NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Name

Capella university

NURS-FPX 6218 Leading the Future of Health Care

Prof. Name

Date

Change Proposal Summary Report

Diabetes foot care is a critical component of diabetes management that improves patients’ quality of life and outcomes.  Unfortunately, diabetes foot care management, especially the prevention of complications such as Diabetic Peripheral Neuropathy (DPN) and ulceration, is neglected in numerous medical settings in the United States. DPN is one of the most common vascular consequences of diabetes. DPN is major contributor of foot ulceration and amputations among 50% of diabetic patients.

This incident has severe implications on patients’ outcomes and adverse impact on Medical expenses (Galiero et al., 2023). This executive summary is intended to advocate for a change in diabetes foot care to prevent DPN or foot ulceration among diabetic patients at Southern West Virginia Health System (SWVHS). It serves the rural areas of Beckley, West Virginia (WV). A thorough evaluation of diabetic foot care was done, including a comparison of their management in non-USA medical facilities. 

Executive Summary

Proposed Change

In the local health management of WV, such as DPN and limb amputation have become a real concern for diabetic patients and are manifest in such features as numbness, pain, foot ulcers, and leg amputations. The SWVHS, which focuses on the communities of West Virginia, has many concerns related to diabetic foot care. Considering the effect of DPN and the presence of foot ulceration on the patient’s quality of life, it is important to implement change in this particular area of the SWVHS. Available literature shows that the rate of amputation caused by diabetes is higher in WV because of the healthcare inequity (Minc et al., 2020).

This entails increasing the availability of Diabetic medical check-ups like HbA1c tests and foot examinations and increasing Diabetic patients’ contact with medical personnel via the use of telehealth for patient guidance. The decision to prioritize this change arises from the necessity of addressing diabetes foot management issues in the SWVHS region. This community has an elevated rate of diabetes and accompanying complications such as DPN and foot ulcers, which are exacerbated by socioeconomic conditions and restricted availability of medical services. The American Diabetes Association (ADA) stated that 223,338 (15.7) people in WV have diabetes.

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

About 10,473 persons in WV suffer from diabetes annually (ADA, n.d.). These statistics indicate a substantial rate of ulceration among diabetes individuals. The onset and development of DPN can be minimized by implementing ADA-recommended procedures such as diabetic foot inspections and regular HbA1c monitoring, as well as extending telemedicine services. The expectations for progress are well-defined and supported by trustworthy evidence. Effective telehealth deployment improves accessibility and standard of life, particularly for individuals living in isolated regions.

This enables patients to effectively manage their diabetes and related issues like diabetic foot ulcers (Hazenberg et al., 2020). Improving foot inspection and regular HbA1c tracking by scheduling alerts integrated with the Electronic Health Record (EHR) will enable comprehensive, integrated treatment for diabetes foot care. Zhao et al. (2023), asserted that frequent examination for diabetic foot is an affordable approach to avoid related issues. These improvements are expected to lead to better patient results, lower medical costs, and boost the standard of life of diabetic patient populations in SWVHS served.

Desired Outcomes

The proposed changes in diabetes foot care attempt to achieve the desired goals. The initial intended outcome is the avoidance of diabetes foot problems and prompt treatment of diabetes issues.  It aids in avoiding complications like infections, prolonged healing, foot ulcers, and limb amputation. This change aims to offer services to underserved areas by expanding telehealth. The justification for this outcome is based on research showing that greater access to medical services via telehealth promotes patient results. Telehealth tools can reduce the risk of foot ulcers, cure ulcers faster, and need fewer inpatient visits, making them inexpensive (Hazenberg et al., 2020). However, existing technological infrastructure can prevent swift adoption.

Other outcomes include glycemic control and regular foot examinations, which provide notifications to patients via the EHR system, which improves patient outcomes and safety. Early identification and effective glycemic control are crucial to avoid risks related to diabetes foot, like cutaneous damage (Casadei et al., 2021). To support change, Medicaid, Medicaid insurance, federal funding, private insurance offerings, and hospital finances will all be used to fund these change efforts. Barriers entail the expense of EHR integration and staff opposition to regular screening owing to increased workload. Acquiring such outcomes requires enough resources, like monetary assets and interprofessional teamwork, to implement changes. 

Health Care System Comparative Analysis

A comparison of diabetes foot care in non-USA health systems offered valuable information. The United Kingdom’s National Health Service (NHS) has improved diabetes foot care and resolved the related complications by adhering to the National Institute for Health and Care Excellence’s (NICE) guidelines on avoiding and controlling foot issues among diabetic individuals. For effective diabetes foot care prevention, they concentrated on multidisciplinary foot care services that included interdisciplinary staff like endocrinologists, diabetes nurses, and specialists.

NICE also recommends regular top-notch foot assessment, including risk analysis and assistance education through e-learning, to enhance patients’ self-management and foot self-care and minimize DPN and other difficulties (NHS, n.d.). Following NICE guidelines, the NHS health system has built a cohesive structure for medical staff, ensuring coordinated care, resulting in better results for patients and mitigating problems like foot ulcers. 

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

A second system, the Australian healthcare system, follows evidence-based care practices for diabetes foot care and the management of related complications like DPN. These practices include offering patient education related to DPN care and regular foot examinations. These care practices are directed by National Health and Medical Research Council (NHMRC) guidelines.

These guidelines mandate that diabetic patients with a low risk of foot ulceration or DPN should be examined annually. Australian healthcare systems have also adopted telehealth services for ongoing surveillance of diabetic patients’ feet from medical staff for prompt diagnosis and care of diabetic foot issues like DPN. Telehealth initiatives have been supported in remote areas of Australia, like Aboriginal patients, with limited opportunities to attend inpatient sessions for diabetes treatment (Kaminski et al., 2022). The strategies implemented by medical systems from other countries will help the SWVHS to achieve positive results in the treatment of diabetes foot and prevent complications.

Nevertheless, SWVHS has some issues, such as the inability to deliver proper services, particularly diabetes foot care services, for all the patients, particularly in rural areas. Lack of attention and recurrent resource deficiency hampers SWVHS in providing productive and timely services to patients with diabetes. Patients will benefit from telehealth because, through the service, SWVHS can offer them the follow-up and support they need throughout their recovery process, all of which help to overcome barriers to care.

 Rationale for the Proposed Change

The suggested changes to implement training initiatives for medical staff, as evident in the NHS system and telehealth integration are evident from the Australian medical system within the SWVHS healthcare system, can aid in resolving difficulties for effective diabetes foot care. By following the NICE and NHMRC guidelines, SWVHS will be able to prevent and manage complications like DNP and ulcerations adequately. Accessibility of care services through adopting telehealth will increase, boosting the continuum of care and eliminating disparities (Hazenberg et al., 2020). Further, SWVHS can boost patients’ foot self-care, which ultimately reduces the burden. NHS care’s approach of regular foot examination and implementation of a multidisciplinary approach have underlined the improvement in the screening process and the offering of collaborative care (NHS, n.d.).

Multidisciplinary team-based care is crucial for effective management of diabetes foot and offering comprehensive care education of diabetic patients on self-management practices (Choi et al., 2023). By adopting these frameworks, SWVHS can expect to boot real-time patient monitoring and offer support and guidance for self-care through telehealth tools efficiently. The expectation is justified that the SWVHS infrastructure is already in place to execute telehealth services. Through a multidisciplinary approach, SWVHS is expected to offer holistic diabetes foot care and improve patient safety and outcomes. SWVHS can align its care practices with global health settings with these approaches. 

Financial and Health Implications

Implementation of the proposed changes, such as telehealth services, a multidisciplinary approach for the identification of various HbA1c levels, and EHR-supported foot screenings, demonstrate significant health and economic benefits. In the short run, it leads to increased accessibility of care services to patients with diabetes regardless of the locality, and patient safety or satisfaction is expected. Long-run gains, therefore, include improved diabetes foot care, extraordinary cost reduction, and a stronger health care sector.

Although the integration of telehealth services and EHR alert tools for regular foot screening demands financial resources, in the long term, they reduce care expenses. Early detection of diabetes-related disorders such as foot ulceration and DPN can lessen the economic strain on patients and hospitals by minimizing the costs related to treating severe neuropathy (Felix et al., 2023). ) Telemedicine leads to improved access to care, early identification, and mobilization of the ability for self-care, hence improving disease management and a higher quality of life (Hazenberg et al., 2020).

The proposed affordable routine examination approaches would enhance glycosylated Hb regulation, reduce hospitalizations, and enhance diabetic client results. Failure in implementation of these recommended changes leads to other issues as well as the development of severe DPN and limb amputation-related morbidities and reduction of patients’ quality of life. It calls for services such as surgery and other clinical procedures such as rehabilitation medication, putting economic pressure on patients and organizations. Evidence showed that medical costs are five times more for patients suffering from ulcers than other diabetic patients (Felix et al., 2023). Implementation of these changes is crucial to improve the health outcomes within the SWVHS health system. 

Conclusion

Implementation of change proposals, such as telehealth services and foot screening within the SWVHS health system, will help address diabetes foot care and increase the management of foot ulcers and DPN. Telehealth solutions will help to minimize care differences between regions as well as provide equal opportunities for people living in rural areas of WV. Recognizing rules of NICE and approaches of the Australian medical setting, SWVHS can strengthen its diabetes care and health outcomes.

References

ADA. (n.d.). The burden of diabetes in West Virginia. American Diabetes Association.org. https://diabetes.org/sites/default/files/2023-09/ADV_2023_State_Fact_sheets_all_rev_West%20Virginia.pdf

Casadei, G., Filippini, M., & Brognara, L. (2021). Glycated hemoglobin (HbA1c) as a biomarker for diabetic foot peripheral neuropathy. Diseases, 9(1), 16. https://doi.org/10.3390%2Fdiseases9010016.

Choi, T., Osuagwu, U. L., Tran, C., Bulsari, K., & Simmons, D. (2023). Impact of multidisciplinary care of diabetic foot infections for inpatients at Campbelltown Hospital. BioMed Central Health Services Research, 23(1), 1126. https://doi.org/10.1186/s12913-023-10119-0

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

Felix, Uçkay, I., Boixader, S. L., Sydler, C., & Gariani, K. (2024). Current knowledge of morbidities and direct costs related to diabetic foot disorders: A literature review. Frontiers in Endocrinology, 14, 1323315. https://doi.org/10.3389/fendo.2023.1323315

Galiero, R., Caturano, A., Vetrano, E., Beccia, D., Brin, C., Alfano, M., & Sasso, F. C. (2023). Peripheral neuropathy in diabetes mellitus: Pathogenetic mechanisms and diagnostic options. International Journal of Molecular Sciences, 24(4), 3554. https://doi.org/10.3390%2Fijms24043554

Hazenberg, C. E., aan de Stegge, W. B., Van Baal, S. G., Moll, F. L., & Bus, S. A. (2020). Telehealth and telemedicine applications for the diabetic foot: A systematic review. Diabetes/Metabolism Research and Reviews, 36(3), e3247. https://doi.org/10.1002%2Fdmrr.3247

Kaminski, M. R., Golledge, J., Lasschuit, J. W. J., Schott, K., Charles, J., Cheney, J., & Raspovic, A. (2022). Australian guideline on prevention of foot ulceration: Part of the 2021 Australian evidence‐based guidelines for diabetes‐related foot disease. Journal of Foot and Ankle Research, 15(1). https://doi.org/10.1186/s13047-022-00534-7

Minc, S. D., Hendricks, B., Misra, R., Ren, Y., Thibault, D., Marone, L., & Smith, G. S. (2020). Geographic variation in amputation rates among patients with diabetes and/or peripheral arterial disease in the rural state of West Virginia identifies areas for improved care. Journal of Vascular Surgery, 71(5), 1708-1717. https://doi.org/10.1016/j.jvs.2019.06.215

NHS. (n.d.)  Northwest Coast strategic clinical network diabetes footcare pathway blueprint. National Health Service.uk. https://www.england.nhs.uk/north/wp-content/uploads/sites/5/2018/05/NWCSN_Diabetes_Footcare_Final_Report_2017-1.pdf

Zhao, N., Xu, J., Zhou, Q., Hu, J., Luo, W., Li, X., Ye, Y., Han, H., Dai, W., & Chen, Q. (2023). Screening behaviors for diabetic foot risk and their influencing factors among general practitioners: A cross-sectional study in Changsha, China. BioMed Central Primary Care, 24(1). https://doi.org/10.1186/s12875-023-02027-3#

NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change

‌‌Appendix 1

Outcomes	United Kingdom Healthcare System (NHS) NICE guidelines	Australian Healthcare system  NHMRC guidelines	US Healthcare System (Southern West Virginia Health System)
Prevention of Diabetes foot complications like ulcers and DPN	Improved reduction in complications by adopting a multidisciplinary approach and following NICE guidelines related to regular foot examination (NHS, n.d.)	Following NHMRC guidelines for diabetes foot care effectively reduced complications through telehealth services for ongoing patient foot monitoring (Kaminski et al., 2022).	Increase diabetic foot cases due to poor care and management, health disparity, and insufficient services to rural communities (Minc et al., 2020). Adoption of a change proposal can effectively reduce DPN cases.
Enhanced access services to underserved areas	Multidisciplinary approach, staff training for improving services in remote regions	Enhanced access to medical staff by telehealth, providing guidance and monitoring (Kaminski et al., 2022)	Restricted access, especially for the rural diabetic patient population, geographic constraints, and inadequate care services (Minc et al., 2020)
Patient safety and health outcomes	Supporting education through e-learning to improve patients’ self-management, foot self-care, and glycemic control (NHS, n.d.)	Patient education related to DPN care and regular foot examinations (Kaminski et al., 2022)	Poor results due to insufficient care practice, delayed diagnosis, and restricted accessibility of care services