Evidence-Based Practice And The Quadruple Aim Discussion

The connection between EBP and the Quadruple Aim

The Quadruple Aim is a framework proposed to improve the performance of healthcare systems. The Quadruple Aim framework encompasses improving patient experience, improving the health of populations, reducing costs, and improving the well-being of the healthcare team (Arnetz et al., 2020)Evidence-Based Practice And The Quadruple Aim Discussion. Implementation of Evidence-based practice (EBP) is essential for healthcare systems to achieve the Quadruple Aim. EBP is integral to the provision of care that is of high quality and cost-effective and it operationalizes the Quadruple Aim framework.   Cardoso et al. (2021) define EBP as making clinical decisions that take into consideration the best accessible evidence, the context of the delivery of care, the health professional’s judgment, and patient preference. Clinicians are recommended to implement EBP as it has been shown to improve patient health outcomes and experience, promote high-value care, and reduce costs of health care.

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How EBP might (or might not) help reach the four measures of Quadruple Aim

Patient experience

Evidence-based strategies such as shared decision-making through effective communication and patient-reported outcome measures (PROMS) can promote patient experience. According to Ndugbu and Agi (2024), PROMS are defined as questionnaires that a patient completes and that are of importance to the patient, such as the burden of symptoms and quality of life. PROMS can offer healthcare providers useful information about how the patient experiences their health condition and care/ treatment, which can assist providers in designing care that fulfills the needs of individual patients. Numerous studies have demonstrated that the utilization of PROMS has the potential to make patients more satisfied with care and have better outcomes. Shared-decision making entails the patient and clinician working jointly in making decisions about treatment based on the best accessible evidence and the values and preferences of the patient.  Shared decision-making is effective in improving patient satisfaction and outcomes. Evidence-Based Practice And The Quadruple Aim Discussion

Population health

Population health can improve through the implementation of population health interventions that are informed by evidence. Movsisyan et al. (2021) posit that population health interventions are programs and policies in health services research and the public aimed at changing the distribution of risk in populations. Rather than developing new interventions, implementing population health interventions that are informed by evidence, that is, interventions that have been evaluated for effectiveness, in new contexts might improve population health and save human and financial resources.

Costs

There has been a constant increase in healthcare costs globally.  Yet, effective healthcare systems are required to reduce costs while at the same time improving patient outcomes and experience of care. EBP can lead to a reduction in per-capita costs by preventing unnecessary treatments.  Evidence-based care and adherence to evidence-based practice guidelines reduce healthcare costs by reducing unnecessary services such as imaging laboratory tests and patient visits.  Unnecessary and expensive imaging studies and laboratory tests are done more regularly without justification (Walewska-Zielecka et al., 2021)Evidence-Based Practice And The Quadruple Aim Discussion.

Work-life of healthcare providers

EBP interventions that create a healthy work environment for nurses and other healthcare providers can improve the work life of providers. According to Mabona et al. (2022), a healthy work environment is created by leadership. Effective leadership along with decision-making are key components in the achievement of a healthy work environment and help in the development of policies and evidence-based practice, which guides nurses. Strong leadership is required at all levels, including bedside practice, the establishment of teamwork and intra-professional collaborations, and offering a safe environment through the identification and control of psychological hazards in the place of work.

Competing Needs

Efficiency vs. Evidence-Based Practice

Based on efficiency, hospital administrators may prioritize the quick deployment of the new medication management system in order to streamline operations, eliminate medication errors, and improve workflow efficiency. They may encourage speedy adoption to minimize disruptions and increase cost-effectiveness.

However, healthcare practitioners, particularly pharmacists, and doctors, may argue for a more careful approach to ensuring that the new system is evidence-based and consistent with best practices. They may urge for elaborate training programs, extensive testing, and a careful evaluation of the system’s effectiveness before wider implementation. This cautious approach may require more time, but it could result in better patient outcomes and fewer unpleasant occurrences.

Patient Safety vs. Cost Containment

            Pertaining patient safety, clinicians and patient advocates may put patient safety first, emphasizing the need for a new medication management system to prevent medication errors, adverse drug reactions, and other safety issues. Kelly and Porr (2018) point out that they may advocate for features like barcode scanning, automatic notifications for drug interactions, and integration with electronic health records to improve patient safety Evidence-Based Practice And The Quadruple Aim Discussion.

Hospital administrators, aware of budget limits, may be apprehensive about the cost repercussions of implementing the new system. They may seek cost-effective options, such as using a simple version of the program with no additional safety features or postponing upgrades and maintenance to cut current costs. However, sacrificing patient safety features in order to save money may increase the likelihood of adverse events and lower the quality of care.

Influence of Policy on the Evidence-Based Practice and Quadraple Aim

Many healthcare organizations create and apply Clinical Practice Guidelines (CPGs) to standardize and improve the quality of care for patients. CPGs are evidence-based recommendations based on systematic reviews and critical literature analysis. CPGs provide a practical example of evidence-based practice in healthcare organizations. They combine the best available data into practical suggestions, giving physicians a structured framework for providing ethical care that is in line with current evidence and guidelines.

CPGs can help achieve the Quadruple Aim by lowering clinical ambiguity and decision-making complexity for healthcare practitioners. When clinicians have access to clear, evidence-based recommendations through CPGs, it can help to reduce the stress and burden of clinical decision-making, potentially boosting provider satisfaction and well-being. Evidence-Based Practice And The Quadruple Aim Discussion

Critiqueing the Policy for Ethcal Considerations

Strengths in Promoting Ethics

CPGs, when created with input from a variety of stakeholders, including patients, can prioritize patient-centered care by incorporating patient preferences, values, and perspectives into clinical decisions. Milliken (2018) postulates this is consistent with ethical ideals like autonomy and beneficence, ensuring that patients receive care that meets their specific needs and desires.

CPGs enhance transparency and accountability in healthcare delivery by establishing evidence-based standards of care. Healthcare practitioners are directed by unambiguous, evidence-based recommendations, which reduce variability in care caused by individual biases or interests. This builds confidence between clinicians and patients, as well as among healthcare team members, and promotes an accountability culture.

CPGs can assist in reducing healthcare disparities by ensuring that all patients have equitable access to evidence-based care, regardless of socioeconomic level, race, ethnicity, or other demographic characteristics (Milliken, 2018)Evidence-Based Practice And The Quadruple Aim Discussion. When used properly, CPGs ensure that patients receive care based on clinical need and evidence rather than arbitrary considerations, fostering justice and fairness in healthcare delivery.

Challenges in Promoting Ethics

While CPGs seek to standardize care based on data, they may not necessarily reflect specific patient preferences, values, or cultural views. This can create ethical quandaries when patients’ autonomy and freedom to self-determination clash with CPG advice. Acording to ANA (2015), healthcare practitioners must navigate these conflicts by involving patients in shared decision-making, incorporating their preferences into treatment plans, and balancing the advantages and dangers described in CPGs.

In resource-constrained healthcare settings, CPGs may unintentionally contribute to ethical issues surrounding resource allocation and rationing. For example, if CPGs recommend costly therapies or pharmaceuticals, access to these interventions may be limited for particular patient populations, raising questions about distributive justice and the proper distribution of resources. Healthcare organizations must evaluate these ethical issues while implementing CPGs and devise measures to address gaps in access to care.

Policy Recommendation

Policy Change: Implementation of Shared Decision-Making (SDM) Protocols

Shared Decision-Making (SDM) is a collaborative process in which healthcare providers and patients work together to create healthcare decisions that are consistent with the patient’s preferences, values, and goals while taking clinical data and expertise into consideration. Implementing SDM procedures alongside CPGs can help resolve ethical issues by encouraging patient autonomy, openness, and equity in decision-making. Evidence-Based Practice And The Quadruple Aim Discussion

Healthcare practitioners should inform patients about their health condition, available treatment options, and the potential advantages, dangers, and uncertainties connected with each one. This allows patients to make informed decisions based on their interests and values. For instance, creating patient-friendly teaching materials (e.g., pamphlets, videos) that explain various treatment options and their ramifications, targeted to diverse patient populations and health literacy levels.

Providing decision-making tools and resources that help patients and providers consider the benefits and drawbacks of various treatment options based on their preferences, values, and unique circumstances. For instance, implementing decision support tools in electronic health record systems or patient portals, such as interactive decision trees or multimedia presentations, help patients make decisions and record their preferences.

Further, SDM procedures allow patients to actively engage in healthcare decisions while upholding their autonomy and right to self-determination. Patients can express their preferences and values, which ensures that treatment decisions are tailored to their specific requirements and interests.

SDM encourages transparency and informed consent by offering patients with detailed information about treatment alternatives, including the uncertainties and trade-offs associated with each option. Patients can base their decisions on a thorough grasp of the available data and probable outcomes.

Implementing SDM principles may necessitate more time and resources for patient education, decision support, and provider training. Healthcare organizations must provide adequate resources and support to facilitate SDM talks without overburdening clinicians or jeopardizing efficiency. Evidence-Based Practice And The Quadruple Aim Discussion

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements Links to an external site.. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-only

Arnetz, B. B., Goetz, G. M., Arnetz, J. E., Sudan, S., vanSchagen, J., Piersma, K., & Reyelts, F. (2020). Enhancing healthcare efficiency to achieve the Quadruple Aim: an exploratory study. BMC Research Notes, 13, 362. doi: 10.1186/s13104-020-05199-8.

Cardoso, D., Couto, F., Cardoso, A. F., Bobrowicz-Campos, E., Santos, L., Rodrigues, R., Coutinho, V., Pinto, D., Ramis, M. A., Rodrigues, M. A., & Apostolo, J. (2021). The Effectiveness of an Evidence-Based Practice (EBP) Educational Program on Undergraduate Nursing Students’ EBP Knowledge and Skills: A Cluster Randomized Control Trial. International Journal of Environmental Research and Public Health, 18(1),293. doi: 10.3390/ijerph18010293

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06.

Mabona, J. F., van Rooyen, D., & Ham-Baloyi, W. (2022). Best practice recommendations for healthy work environments for nurses: An integrative literature review. Health SA, 27, 1788. doi: 10.4102/hsag.v27i0.1788

Milliken, A. (2018). Ethical awareness: What it is and why it matters Links to an external site.. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01.

Movsisyan, A., Arnold, L., Copeland, L., Evans, R., Littlecott, H., Moore, G., O’Cathain, A., Pfadenhauer, L., Segrott, J., & Rehfuess, E. (2021). Adapting evidence-informed population health interventions for new contexts: a scoping review of current practice. Health Research Policy and Systems, 19, 13.

Ndugbu, K. U., & Agi, L. (2024). Re-tooling for effective patient-centered care: the need for evidence-based strategies. World Journal of Advance Healthcare Research, 8(2), 122.

Walewska-Zielecka, B., Religioni, U., Soszynski, P., & Wojtkowski, K. (2021). Evidence-Based Care Reduces Unnecessary Medical Procedures and Healthcare Costs in the Outpatient Setting. Value in Health Regional Issue, 25, 23-28. https://doi.org/10.1016/j.vhri.2020.07.577

Add a section to the 2-3 page paper attached to the The new section should address the following in 1-2 pages:

Identify and describe at least two competing needs impacting your selected healthcare issue/stressor.
Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor.
Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics.
Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples.
Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations.

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Please use the references below:
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements

Links to an external site.. Silver Spring, MD: Author. Retrieved from

https://www.nursingworld.org/coe-view-only

Note: Review all, with special attention to “Provision 6” (pp. 23–26).

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice
OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Milliken, A. (2018). Ethical awareness: What it is and why it matters

Links to an external site.. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html Evidence-Based Practice And The Quadruple Aim Discussion