Furthermore, 20% of Texas women reported not being seen by a healthcare provider in the previous year (KFF.org, 2020). There were likely several factors that influenced the above statistic, one of them being lack of insurance. As reported by KFF.org (2020), in 2018, 23% of women in Texas ages 19-64 were uninsured. Lack of access to healthcare leads to a decrease in screening for HPV in this population, increasing the risk for the development of cervical cancer. org (2020) reports 2.7 cervical cancer deaths per 100,000 women in Texas in 2018. Furthermore, the incidence of cervical cancer deaths among black women was almost double that of white women in Texas in 2018 (KFF.org, 2020). It is statistically evident that there is a racial disparity amongst the population group. To further support this finding, Lin and his cohorts found African American women to be 38% more likely to succumb to their diagnosis of cervical cancer than non-Hispanic white women (Lin et al., 2015, p. 24)
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