The goal of this research is to acquire data regarding the opinion given by patients suffering from diabetes mellitus (DM) and heart failure (HF). These two instances have had a huge financial impact on the American government. It is crucial to note that cases of diabetes and heart failure are manageable, especially when people learn to maintain proper diets that consist of natural foods, as opposed to processed ones, or engaging in consistent exercising among other interventions. Moreover, avoiding smoking and ensuring regular screening can help to prevent heart failure and diabetes. However, these conditions are common among citizens in the U.S., a situation that has been associated with the observed high readmission rates. Specifically, avoidable cases of readmission of diabetes and heart failure patients have forced America to allocate a yearly budget of more than 14 billion USD. Hence, investigating factors that lead to such increased levels of unnecessary readmissions to hospitals can be resourceful. For instance, it can influence decisions regarding systems, institutional level measures, and appropriate medical activities to put in place to manage this situation.
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Many scholarly works conducted to explore the subject of diabetes and heart failure have not considered patients’ opinions regarding these conditions. In addition, researchers have failed to capture data on cultural and racial variations among patients. Findings from the available literature indicate the extent to which socio-demographic forces have contributed to high levels of patients’ readmission to hospitals (Sentell et al., 2016). However, a thorough review of the existing studies indicates that the subject under investigation has not been given significant scholarly attention. In particular, current materials emphasize administrative information that does not include major socio-demographic elements.
Participants who were required to respond to the set questions were drawn from Queen Medical Center (QMC), which is among the biggest health centers in Hawaii (Sentell et al., 2016). The researcher incorporated 90 interviewees who were available in this health facility during the period of June 2013 and December 2014. However, it is crucial to point out that participants had to be patients who had been admitted to the specified medical center with heart failure and diabetes mellitus resulting in potentially avoidable readmissions. The researcher relied on the criterion established in the matrix by the Agency for Health Care Research and Quality (Sentell et al., 2016). In addition, it was vital to categorize participants in terms of their races, including Asians, Natives, Hawaiians, and other Pacific Islanders.
Additional conditions that needed to be fulfilled included their expertise in speaking English and having attained more than 21 years of age. Interviewees were taken from health experts’ office referrals or from individuals who were qualified as medical doctors (MDs) or advanced registered nurse practitioners (ARNPs). Upon getting approvals to continue with the set questions, participants were subjected to a one-on-one dialogue to gauge their mastery of the English language. Those who passed this step were provided with a permission document in which they were required to confirm their willingness to take part in the next phase.
Patients who agreed to proceed had to undergo a Rapid Estimate of Adult Literacy in Medicine test after which a semi-structured interview was given to them. It was estimated to last between 25-30 minutes. This discussion consisted of open-ended queries whose responses facilitated the documentation of field notes. Other health details were examined. Two autonomous specialists dealing with patients who have persistent sicknesses and capable of determining any social elements among this category of people were recruited to help in developing data analysis themes.
The average years for the sampled interviewees stood at 55.7. One-third of the whole sample consisted of females. Approximately 90% of all respondents had medical insurance covers. About 88% had been allocated a specific doctor. Around 29% of the entire sample presented with heart failure issues while 34% demonstrated signs of diabetes mellitus. More than two-thirds of them had been readmitted. Various racial groups had been captured in this research. Many interviewees proved to have low health education levels. In addition, the majority came from poor backgrounds. Data transcription was done to help in the analysis process, which was based on the “framework strategy” that enabled researchers to combine qualitative case studies and various subjects (Sentell et al., 2016). Several pathways were noted, including the lack of proper shelter, poverty, access to health services, and rejection by healthcare givers. The researcher grouped the basis for potentially preventable hospitalizations (PPH) in terms of instantaneous, sudden, and causal cases.
The scholar found several aspects that determined pathways for avoidable admissions from a population that mainly consisted of insured people. The identified elements were not related to conventional hospital admissions or healthcare forces. However, they were linked to social aspects. As a result, the opinion of a sick person was found to be resourceful because managerial statistics alone could not facilitate the process of acquiring such information. Hence, collaboration was suggested to seal the current data gap. Policy developers are encouraged to realize that sanctioning medical facilities, which serve at-risk patients, hinders the process of solving the issue of high readmission cases. This idea obstructs the identification of social forces that primarily influence the rate of readmission.
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The selected sample represented the overall situation among Asian-Americans and Pacific Islanders. Approximately two-thirds of the group under investigation had been rehospitalized. This research reveals some elements, including social susceptibility, awareness, patients’ behavioral well-being, and rejection that were found to determine their readmission levels.
However, several weaknesses were observed in this research. Since it only aimed at investigating patients with heart failure and diabetes mellitus, it failed to examine the implication of healthcare givers’ job setting and the doctor-to-workforce proportion. Having this information could reveal additional strategies that once implemented could help to lower cases of avoidable readmissions. Furthermore, such data could be resourceful in identifying more elements related to patients’ opinions. The sample also could not capture opinions from many patients with heart failure and diabetes mellitus due to their incapacity to converse in English. Other potential participants were eliminated due to their psychological challenges. Influencing interviewees to participate in this research through the 20 USD gift may have served to attract more people who had some pressing financial problems.
Impact on Nursing Practice
From the findings of this study, it is apparent that healthcare managers and policy developers should be equipped with knowledge regarding various elements that influence PPH readmissions. Deriving data from patients’ opinions reveals alarming aspects that act as PPH readmission determinants, despite them not lying within healthcare settings. As a result, a bedside healthcare official may be required to undertake various evaluations of sick people’s demands immediately they are admitted to a medical facility and after being discharged. The goal is to facilitate the establishment of a follow-up mechanism with a view to ensuring that all social obstacles they face are dealt with to enhance their recovery. The establishment of collaborative networks and guidelines may be helpful in facilitating the continuous delivery of health services to the identified group of patients, hence minimizing the number of reported cases of readmission.
Sentell, T. L., Seto, T. B., Young, M. M., Vawer, M., Quensell, M. L., Braun, K. L., & Taira, D. A. (2016). Pathways to potentially preventable hospitalizations for diabetes and heart failure: A qualitative analysis of patient perspectives. BMC Health Services Research, 16(1), 300.