FALL PREVENTION THROUGH INDIVIDUALIZED DISCHARGE PLANS”
Now that you have examined the evidence for your practice issue/problem, you will need to weigh the costs. You have searched the literature and discovered great strategies for improving patient outcomes but have you looked at the costs? Is the strategy/intervention worth doing?
The saying, “Money makes the world go ’round”, is no place truer than in the ‘business’ of health care. The APN/DNP of the future not only must be highly skilled in the art and science of advanced practice; they must also be expert fiscal managers. Without competency in “paying the bills”, there won’t be a practice, a hospital, a place to deliver the product.
Too often nurses have let others be responsible for the money. For some, money is somehow dirty, or distracting from the altruistic mission of nursing. The consequence is that nursing is part of a bed-rate, nurses are underpaid, overworked, and have, in some nurses eyes, compromised the values of the profession.
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There are two parts to this assignment. The first part is to develop a program budget on the policy issue/problem identified in the Examining the Evidence assignment. The next part is to develop a cost analysis for your project plan. A healthy respect for, and an understanding of the economics of health care, will assist the APN/DNP in delivering efficient, quality, and cost-effective care for the population served.
For this assignment, you will be comparing the costs in your budget to the cost of usual treatment (or comparing the cost of one bill with another). In the various sections, you will compare the cost per patient, include overall costs vs. savings over a period of time for the clinic, unit hospital, etc.
Economics, budgeting and cost analysis crosses over into the business discipline. However, in order to understand economic resource management in health care, and determine if a change is beneficial, knowledge of budgets and cost analysis is essential. There are multiple ways to perform a budget and cost analysis, but you should follow the guidelines and definitions provided for you in the unit overview.
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Performing a cost analysis has several purposes. First and foremost, a cost analysis demonstrates the cost effectiveness of a particular program or health care plan versus the financial and human suffering costs of an existing plan or the status quo without any plan to address an issue. A cost analysis is very powerful in persuading policy makers to allocate limited financial and human resources to a particular plan.
Below are selected resources that should be read to help you learn the purpose of cost analysis, budgets, and some examples of types of cost analysis. Do not get confused by the process used in these articles as there are multiple ways to perform a cost analysis. These readings are for background information.
Cost/Benefit Analysis
Cost Analysis Toolkit
What is a program budget?
Common Steps in Developing a Program Budget & Cost Analysis
Someone once said, “Money may not be important, but those who have it are”. Disagree with the statement or not, nurses for too long have let others control the bottom line, and have taken what others thought they contributions were worth. The APN/DNP of the future (and for the future) will be at the table making decisions that will affect the allocations of resources, and ultimately the health care available for their clients. Knowledge of economics will be a valuable commodity for the APN/DNP
.
http://www.econlib.org/library/Enc/BenefitCostAnalysis.html
http://www.bridgespan.org/Publications-and-Tools/Strategy-Development/Nonprofit-Cost-Analysis-Introduction.aspx#.UuqQWNGPK00
http://www.ehow.com/info_8461022_program-budget.html
http://ag.arizona.edu/sfcs/cyfernet/cyfar/Costben2.htm
Counting the Costs
Now you are ready to count the costs of your strategy/intervention (s). From the three best strategies identified in Assignment 2, select the strategy/s you would want to implement to address your practice issue. The assignment has two parts; a budget and a cost analysis.
For Your paper, you MUST include the headings in the grading guide to help organize your paper. The paper should not be more than 4-6 pages in length (excluding title page and reference list). You will need a minimum of six references for this paper.
Start out your paper with an introduction to the project. Briefly state what will be done by whom and where will it be done. What is your overall goal? (No more than 1/2 page….this and all subsequent page limits per item are recommendations).
Then prepare a line by line budget as an appendix
Budget examples and information:
Budget Guidelines
Sample Budget Narrative
Sample Budget Template
Sample Line Item Budget
Sample Line Item Budget
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Now break down the expense for each item. For example, you may have listed $4000 for nursing expenses in your budget. Now you should explain that if an RN sees 10 patients per week, and there is a nursing assistant receptionist, the plan will cost $1000 each week. This would be a cost of $100 per patient to pay the salaries of the RN and assistant. If you plan to carry on the project for a month, it will cost $4000 for 40 patients.
These are the type of things you must consider in your budget:
Any increased personnel (RNs, LPNs, or NAs) needed to implement your plan.
Any extra overtime for existing personnel to learn the new teaching plan.
The cost of duplicating handouts, booklets, etc to teach the program.
The cost of flyers or ads to advertise about the new program.
Any new equipment needed for patients to take home (i.e. BP monitor, cook books, pedometer)
Will you need a projector and computer to teach large groups of patients and families?
Will the patients need to come back for follow up assessment and possible reinforcement teaching or will this be a one time discharge teaching course? (If another follow-up class is needed, calculate the cost of an individual doing this.)
Will you need a secretary or some other personnel to do a follow-up phone call and find out how the patient is doing, reinforce teaching, or schedule another class for more teaching?
Also look at the indirect cost of the plan (i.e. fringe benefits for extra employees).
The cost of room to teach in may be an indirect in-kind cost.
What is the total cost of the project?
What is a program budget?
Common Steps in Developing a Program Budget & Cost Analysis
Using Cost Analysis in Evaluation
Benefit/Cost Analysis
Barnett Article (Cost Analysis)
Grading guidelines for Budget /Cost Analysis
Develop your budget/cost analysis based on your selection of strategy/s from the Examining the Evidence assignment. In other words, you do not have to use all three strategies for your quality improvement initiative.
4-6 pages in length-use guidelines below. Include headings corresponding to rubric points.
Criteria
Points
1. Introduction and thesis statement
1
2. Develop a line-item budget that shows all expenditures
Determine total program costs (include as an appendix)
3
I 3. Include a breakdown of each individual item
3
4. Broad Scope Perspective of the Analysis
2
5. Estimate Program Effects
(use existing data to estimate to estimate program effects)
2
6. Estimate the Monetary Value of Outcomes
3
7. Account for the Effects of Time
3
8. Describe Distributional Consequences
3
9. Conduct Sensitivity Analysis
2
10. Discuss the Qualitative Residual
2
11.Conclusion, sum up the points of your paper.
1
Total points
25
Broad Scope of Analysis: Explain what you are comparing. For instance, you might be comparing the cost of an educational class on strategies to lower Hemoglobin A1Cs for diabetics vs. the costs of the consequences of diabetics not reducing A1Cs. Include the total estimated cost of the planned project or policy. (Please note: the program budget should already be developed and have identified the budgetary costs as a line item).
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Estimate Program Effects: Here is where you bring in your background material. For instance, patients with this disease come to the ER or the clinic or the hospital typically 5 times per year. The length of stay is usually 3 days. The usual patient has to take these 3 medications for BP if they have not been educated about an exercise walking or diet plan, etc.
Estimate the Monetary Value of Outcomes: The cost of each ER visit is XX. The cost of each day in the hospital is YY. So if the program reduces the number of ER visits to 2 per year, it will save $LLLL. If this project will reduce the Length of Stay to 1 day, this will save $ZZZ. The project will reduce the use of emergency medications by YYY, etc. Remember you are comparing the cost of the planned policy change with the status quo or with an alternate plan (i.e. comparing 2 different legislative bills).
Account for the Effects of Time: Discuss how many hospitals days will be saved. Discuss increased work productivity or increased attendance at school if these days are saved. Estimate out the effects of time over a one year period.
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Describe Distributional Consequences: Who all will benefit from this program? Look at family members. If this involves children, parents will have fewer days lost at work taking their children to the ER, Hospital, etc. Will insurance companies benefit through cost savings? Discuss how much more free time RNs might have to teach the program, follow-up or concentrate on other duties. Discuss nurse patient ratios that might be helped by decreased hospital visits, increased access to clinics, etc…
Conduct Sensitivity Analysis: How could your cost estimates change? For instance salaries might go up. Or you might have equipment donated by an organization or educational materials donated by a national foundation instead of developing and duplicating your own materials.
Discuss the Qualitative Residual: Discuss reduced pain and suffering to patients and families. Discuss improvement in quality of life. If your new project relates to foot care for diabetics and early intervention, talk about how this could save an amputation and how this would impact the individual. Or it might reduce retinopathy and blindness. If so the individual may be able to go to school, learn a new vocation, continue working in job that requires good eye sight, etc.
Deductions:
Papers must be submitted to turnitin.com and students are to review the report generated by this software system. Students will be given the opportunity to submit revisions of the paper to turnitin.com. The final report is to be saved as a pdf document and merged with the paper (in other words, you will be submitting one document). Assignments submitted without a turnitin.com report will not be accepted and will result in a 10% point deduction for failure to submit properly on initial submission. You are clinical nurse scholars in the making. You are the advanced practice nurses/DNPs and members of the highly literate profession of advanced practice nursing who will chart the future of health care. Good writing ability is as much a required skill for nurses in advanced practice as performing clinical functions. Therefore, precision and scholarship is expected in all assignments.
Papers over the page limit will not be accepted and will result in a 10% point deduction for failure to submit properly on initial submission. Failure to include headings.
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All assignments are to be submitted electronically within the course. Because the faculty receive many of the same assignments a file naming format is established for all student submissions. The file naming standard is as follows:
File naming standard: Student’s Last name, First name, Class Number, and Assignment Name, (For example, Doe-Jane-NU611-Counting the Cost)
Scholarship Expectations
Up to 20% of points will be deducted from grade for lack of scholarship. Scholarship is evidenced by organized and logical progression of ideas; effort and attention to detail is evident; communicates effectively all aspects of discussion. Correct grammar, spelling, and word choice. Liberal number of references (minimum of 6 references). References are current, appropriately paraphrased, and acknowledged. Correct use of APA. Correct title page used for assignment copy.
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ScholarMatic: Explanation & Answer
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