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Rate-based measures of quality in Palliative Care
Rate-based measures of quality in Palliative Care
Describe the three rate-based measures of quality to improve the quality improvement practice gap in Palliative Care
Assignment 2: Tools for Measuring Quality
How do we determine quality? Quality in other areas of our lives can be subjective, so how do we ensure—specifically as it relates to our nursing practice— that quality is clearly defined and measurable?
Tools for measuring quality are used to assess the value measured, collected, or compared. These tools allow for subjectivity to be replaced with objectivity through data, formula, ranking, and analysis
Photo Credit: Getty Images/iStockphoto
For this Assignment, you will explore at least three rate-based measures of quality. You will deconstruct each measure to explore your understanding of the measure, its importance, and its impact on patient safety, cost of healthcare, and overall quality of healthcare.
To Prepare:
Review the Learning Resources, for this week, and reflect on tools for measuring quality in nursing practice.
Select three rate-based measurements of quality that you would like to focus on for this Assignment.
Note: These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care.
For the purposes of this Assignment, an analysis of staffing levels is not permitted.
You can find useful information on quality indicators that are of interest to you on these websites and resources. You may choose only one of the three measures to be some form of patient satisfaction measure.
Consider how the three rate-based measures (you will select) are defined, how the rates were determined or calculated, how the measures were collected, and how these measures are communicated to both internal and external stakeholders.
Reflect on how the three rate-based measures (you will select) may relate to organizational goals for improved performance.
Reflect on the three rate-based measures (you will select), and consider the importance of these measures on patient safety, cost of healthcare, and overall quality of healthcare.
The Assignment: (8–10 pages)
Describe the three rate-based measures of quality you selected, and explain why.
Deconstruct each rate-based measure to include the following:
Describe the definition of the measure.
Explain the numerical descriiption of how the measure is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.).
Explain how the data for this measure are collected.
Describe how the measurement is compared externally to other like settings, and differentiate between the actual rate and a percentile ranking. Be specific.
Explain whether the measure is risk adjusted or not. If so, explain briefly how this is accomplished.
Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace. Be specific and provide examples.
Describe the importance of each rate-based measure to a chosen clinical organization and setting.
Using the websites and resources, you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic, or private office; a total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might home in a particular health plan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings.
Note: Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the Instructor for guidance. You do not need actual data from a given organization to complete this Assignment.
Explain how each rate-based measure (you selected) relates to patient safety, to the cost of poor quality, and to the overall cost of healthcare delivery. Be specific and provide examples.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.
Patient Healthcare Plan
Patient Healthcare Plan
Over the last two weeks, you sketched out some demographics for your fictitious client. Using these
characteristics, you will now begin the incremental process of creating a physical activity plan – also known
as an exercise prescriiption – for your client.
For your Module 3 assignment, you will complete the AHA/ACSM Health/Fitness Facility Preparticipation
Screening Questionnaire for your chosen client. This should align with the demographic and health status
profile you completed in Modules 1 and 2.
Then, select one screening questionnaire/calculation from ExRx.net for each of the three health-related
4 components you identified for your fictional client.
After completing the forms and reviewing the rubric for this assignment, it is time to look at the evidence
base to guide your work. Go the literature at the Excelsior Library and to one of the professional
associations/organizations provided at the end of this document. In an APA formatted, 2 to 4-page, doublespaced paper, please address the following:
1. In 1-2 paragraphs, briefly describe your fictitious client so that the reader has some context for the
project.
2. In 1-2 paragraphs, state which fitness tests you completed on behalf of your client on ExRx.net and
what the results were.
3. Considering the client’s health status (from Module 1), barriers and motivators to exercise (from
Module 2), risk stratification results, and results from the fitness tests performed, describe 2
potential exercise restrictions you might recommend.
4. Based on the literature you have read, your course readings, and evidence-based recommendations
from professional sources, what would be your suggestions for starting an exercise program?
5. What modifications do you envision for aerobic and strength-based training? Do you foresee any
potential modifications for flexibility training? Please explain, supporting your rationale with course
and external literature.
You will need to apply information from at least four sources. Your sources must include the following:
● One of your course readings or videos and
● At least one current and credible article from the Excelsior Library directly related to the fictitious
client’s health status or risk profile and
● Information from the ACSM on risk stratification or results from the ExRx.net tests and
● At least one professional association/organization (ACSM or other credible organization). See the
organizations list below.
Your sources must reflect current standards in physical activity and fitness training.
Your paper must also include the following:
● Use of essay style, including complete sentences and paragraphs
● Thorough spell and grammar checking
● Use of in-text citations (with corresponding references) for all information that is from another
source
● An APA formatted title page
● An APA formatted reference page.
The following are some of the top exercise organizations. You will find helpful information to assist you in
completing your assignment.
● American College of Sports Medicine (ACSM)
● American Council on Exercise (ACE)
● International Sports Sciences Association (ISSA)
● National Academy of Sports Medicine (NASM)
Immune Cells as Villains Misdirected Immune Attack During Autoimmune Diseases
Immune Cells as Villains Misdirected Immune Attack During Autoimmune Diseases
Cells of our immune system often serve as “heroes,” playing protective roles in our bodies against
various pathogens and diseases. However, failure of tolerance to self-antigens elicits “villainous”
immune activity by an individual’s T cells and antibodies, resulting in destructive tissue damage and
disease. These misdirected immune attacks are called autoimmunity, and the diseases they cause are
called autoimmune diseases.
Autoimmune diseases, like allergic reactions, are more common in countries with more prosperous
economies. The incidence of autoimmune diseases in these countries has steadily increased over the
last 80 years and is largely explained by the impact of lifestyle and a hyper-sanitized environment on
the immune system. Researchers are trying to elucidate what makes some people more susceptible to
autoimmunity. Genes that control self-tolerance mechanisms play an important part, but a trigger is
necessary to prompt the autoimmune process. The main culprits are viral infections, and data from the
current Covid pandemic have reinforced this idea. However, changes in microbiome composition are
also starting to emerge as possible contributors to autoimmune susceptibility. Autoimmune diseases
are generally more common in women than in men but the reasons for this observation are unclear.
Various immune effectors, mainly autoantibodies and autoreactive T cells cause tissue injury in different
autoimmune diseases. The clinical manifestation of the disease depends on whether the site of the
autoimmune attack is localized to a particular organ/tissue or is more systemic. Autoimmunity tends to
be discovered after years of the initial immune attack when the tissue damage has escalated to cause
a disease that becomes chronic and self-perpetuating since the target of immune attack are self-antigens
that cannot be eliminated.
Format: 5-6 pages long (max 1800 words); double-spaced; 1-inch margins; 12 pt Times. Your paper
can refer to any assigned course content (required/recommended readings (e.g. papers, textbook),
references provided on slides) or additional references that you find on your own. Please do not
reference lecture slides.
Assignment Content
The assignment can be approached in several ways, including (but not limited to):
1. Focus on the mechanisms governing tolerance to self: elimination of autoreactive clones during
lymphocyte development; induction of ‘anergy’; function of regulatory T cells (Tregs);
engagement of inhibitory molecules such as CTLA-4. Gene variants that abrogate or impair the
function of these regulatory processes should be at least mentioned.
2. Focus on genetic susceptibility to autoimmune disease. This focus can be seen as a
variation/extension of point 1 and should focus on susceptibility genes that have been identified
in family studies and genome-wide association studies (GWAS), including HLA and non-HLA
genes.
3. Focus on environmental factors which are thought to act as triggers of autoimmune attacks in
susceptible people. These should include the role of viral infections (of which a focus of its own
could be ‘long Covid’ and autoimmunity); sex hormones; microbiome imbalance
4. Focus on a particular disease, e.g., multiple sclerosis or type I diabetes. In this focus, your
paper should provide context by including an introduction where points 1-3 are summarized in
half to one page.
5. A ‘holistic approach’ where points 1-3 are all explored in some depth, as per word limits.
6. Focus on the treatment of autoimmune disease. In this focus, your paper should provide context
by including an introduction where points 1-3 are summarized in half to one page. It can include:
A. conventional immunosuppressive therapy; B. monoclonal antibodies targeting specific self-antigens,
blocking inflammatory cytokines, blocking immune cell trafficking, blocking costimulatory
pathways; C. therapies to restore tolerance; D. more experimental therapies
including the creation of personalized Tregs.