MSN6414 Vila Health™ Activity Population Health

February 20, 2018August 16, 2017 admin

MSN6414 Vila Health™ Activity

Population Health
• Vila Health Challenge
• Population Health
• Email #1
• Documents
• Choice Module
• Intermission
• Lakshmi Sharma Interview
• Conclusion
• Credits
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Vila Health Challenge
Population health is a critical issue for any health care organization. Understanding the community through the lens of collected data is integral to the delivery of appropriate services. In this activity, you will assume the role of a nursing informatics intern. In this role, your preceptor will ask that you compile data to be used in the identification of specific population health issues.
In this activity, you will:
• Determine what health issues to analyze.
• Request the appropriate reports and data.
• Identify next steps in the process of organizing the data.
Learning Objectives
After completing the activity, you will be prepared to:
• Analyze the data you receive for the selected health issues.
• Develop and articulate an organizational strategy for the data.
• Determine the best graphical representation for the data and intended audience.
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Population Health
Vila Health is a medium-sized system of health operating facilities in the Minnesota and Wisconsin area. They have recently acquired two smaller systems including Red River Rural Health System, which consists of Valley City Regional Hospital and several small clinics.
Recently, there has been a push to ensure Valley City Regional Hospital’s focus is aligned with the needs of its population. Data analysis is required and hospital leadership is looking to informatics nurses for that analysis.
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Email #1
Internship at Valley City Regional Hospital
From: Lakshmi Sharma, Informatics Nurse
I am very pleased to welcome you to your informatics internship at Valley City Regional Hospital. As stated in the offer letter you received from our HR department, I will be your primary preceptor for this internship.
I have a project that I think you may find interesting. We’re trying to put together some information on specific population health issues. What I would like you to do is select five conditions from those we’re tracking and obtain the appropriate data for the population served by this hospital. You’ll also need to determine the most appropriate data representation methods for the data you receive.
I will be in a meeting this morning, so you should review the basic information about our hospital and the list of conditions we’re looking at so you can select the five on which you’ll focus your attention.
I am looking forward to working with you.
Lakshmi Sharma, MS, RN-BC
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Documents
Valley City Regional Hospital
About Us
Whether it’s a car accident, a pregnancy test, or physical therapy after a broken ankle, the medical services at Valley City Regional Hospital are here for the Valley City community. We meet patients’ routine and unexpected health care needs 365 days a year.
Valley City Regional Hospital is proud to offer a wide variety of medical services, including:
• Behavioral health services
• Emergency room
• Home care and medical equipment
• Imaging services
• Inpatient and outpatient surgical care
• Laboratory testing
• Pediatrics
• Physical and occupational therapy
Organization Chart

Admissions and Discharge
Admissions specialists at Valley City Regional Hospital help patients with both elective and emergency admissions. Elective admissions are planned stays at the hospital for procedures or surgery. Our specialists gather necessary information from patients and answer their questions, and also provide information regarding their stay, such as what to bring when checking in. They also help patients with discharge and coordinate with other facilities for transfers, such as a skilled nursing facility. Finally, they connect patients with necessary resources for their post-admission care and recovery. For emergency admissions, they gather patient information, reach out to patients’ emergency contacts, and submit claims to insurance for services rendered.
Facilities
Dietary Services
The dietary services department at Valley City Regional Hospital is here to provide patients with the nutritious food they need to start a full recovery. We serve balanced meals at breakfast, lunch, and dinnertime, both on a delivery basis and in the hospital cafeteria, which seats up to 60 people at one time.
We want patients and their visitors to enjoy meals together, so we encourage visitors to take advantage of our food service. Visitors may join us in the cafeteria during the following hours for mealtimes:
• Breakfast: 6:00 a.m. to 9:00 a.m.
• Lunch: 11:00 a.m. to 1:00 p.m.
• Dinner: 5:00 p.m. to 7:00 p.m.
• Snacks are available at all times between 7 a.m. and 7 p.m.
Housekeeping
Our well-trained staff of housekeeping professionals works day and night to make sure that patient rooms, nursing units, surgical areas, and other areas of the hospital are kept clean and well stocked with important supplies for patient health. Our housekeepers are responsible for the following:
• Equipment cleaning
• Floor maintenance
• Hospital laundry
• Furniture cleaning
• Linen collection and distribution
• Trash collection and removal
• Restocking of medical supplies
Information Systems and Technology
The Information Technology Department maintains all network, telecommunications, computer, and health information systems at Valley City Regional Hospital. We use the most advanced and relevant information technology available to offer the best possible care to our patients.
Our IT professionals work with outside vendors to install state-of-the-art applications that help hospital staff to do their jobs efficiently and well. They help nurses and doctors with technical support and training so that medical staff can both access the technology they need and use it according to hospital policy, procedures and practices.
Security
To maintain safe conditions for patients, visitors, and employees at Valley City Regional Hospital, we employ both physical presence and cutting-edge technology. We contract with a local security firm for security officers who monitor entryways and closed-circuit television monitors of all hospital areas. They monitor all visitors, including vendors, and keep points of entry like the hospital’s loading dock and receiving areas secure from unauthorized entry.
Financial Services
Billing
At Valley City Regional Hospital, we want our patients to understand their bills. Our professional staff of knowledgeable billing specialists submits claims to insurance and helps patients to understand what they’re being charged for, as well as what insurance has paid for. They have detailed knowledge about and experience with private insurance, Medicare, Medicaid, Medical Assistance, commercial insurance, and worker’s compensation.
Our billing specialists can help patients with:
• Online bill pay.
• Refunds.
• Address changes.
• Billing information.
General Services
Pharmacy
For the convenience of our patients, we maintain a state-of-the-art pharmacy on hospital grounds. Patients may obtain any medication ordered by their doctor at the pharmacy, and also get detailed information about the medication or medications they take. Our pharmacists will explain how multiple prescribed medicines or prescribed medicines and herbal medications or supplements might interact. They will also warn patients about potential side effects and what, if anything, they should do if certain side effects present themselves.
Our highly educated pharmacists also help nursing staff to educate patients about the safe and effective use of their medications. Like most hospitals and health plans, Valley City Regional Hospital has a list of drugs on hand which are routinely available for dispensing to patients. With some exceptions, medications that hospital doctors order will be on the hospital’s formulary and therefore available for immediate pickup by the patient.
Phlebotomy
Our on-site clinical laboratory is staffed with highly trained and dedicated technologists, technicians, and phlebotomists who perform blood draws and other needed sampling for accurate laboratory testing. Results from procedures that we cannot perform in-house are usually available within 24 hours from Community MRI Services in Jamestown, N.D.
Some of the tests we perform on site include:
• Basic metabolic panel
• Hemoglobin A1C
• Glucose tolerance
• Renal function panel
• Influenza A and B antigen
These and all other tests done at Valley City Regional Hospital can be completed at a doctor’s order and results reported the same day.
Radiology
Valley City Regional Hospital offers state-of-the-art medical imaging technology. Images captured by our professional technicians are sent to board-certified radiologists in Valley City, or to Jamestown Hospital Radiology when local specialists are not available. Our technicians explain what the patient needs to do for a quality image, answering any questions and always keeping the patient’s comfort in mind.
Some of our imaging services include:
• CT/PET scans
• Colonoscopy
• Digital mammography
• Electro/echocardiograms
• Ultrasound
• X-rays
For imaging that we cannot provide on-site, we contract with Community MRI Services in Jamestown, N.D.
Human Resources
A career at Valley City Regional Hospital means a career of helping neighbors, families, and friends live healthier lives. Our Human Resources department helps our caring and knowledgeable staff to get the continuing education, benefits, and career development they need to be the best they can be. Our HR department also seeks out and screens the best candidates for job openings at Valley City.
Medical Services
Whether it’s a car accident, a pregnancy test, or physical therapy after a broken ankle, the medical services at Valley City Regional Hospital are here for the Valley City community. We meet patients’ routine and unexpected health care needs 365 days a year.
Valley City Regional Hospital is proud to offer a wide variety of medical services, including:
• Emergency room
• Pediatrics
• Inpatient and outpatient surgical care
• Imaging services
• Laboratory testing
• Physical and occupational therapy
• Behavioral health services
• Home care and medical equipment
Critical Care
Valley City has a 6-bed intensive care unit for critically ill patients with heart problems, lung diseases, trauma, or other critical conditions. The unit’s life-saving and –maintaining capabilities include:
• Cardiac monitoring
• Mechanical ventilation
• Post-operative care for patients not ready to be discharged from the hospital
• Cardiac care
Emergency Services
If you or a family member is experiencing a life-threatening injury or illness, call 911. Valley City Regional Hospital is a Level IV Trauma facility. Our staff of registered nurses, physicians, and nurse practitioners is available 24 hours a day, 7 days a week to handle all types of emergencies, including acute medical emergencies, severe injuries, and other crises. Our nurses are trained in cardiac support, trauma nursing, life support, wound care, and many other advanced emergency room areas of expertise.
ER staff evaluate, stabilize, and diagnose emergency patients, and may provide surgery or other critical care services. When the emergency is beyond Valley City’s capabilities, they will arrange for the patient’s transfer to a higher level of care.
Specialists
Valley City Regional Hospital has respiratory therapists, nurse anesthetists, and other specialists on call to consult with ER staff in various types of emergencies.
Inpatient Services
For medical, surgical, or orthopedic illnesses and treatments, Valley City has the best inpatient services available. Our staff of nurses and nursing assistants provides superior patient care for pre- and post-operative patients, patients in need of medical product administration or cardiac monitoring, and patients with all manner of medical conditions. Nurses also work with the hospital’s case managers and specialty services, such as physical therapy, to coordinate patient transitions from inpatient to discharge.
Our many inpatient services include:
• Critical care
• IV antibiotic administration
• Observation
• Restorative care
• Hospice
OB/GYN
At Valley City Regional Hospital, women’s health is a top priority, and we offer experienced care at every stage of the reproductive cycle. Our on-staff obstetricians and gynecologists help women monitor their reproductive health, and provide expert medical advice and treatment for other conditions specific to women.
Among the services we provide for women:
• Annual exams
• Hormone therapy
• Labor and delivery
• Postmenopausal treatment
• Urinary problem diagnosis and treatment
• Pelvic pain consultation and referral
• Menstrual difficulty diagnosis and treatment
Outpatient Services
For patients who don’t need a hospital stay, Valley City Regional Hospital has a range of high-quality outpatient services. For those patients who need same-day surgeries such as knee, shoulder, or eye surgery, our medical professionals provide pre- and post-operative care as well as patient education for at-home management.
Patients with healing injuries, stabilized chronic conditions, and medication management needs can also get individualized help and specific treatment plans for their conditions. Among our many outpatient services are:
• Anticoagulation assistance (for patients on Coumadin/warfarin)
• Cardiac rehabilitation
• Diabetes management
• Dialysis
• Infusion
• One-day surgery
• Wound care
Psychiatric Services
Valley City Regional Hospital has the capacity to manage acute behavioral health crises such as acute depressive episodes, detoxification, substance use and abuse evaluation, and other mental health needs. We stabilize patients in crisis and refer them after they have been stabilized to local outpatient behavioral health services. We provide the following services:
• Mental health and substance abuse crisis stabilization
• Consultation on psychiatric disorders related to pregnancy
• Education about behavioral health issues
• Medication management consultations
Surgical Care
At Valley City Regional Hospital, our board-certified staff of nurses, doctors, anesthesiologists, and other medical staff are dedicated to providing comprehensive surgical services for patients and their families. Whether the procedure is inpatient or outpatient, our care includes the latest medical technologies and experienced surgeons whose top priority is patients’ health. It also includes preoperative counseling and education, postoperative prophylaxis (such as steroids or antibiotics), and rehabilitation and recovery assistance.
We perform a wide variety of procedures at Valley City, including but not limited to:
• Ear, nose and throat surgery
• Open heart surgery
• Ophthalmological surgeries
• Thoracic surgery
• Urological procedures
• Vascular interventions
Quality Assurance
To make sure we’re delivering the best patient care while managing our resources efficiently, Valley City Hospital’s Quality Assurance manager analyzes costs, patient loads, individual cases, admission data, and patient satisfaction data to identify opportunities for improvement. Using indicators as diverse as blood pressure results for hypertensive patients and the proportion of patents assessed by a doctor within 24 hours of referral, Valley City Hospital’s quality assurance staff helps to identify areas for improvement
The QA manager runs the Quality Management Committee, which brings nurses, doctors, and other hospital staff together to talk about data trends, opportunities for improvement, and needed process changes.
Basic Data Spreadsheet
Basic Data Spreadsheets
Barnes County, North Dakota Community Health Profile Population by Age Group, 2010 Census
Barnes County North Dakota
Age Group number percent number percent
0-9 1209 10.9 84,671 12.6
1-19 1423 12.9 87264 13
20-29 1299 11.7 108552 16.1
30-39 1069 9.7 77954 11.6
40-49 1386 12.5 84577 11.6
50-59 1785 16.1 96223 14.3
60-69 1287 11.6 61901 9.2
70-79 886 8 39213 5.8
80+ 722 6.5 32236 4.8
total 11066 100 672591 100
0-17 2280 20.6 149871 22.3
65+ 2170 19.6 97477 14.5
Barnes County, North Dakota Community Health Profile Population by Gender Group, 2010 Census
Barnes County North Dakota
Age Group
Female
Male % Female % Male
Female
Male % Female % Male
0-9 621 588 51.40 48.60 41330 43341 48.80 51.20
1-19 715 708 50.20 49.80 42277 44987 48.40 51.60
20-29 610 689 47.00 53.00 50571 57981 46.60 53.40
30-39 513 556 48.00 52.00 37144 40810 47.6 52.40
40-49 674 712 48.60 51.40 41499 43078 49.10 50.90
50-59 877 908 49.10 50.90 47283 48940 49.10 50.90
60-69 632 655 49.10 50.90 30699 31202 49.60 50.40
70-79 472 414 53.30 46.70 21453 17760 54.70 45.30
80+ 462 260 64.00 36.00 20471 11765 63.50 36.50
total 5576 5490 50.40 49.60 332727 339864 49.50 50.50
0-17 1179 1101 51.70 48.30 73083 76788 48.80 51.20
65+ 1218 952 56.10 43.90 55050 42427 56.50 43.50
Barnes County, North Dakota Community Health Profile Population by Race, 2010 Census
Race Barnes County North Dakota
White 10668 96.4 605449 90
Black 86 0.8 7960 1.2
American Indian 72 0.7 36591 5.4
Asian 58 0.5 6909 1
Pacific Islander 2 0 320 0
Other 24 0.2 3509 0.5
Multirace 156 1.4 11853 1.8
total 11066 100 672591 100
Marital Status of Persons Age 15 and Older, 2006 – 2010 ACS
Barnes County North Dakota
Marital Status Number Percent Number Percent
Total Age 15+ 9240 100 538799 100
Never Married 2393 25.9 163256 30.3
Now Married 4990 54 288257 53.5
Separated 65 0.7 4310 0.8
Widowed 804 8.7 36100 6.7
Divorced 979 10.6 46876 8.7
total 11066 100 672591 100
Educational Status, 2006 – 2010 ACS
Barnes County North Dakota
Number Percent Number Percent
Population 25 Years & Over 7755 100 42933 100
Less Than 9th Grade 411 5.3 24043 5.6
9th – 12th Grade, No Diploma 481 6.2 21467 5
High School Graduate or GED 2606 33.6 120643 28.1
Some College, No Degree 1675 21.6 99176 23.1
Associate’s Degree 589 7.6 51091 11.9
Bachelor’s Degree 1365 17.6 83291 19.4
Graduate or Professional Degree 636 8.2 29624 6.9
Income and Poverty Status by Age Group, 2006 – 2010 ACS
Barnes County North Dakota
Median Household Income $41,773 $46,781
Per Capita Income $26,152 $25,803
Number Percent Number Percent
Below Poverty Level 1276 11.5 78405 12.3
Under 5 Years 137 23.5 4120 9.2
5-11 Years 118 13.5 7908 14.2
12-17 Years 22 2.7 5457 11
18-64 Years 689 10.4 46471 12
65-74 Years 139 13.4 4149 8.9
75 & Over 171 15.1 7072 14
Total Known Children in Poverty (0-17) 277 12.1 17485 11.7
Total Known Age 65+ in Poverty 310 14.3 11221 11.5
Family, Childhood, and Elder Poverty, 2006 – 2010 ACS
Barnes County North Dakota
Number Percent Number Percent
Total Families 2861 100 170477 100
Families In Poverty 183 6.4 12274 7.2
Families With Related Children 1130 39.5 78224 45.9
Families With Related Children In Poverty 124 4.3 10679 6.3
Families With Related Children And Female Parent Only 222 7.8 15482 9.1
Families With Related Children And Female Parent Only In Poverty 83 2.9 6022 3.5
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Choice Module
Data Analystics has prepared a report which provides information on population based data and condition specific rates of prevalence. Using this report and your knowledge of the hospital’s resources, select five conditions to further analyze.
1. Diabetes
2. Obesity
3. Hyperlipidemia
4. Hypertension
5. Asthma
6. Congestive Heart Failure
7. COPD
8. Breast Cancer
9. Cervical Cancer
10. Colorectal Cancer
Here are the health conditions you have chosen for further analysis. The data sets for the conditions you chose can be downloaded by selecting download.
1. Diabetes Data Set
2. Obesity Data Set
3. Hyperlipidemia Data Set
4. Hypertension Data Set
5. Asthma Data Set
6. Congestive Heart Failure Data Set
7. COPD Data Set
8. Breast Cancer Data Set
9. Cervical Cancer Data Set
10. Colorectal Cancer Data Set
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Intermission
Lakshmi Sharma:
Good job! You’ve selected five population health issues to analyze. If you’re satisfied with your choices, click next. If you’re having second thoughts, click back and revise your choices.
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Lakshmi Sharma Interview
Lakshmi Sharma
Getting Started
Alright. At this point you should have received various data sets for the health issues you decided to focus on. Hopefully, that first decision was made based on comparing needs in our community with the services provided at Valley City Regional Hospital. I asked you to look at the issues from that perspective because an important aspect of the informatician’s job is to help drive process and performance improvement within the organization.
Let me give you an example. Let’s say we were looking at data related to depression and suicide in returning veterans. This is a serious issue and one that has received a fair amount of coverage in the national media. However, in terms of performance or process improvement in this hospital, it might not be a good fit because our behavioral health services are limited to crisis management and stabilization.
The point I’m trying to make is that you need to have a question or focus that is guiding your analysis. In this case, we’re looking for ways that we can identify potential process improvements for services we’re currently providing.
Can you give me examples of applying data to performance improvement?
Absolutely. Let’s say that the women’s health department is concerned about maternal substance-abuse. They may want to improve their screening process, or improve the type of education they provide to new mothers. There any number of areas where they might want to modify their current process. The first place they should start, however, would be in collecting and analyzing data around the issue and their current process.
Some examples of data they could examine might include the number of cases of fetal alcohol syndrome seen in this area or whether women are asked about alcohol or tobacco use when they are seen in the OB/GYN clinics or by their primary care physician.
When this data is collected and analyzed, clinicians can look at the results and determine how to proceed, but the first step should be to look at the data and see how it informs potential process improvements.
It’s hard to know what to ask for. I don’t always know which variables or parameters are needed. Wouldn’t it be easier if we just had access to the data?
Yes, it probably would be easier, but there are a number of reasons that access to the various databases is limited. We could debate the validity of these restrictions until the cows come home, but at the end of the day, having unrestricted access to everything we need is simply not the reality in which we work.
For that reason, understanding how to frame requests for data is an important skill for the informatics nurse. To develop that skill, you need to have a clear understanding of the needs that underlie your request. You will need to look at what you have been asked to do and brainstorm your approach to the task. You will almost certainly need to take a collaborative approach and speak with clinicians who work in the area in order to determine which variables are important. Invariably, you will return to the data analytics department with further requests. This is not a failing on your part or on their part, but simply a reflection of the nature of the job.
Graphical Representation of Data
What is the best or most appropriate graphical representation of data? While it would be great if there was one definite answer, that isn’t realistic. What you should be aware of though, are some of the mistakes that can be made when you are presenting visual representations of your data.
The first thing to understand is that much depends on what you are trying to accomplish in presenting your data. What are the users of this information going to do with it? You need to know what message you are trying to communicate with the data.
Once you understand that, you want to be sure that the form you choose is suited to the data. Common forms include bar charts, pie charts, scatter plots, and line graphs, to name a few and each of these is better suited to some types of data than others.
Finally, make sure you provide clarity. Label axes and provide any other textual information the audience will need to understand your graphic. That said, avoid clutter and distractions. Let the data be the dominant feature. One way to help the audience understand what is important in your data is through the judicious use of color, size, and location.
How do you know what the best visual representation of the data is?
The data will drive the decision you make about visual representation. I know that like a non-answer, but unfortunately there is no one answer that will be true in every circumstance. Often there is more than one good way to display the data and determining the “best” method will be a matter of trial and error.
Think about the story you are trying to tell with this data. The more you can understand why you want to show this data in a visual format the more you’ll be able to understand and decide and make good decisions about how it will be represented visually.
I was taught in my statistics course that outliers are considered errors and therefore should be deleted. However, in data analytics there seems to be disagreement. How should I address outliers?
Informatics nurses – the good ones, at least, – find outliers very interesting. While it’s true that outliers can be the result of sampling error, misreported data or other types of mistake, it is also possible that they represent legitimate members of the population.
By maintaining a sense of curiosity, it is possible to see outliers inspiration for inquiry. Consider aging … someone living to 95 or 100 is atypical, particularly if that person is a cancer survivor. What is it about these individuals that makes them different or unique, and what can we learn from them?
Audience
One last point I’d like to address is audience. As an informatics nurse, you’re a liason between the data analytics team and the “consumers” of data – administrators and clinicians. When you’re presenting your findings, it is vitally important that you understand your audience. You need to know their needs and their expectations.
For example, if the audience is hospital leadership, you may have only 10 or 15 minutes to present your material. This is not the time for a deep dive into the data with excruciating detail on every point. In this situation, you need to be able to summarize your findings and clearly present the key takeaways.
On the other hand, if you are brainstorming process improvements with a group of clinicacians, you will probably be expected to go into far more detail and you would have more time – say an hour – in which to explore specific details and findings. In this case your audience probably wants to know details. They would expect to know which variables were examined and which were not, and why. They maybe interested in comparisons or other explorations of the data.
The bottom line is that it is important to understand what your audience’s values and needs are. If you don’t know, you will need to ask – prior to presenting the data so that what you bring to the discussion will serve the intended purpose.
How do I analyze audience if I haven’t met them?
That’s a good question. If we’re talking about leadership, you may want to look at mission statements and any documentation of strategic goals for the organization. What are the current business drivers and what role does the material you’re researching play in meeting those goals? The key is to understand the purpose for the meeting at which you’re presenting information. Who is attending the meeting and what are they concerned about?
What if I have a mixed audience? Tailor it toward the basic.
If, as is often the case, your audience is a mix of people who are knowledgable about the topic or more experienced consumers of data and those who are less knowledgable, less experienced, or less involved with the issues; then you need to take a more basic approach to the presentation. This can be difficult because you want to still provide value to those with more knowledge. One way to approach this is to provide a basic overview and analysis in your presentation, and to have a deeper analysis available as a handout or link you can share with those who want more detail.
Last Point
The last point I want to make is that as an informatics nurse, you may find yourself in a situation where leadership has a particular course of action in mind that is not supported by a close analysis of the data. There may be external pressure to add a particular service or purchase a particular technology. Our function is to provide our bosses with the information they need in order to make informed decisions. Obviously, sometimes political or other pressures may prevail, but as much as possible, our role is to help leadership make informed decisions.
So… what I would like you to do now is to review the data you have for the health issues you selected and send me an email describing at a very basic level how you plan to organize the information and what sort of graphical representation you think will be best suited for the data. Your description can be fairly informal. What I want is for you to begin the process of organizing the data into a meaningful and logical discussion.
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Conclusion
Activity Complete! You have completed all the sections of the Population Health challenge. You should now be able to use the data you gathered and the pointers from your preceptor to determine appropriate data representation methods. Remember that you will also need to document the processes you used to obtain the data and generate reports and graphics.
The choices you’ve made at each step of this activity have been logged for you.
If you wish, you may repeat this activity, but all previous attempts will be overwritten. You can download a copy of the current activity log by viewing the activity log and selecting download.
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Credits
Subject Matter Expert:
Francisco C. Dominicci, MS, MA, RN-BC, MAJ, AN
Interactive Design:
Mark Bune, Justin Lee, Matt Taylor
Instructional Design:
Felicity Pearson, Anne Geske
Project Manager:
Courtney Judd, Amanda Holman, Tom Kapocious
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Licensed under a Creative Commons Attribution 3.0 License.

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