Assessment 3 Instructions: Evidence-Based Population Health Improvement Plan PRINT Create a 3-5 page paper identifying the health concern you think is most appropriate for the community in your practice environment. Your choice should be based on evaluating the relevant data you have gathered for your chosen issue. Evidence-Based Population Health Improvement Plan Evidence-Based Population Health Improvement Plan Master’s-level nurses need to be able to think beyond the bedside. It is important to be able to research, synthesize, and apply evidence that will result in improved health outcomes for the communities and populations that are part of your care setting. Improving outcomes at a community or population level, even incrementally, can create noticeable and significant aggregate health improvements across all of a care setting’s patients. Scenario Your organization has created an initiative to improve one of the pervasive and chronic health concerns in the community. Some exam
Evidence-Based Population Health Improvement Plan
The Population Health Improvement Plan (PHII) incorporates all healthcare stakeholders to implement evidence-based strategies to improve population health. The Institute of Healthcare Improvement developed the Triple Aim Framework to improve patient experience, reduce healthcare costs and improve population health (Obucina et al., 2018). This framework can be applied in the implementation of population health improvement initiatives. Different populations have different healthcare needs. It is thus critical for healthcare professionals such as nurses to implement evidence-based strategies that consider the unique needs of the population of interest.
Data Evaluation
Establishing a geographical area where the population health improvement plan will be encountered is critical. The utilization of epidemiological data is essential in identifying population healthcare needs, and it can also help in monitoring and evaluating healthcare outcomes. Type 2 diabetes is prevalent in the United States, and it is associated with morbidity, mortality, and high healthcare costs. The geographical area of interest will be New York. Two million individuals in New York have diabetes, with 517,00 unaware (American Diabetes Association(ADA), 2022). Annually, approximately 66,000 individuals in New York are diagnosed with diabetes (ADA, 2022). Of individuals diagnosed with diabetes,31% are African Americans (ADA, 2022). It is thus essential to implement a PHII among African Americans in New York.
Behavioral risk factors for diabetes include excessive alcohol use, physical inactivity, and sedentary lifestyles (Bellou et al., 2018). These are the environmental risk factors present in African Americans in New York. Besides, a family history of diabetes is also a risk factor for developing diabetes (Bellou et al., 2018). After evaluating the environmental and epidemiological data in African American communities, several knowledge gaps were identified. There is more data on behavioral risk factors but little data on the role of environmental pollutants. It is also essential to evaluate the social and cultural factors that prevent African Americans in New York from accessing healthcare services.
Meeting Community Needs
The Chronic Care Model model (CCM) will be used to help in diabetes management. CCM has six essential models: clinical information systems, health systems, decision support, delivery system design, self-management support, and community resources and policies (Boehmer et al., 2018). This model will be utilized to improve the population health of African Americans in New York. Accordingly, this plan will have five basic principles: long-term sustainability, compliance with evidence-based strategies in patient care, patient education and lifestyle modifications, provision of affordable healthcare services, and culturally sensitive care.
Moreover, this model will promote proactive community participation in their healthcare. CCM will guide the establishment of a data collection system and operational leadership to provide culturally sensitive care (Boehmer et al., 2018). Healthcare professionals will be educated on linguistic and cultural competence. Finally, local community resources such as community health centers will help connect with diabetic patients. Some of the barriers that this plan may face are community resistance and cultural barriers that may impede the implementation of culturally competent care.
Value & Relevance of Evidence
Since its establishment, CCM has been utilized in many healthcare organizations in diabetes management with positive outcomes (Bongaerts et al., 2017). A lot of evidence supporting CCM is from meta-analyses, systematic reviews, and randomized controlled trials. Study results indicated that CCM utilization has proved effective in better diabetes management. Healthcare leaders implemented CCM by initiating changes in their organizations that improved diabetes management. These changes included the introduction of disease registries, the establishment of patient-centered goals, patient education on self-management, and the training of healthcare workers on evidence-based care (Bongaerts et al., 2017). CCM model can be effective since it incorporates system-level interventions, patients, and healthcare professionals.
Evaluation of Achievement
The outcome measures that will be used to evaluate the achievement of this plan are optimal clinical indicators, patient satisfaction and experience, quality of life, and impact on healthcare disparities. These measures are measurable and can effectively help determine the success of PHII. Another evaluation criterion that can be used is the diabetes evaluation criteria. This criterion will aid i