Planning Model for Population Health Management Veterans Diagnosed with Non cancerous chronic pain – Part 1 & 2 Solutions

Planning Model for Population Health Management Veterans Diagnosed with Non cancerous chronic pain – One of the strategies that add impetus to the achievement of higher value in healthcare while using primary strategies is population health management. To reap the full benefits of PHM, healthcare facilities must adopt a new approach that views health and healthcare using a different lens….

Planning Model for Population Health Management Veterans Diagnosed with Non cancerous chronic pain

In this Work Product Assessment, you will identify and research the health needs of a specific population, define a problem, and develop a plan in collaboration with public health agencies and community-based organizations, for addressing that problem. The five parts of the Assessment will take you from an initial needs analysis through the creation of a budget. You will also be assessed on the Professional Skills of Written CommunicationCritical Thinking and Problem Solving, and Information Literacy

PART 1

For this Assessment, you will first select a priority population on which to focus. The population could be defined by geographic boundaries, such as a city, town, or neighborhood, or by demographics within the community, such as senior citizens, infants and toddlers, children, teens, men, or women. You may also define the community by locale, such as urban, rural, or suburban. The population can be further narrowed by race/ethnicity, socioeconomic status, gender or sexual orientation, or specific situations: pregnant women, children at risk for obesity, senior citizens living below the poverty line, victims of domestic abuse, veterans, etc. It is suggested that you select a population in which you have an interest or are familiar. Keep in mind the availability of data for the population you select. The more narrow the population or geographic area, the more difficult to find data. The more broad, however, the more difficult it might be to determine meaningful trends.

Once you select the priority population, you must determine how you will collect information and data regarding the authentic health needs of that population. Keep in mind that a needs analysis is taken to ensure that an initiative is based on clear evidence and is, in fact, needed. Consider: What existing health regulations or policies might prompt an initiative for this population? What are the population’s greatest health needs? What initiatives already exist addressing the needs? What financial and human capital are available to this population? In what ways might the population be underserved? What organizations and health programs serve this population? What initiatives have been successful and not successful in the past?

Consider these approaches to information and data collection:

  • Start with public health agencies. These are often the best source for local and targeted information, and public health staff can also point you toward sources of the statistical information that you need.
  • Check individual states and towns for community health statistics. Speak to members of the community and ask questions. Qualitative as well as quantitative data is valuable, and information gained can further focus your efforts. Review media and research.
  • Speak to community organizations. For example, United Way, local senior centers, after-school programs, veterans’ services, baby clinics, maternal and child health services, support groups, or whatever organizations are involved with the selected population.
  • Locate the statistics that can help pinpoint and verify needs, and provide the persuasive quantitative data you will need to inform an initiative.
  • Look at resources listed in this Competency and other online resources.

In a 2-page needs analysis, briefly describe the results of your research. Include the following:

  • A description of the priority population or community.
  • A list of at least five chosen indicators (statistics that you have found) and comparison to the state or national levels (Note: It may be helpful for you to organize this information in a table first.)
  • A list of at least three stakeholders (individuals, organizations, etc.) representing the priority population that you wish to receive feedback from concerning their perceived health needs, including an explanation of how the stakeholders are relevant to the priority population.
  • Identification of the health need you wish to address based on gaps between indicators among your priority population and state/national averages.
  • A data-based rationale for selecting this need.
  • A brief description of at least five sources you used to verify this need.
  • Descriptions of existing financial and human resources, policies, and programs in place for this population.
  • part 2

You will now focus on a planning model that aligns to the health need you have identified and wish to address. A planning model is a comprehensive framework for creating a health initiative (also called a health program) and, in particular, guides the goals, specific objectives, and theoretical considerations of the initiative.

Many different planning models are applied in healthcare. Most address common elements such as engagement of the community, prioritization of health issues, and development of a goal or vision. When selecting a planning model for a health initiative it is important to select one that best provides a strong correlation between the model and identified health needs. Refer to the Jellybean Diagram included with this Assessment as an example of a model in population health that demonstrates the relationships between community partners, and all who could be involved in health program planning.

In a 3- to 4-page narrative, describe the planning model of your initiative as follows:

  • List the goal (at least one) and objectives (2–3) of your initiative based on the identified health need of your priority population.
  • With the intended goal(s) of your health initiative in mind, select one planning model that provides a direct correlation between the model and initiative objectives. Identify and describe the planning model you have selected. Provide a rationale for choosing this model. Why is it most effective for your program?
  • Describe specific aspects of your initiative including:
  • Inputs: What resources will go into the program?
  • Activities: What are the events or actions that will take place?
  • Outcomes: What are the intended outcomes of the initiative?
  •  
  • PART 3

Assume that your health initiative has been approved. With the planning you have already accomplished, consider a 1-year timeline for initiating the program. Ask yourself: For this initiative to launch in 1 year (the typical timeline for grants and evaluations), what activities need to happen by when?

Create a timeline of your activities for launching your health initiative using the Timeline Template provided.

Save this file as HE009_Timeline_firstinitial_lastname (for example, HE009_Timeline_J_Smith).

PART 4

A well-thought out budget proposal is a critical part of getting any health initiative approved. Create a budget proposal for your health initiative using the Budget Template provided.

In addition, create a 2-page budget narrative as follows:

  • Explain each category and item. This might include donations that might be covering some costs.
  • Describe potential funding sources for the health initiative. Consider local corporate sponsors, community organizations, special interest groups, or any other place that you might realistically go looking for money.
  • Describe any community partner collaboration (i.e., financial, gifts, or bartering) for this initiative that includes at least one public health agency and a community-based organization.

Save this file as HE009_Budget_firstinitial_lastname (for example, HE009_Budget_J_Smith).

PART 5 

The logic model summarizes the program that has been designed. Create a logic model graphic using the template provided. Your “Logic Model Graphic” should reflect all core aspects of your initiative as described in Part 2.

Save this file as HE009_Narrative_firstinitial_lastname (for example, HE009_Narrative_J_Smith).

Solution

Introduction

One of the strategies that add impetus to the achievement of higher value in healthcare while using primary strategies is population health management. To reap the full benefits of PHM, healthcare facilities must adopt a new approach that views health and healthcare using a different lens. The paradigm shift has to shift from the traditional trend of focusing on the diagnosis and treatment of diseases to behavioral and socioeconomic factors so that they play a significant role. These healthcare entities must address the broader considerations and reexamine their care delivery system in the context of new payment models and cost overruns. By definition, PHM describes the organization coupled with the accountability health and healthcare needs of defined groups of individuals. This is done using strategies that are proactive and interventions that are coordinated and also not only engaging but also clinically meaningful, cost-friendly, and safe.

On the other hand, population health is regarded as a collection of health outcomes of a specified group of people with a focus being how these outcomes are distributed within the group. Population health differs from public health in that the latter looks at the health of an entire population. In contrast, its counterpart population health examines a wide variety of groups of individuals comparing the incidence of diseases between races or age groups, amongst other factors. Consequently, the paper of presenting a planning model that identifies the health needs of veterans aged sixty-five years and above diagnosed with chronic pain unrelated to cancer (CPUC). The paper is divided into five sections, the first of which presents an analysis of the CPUC veterans’ health needs. Part 2 concentrates on a planning model that addresses the needs of veterans diagnosed with CPUC, while Part 3 outlines the planning model12 month timeline. Part 4 covers the budget proposal of my approved healthcare initiative, which seeks to decrease opioid medication addiction. In contrast, the 5th and last part create a logic model graphic covering the core aspects of the proposed health initiative, as described in section 2 of 5.

Part 1 of 5: Needs Analysis of Veterans Diagnosed with CPUC

Chronic pain refers to pain that lasts more than 90 days or past the expected tissue healing time, which affects more than 100 million grown-up Americans. According to Peterson et al. (2017), chronic pain among veterans occurs in about half of those seeking treatment in primary care. Since pain is a function of dynamic interactions between physiological, psychological, and social factors, pain care needs should be customized for each patient with the Veterans health association, recommending a multimodal approach to pain care. National safety council (2018), in its report titled Prescription Nation 2018, notes that prescription opioids form the gateway to heroin, which is similar in its composition and is more comfortable and less expensive to get. Be that as it may, heroin and illicitly made fentanyl (a synthetic opioid is 50 to 100 times more potent than morphine. In 2016, the National Safety Council report notes that more than 42 000 Americans succumbed to opioid overdose translating to 115 deaths every day, all of which could have been prevented. Healthcare professionals should always remember that the initial opioid prescription might trigger an addiction that was not intended in the first place (Dasgupta, Beletsky & Ciccarone, 2018). As such, they should always strive to ensure they meet each of the listed indicators irrespective of the state in which they practice

The first indicator is the requirement that all healthcare providers complete continuing education linked to chronic pain management, opioid prescribing, or addiction. Thirty-four states and the District of Columbia realized this indicator among New York. The second indicator is the adoption of a recommendation that practitioners use a written treatment plan for chronic pain. In contrast, the third indicator calls for confirmation of the guidance that physicians conduct a physical examination and an assessment of substance use disorder before controlled substance prescription. It worth mentioning that 33 states and the District of Columbia (DC) achieved these two indicators. However, New York is amongst those that failed in this regard. Besides these three indicators, 39 states and the DC of achieved at least four of the following five symbols and met the state essential action namely having an operational PDMP, requiring prescribing the use of the relevant state PDMP for the first prescription, the requirement for collection of prescription information within 24 hours. Additionally, they permitted delegate access and interstate sharing of state PDMP data. New York State is amongst those that achieved these four of the five indicators.

Summary of the states and the indicators they have met

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Planning model for population health management veterans diagnosed with non cancerous chronic pain
Planning Model for Population Health Management Veterans Diagnosed with Non cancerous chronic pain

Source: National Safety Council (2018)

The stakeholders include the Veterans Health Association, veterans diagnosed with chronic pain unrelated to cancer active duty as well as reserve military personnel. The stakeholders are relevant to veteran affairs because aging infrastructure and the absence of proper planning cause VA facilities to source private contractors for services and updated technology. In addressing the prescription opioid addiction, these stakeholders are in a position to mobilize resources like staff, medication equipment, and non-pharmacological interventions to help ex-service military personnel in their hour of need.

Part 2 of 5: Planning Model

In contemporary healthcare, there is a resurgence of interest in registered nurses dealing with prescription opioid addiction. The absence of robust research evidence continues on the most effective and efficient strategies to deliver maximum sustained performance in reducing prescription opioid addiction among veterans. The primary goal of this initiative to provide veterans diagnosed with CPUC with non-pharmacological alternatives to manage their pain. The objectives to help in the achievement of his goal are to increase the number of veterans with musculoskeletal pain using complementary alternative medicine (CAM) in pain management. The second objective is to analyze chronic pain guidelines using non-pharmacological interventions to reduce pain. In contrast, the third objective entails establishing quality non-pharmacological interventions and makes recommendations based on the quality of quality non-pharmacological responses for application in clinical practice.

To achieve the non-pharmacological chronic panic pain management initiative and help bridge the existing knowledge gap, the author of this essay formulated a generic RN logical model that offers a causal pathway to improved performance from a theoretical point of view. Mills, Lawton & Sheard (2019) opine that analysts, policymakers, program planners, and project managers apply the logic model in concise communication of the underlying theory of their proposed policies in both projects and programs in a visual way. The logic model stems from program evaluation research, but it is used in contemporary program planning and has widened to embrace guiding prom design, implementation, and monitoring. Furthermore, the logic model can also apply in conducting operational research together with evaluation. I opted for this planning model since a logic model defines the anticipated relationships and causal links in connection to what the population health management program seeks to do and what it expects to achieve. The logic model is the most effective for a health initiative aiming to reduce prescription opioid addiction among veterans with CPUC. It captures a variety of contextual factors that may affect the program’s implementation and the subsequent attainment of the results.

To elucidate the vertical logic of the Logic Model, this pyramid summarizes its principal components.

Description of Specific Aspects of the CAM Initiative to Manage CPUC among Elderly Veterans

`           The purpose of this essay is to enhance early and persistent causal thinking as makers of decision formulate, execute, scale-up, and evaluate prescription opioid addiction and other interventions seeking to impact population health positively. The steps outlined below describe the generic RN generic logic model constructed drawing primarily from nursing experts’ experience in the New York state. A graphic display of the model is presented with a detailed explanation of its parts in a narrative as well as Jelly bean diagrammatic form.

The Process of Generic RN Logic model Construction

The generic RN logic model Construction arose from 12 months of May 2019 to May 2020 after a multiple-stage inductive process. The model construction commenced during the initial planning of a systematic review of evidence on population health and formal health system meant to support the US government-sponsored initiative to address the opioid epidemic crisis. The first step in the planning process entails developing alternative definitions of RN performance, recognizing the various factors that might impact this performance, and then categorizing everyday activities to support RN performance, whether offered by the communities, health systems, or by a combination of the two. The NSC (2018) definitions are adopted. Some of the definitions adopted were misuse, which contextually refers to the use of medication saved from prior medical conditions for a non- prescribed purpose. Likewise, dependence describes an individual’s physical, the need for a substance or medication causing tolerance or physical withdrawal symptoms if the said drug or medication is not supplied. Addiction herein is described as a chronic brain condition that manifests behaviorally by losing control of medication use, followed by loss of control of life functions as a result of drug abuse.

Similarly, opioid use disorder (OUID) is a particular subset of substance abuse disorder (SUD) that defines a diagnosis that satisfies the criteria for alcohol or drug dependence or misuse as stipulated in the Diagnostic and Statistical Manual for mental disorders fifth edition (DSM-5). Initial planning or concept development was followed by a review of evidence whereby the RN organizing the CAM program reviewed the evidence gathered.

The RN team utilized a variety of methods to evaluate the evidence, which included but were not limited to group discussion, review of literature, and analysis of case studies related to opioid medication addiction amongst veterans. Experts were also consulted, and at the end of the consultation process, the review teams revised their frameworks. Granted, the fact that no human subjects were used ethical approval was required for this study and therefore obtained; hence, the next step was a synthesis model development premised on the review of the evidence, consultation of experts as well as extra analytical work.

            The result was the generic RN Logic Model, as demonstrated in Figure 1. The generic RN model indicates that optimal RN performance is a derivative of high-quality RN programming. It is strengthened, sustained, and guided to scale by health and community systems that are not only robust but also high performing. The input activities of the CAM initiative to manage CPUC amongst veterans include the written policies as well as programs. They are also individuals, funding, and other resources like materials, equipment, facilities, and time. It is essential to acknowledge that now, this planning model assumes both sufficient levels of the said resources at the most convenient time. Activities within the programming level entail the mobilization of the necessary inputs and implementing the processes whose accomplishment would result in the achievement of this programming model objectives. As such, CAM therapies to be used in clinical practice include hands-on therapy, like massage, mind-body practices like meditation, yoga ad music therapy, and energy therapy like acupuncture as the RNs work together with community health workers (CHWs). The adoption of CAM initiative is recommended because this therapy is cost-effective and has little or no risks and side effects.

            The CAM initiative as a method of managing CPUC anticipates outcomes like improved quality of life for veterans diagnosed with CPUC despite having to use the opioid medication in reduced quantities hence minimizing opioid addiction and the accompanying health risks. In addition to the effective management of CPUC pain through CAMs and cognitive behavioral therapy, the success of this programming model will lead to the development of quality recommendations as far as CPUC management is concerned. The outcomes and their effect can be categorized as a short term like knowledge of guidelines based on evidence, and understanding of alternative measures to control chronic pain. The next subgroup of outcomes is medium, like getting informed consent, decreasing opioid doses, and patient education of medication safety. The third and last category is long-term outcomes like effecting behavior modification in the prescribing physician habits, improved quality of life for the patient, decreased healthcare costs, and effective CPUC management.

In summary, an overview of the steps used to formulate the logic model is first to identify a problem like CPUC in elderly veterans. They manage it using opioid medication, leading to OUD. Phase 2 entails establishing the primary inputs to the program then the determination of the applications key outputs. Step four involves recognizing the program outcomes, followed by the creation of the logic model outline before identifying the factors influencing the program externally and, lastly, identifying the program indicators.

PART 3: 1-Year Timeline

Timeline for Initiating a Health Initiative

EventJanFebMarAprilMayJuneJulyAugSeptOctNovDecConduct a survey            Complete Elderly veterans need assessment            Formulate CAM educational resource            Undertake patient education on CAM as alternative CPUC management            Develop multidisciplinary team report and key recommendations            Print final CAM protocol on CPUC management and ready it for dissemination            

PART 4: Budget Proposal

Expenses( Project Budget)Projected Cost
Staffing 50 hours per meeting times 4 for planning, research, and resources Benefits Consultations   Workers subtotal$ 5 000   $ 1000 $ 2 000   $ 8 000
Direct expenses  Speakers travel Meetings Printing and designs Direct expenses subtotal  $ 700 $ 1 300 $ 2 000 $ 4 000
Miscellaneous Stipends Subgrants to collaborating community organizations Miscellaneous subtotal Expenses total  $ 1 000 $ 1 500 $ 2 500 $ 14 500
OTHER INCOME Request from my organization Requests from other organizations In-kind contributions Total Project Budget  $ 10 000 $ 2  500 $ 3 500 $ 16 000

The Budget Narrative

Money plays a crucial role in the successful implementation and sustenance of population health management initiatives. A project manager assumes that if they had a bigger budget, then they could enlist more people into their project and even deliver more outcomes that are positive within the specified period (Benzeval et al., 2014). No project plan can be deemed complete until the program creator comes up with a budget no matter how big or small premised on the resources and activities contained therein. As such, the fifth and last section seeks to justify the proposed budget for CAM health initiative to use this non-pharmacological therapy to manage CPUC among veterans using opioid-based medication effectively.

Justification of the Budget Proposed

The administrative expenses include the advertising costs for complementary alternative medicine as well as the lead researcher’s travel expenses. With a projected cost of $ 16 000, the project initiator hopes that VHA facilities will donate printing equipment in kind during the planning stages of the program. The vote on staff expenses includes the research assistant salary, travel expenses, and conference attendance fees. The upper ceiling for the staff expenses is capped at $8 000. Another critical component of the CAM health initiative in pain management of CPUC among veterans on opioid medication is training expenses. Here catering costs, as well as presenter fees, are factored, which the VHA facilities will donate in-kind the venue combined these will spend around $ 3500. Once the CAM resource is developed, and its final draft is prepared, the initiative requires a marketing consultancy fee, printing fees, and the cost of disseminating the focus group findings and recommendations. This comprises the bulk of the health initiatives consuming around $2400. Finally, the CAM health initiative among veterans diagnosed with CPUC will incur evaluation expenses in the form of consultancy fees, development of an evaluation report, and other miscellaneous costs. These will amount to $ 500, bringing the proposed budget for this project to $ 16 000

Potential Financial Funding and In-Kind Donations

Holistic Research Funds and the federal department of Human Resources and the4 American Pain society will fund the CAM project. Suffice to say that a military is a tightly knit group that shares their bond through camaraderie. Other agencies in which I may go looking for funds are like the National League for Nursing (NLN) and the American Nurses Foundation. I will seek the collaboration of the National Institute for health and CDC‘s overdose prevention in states to secure resources among a host of other organizations. With about nine million opioid prescriptions having been dispensed in the state of New York in 2015 and more than 140 000 individuals in New York abusing or dependent on opioids, there is a need to collaborate with community agencies in this state (New York State Health Foundation, 2018). One of these agencies is Essex County Heroin and Opioid prevention coalition.

Part 5 of 5: The Logic Model Graphic

Logic Model

SituationInputsActivitiesOutputs
To evaluate the efficacy of complementary alternative medicine in pain management amongst elderly veterans diagnosed with chronic pain and using opioid medications.A monitoring program to decrease the use of opioid-based medication to manage chronic pain unrelated to cancer among veterans.Prescribing physiciansSupport staffDatabase for researchTechnology utilizedTime CAM educational resourcesRegistration of all prescribing physicians  on the prescription drug monitoring program(PDMP)Carry out discussions with the prescribing physicians on evidence-based guidelines.Assess barriers.Review records to assess prescribing physicians’ habits.Impress the prescribing staff, nursing professionals, key stakeholders like VHABesides, the project director to take part.Increased knowledge of evidence-based guidelines. Enhanced awareness and knowledge concerning PMDP and increase the program’s usage. Improved knowledge of alternative non-opioid pharmacological and non-pharmacological therapies in CPUC management like CAM. Decreased usage of opioid medication manages CPUC. Encourage behavior modification on prescribing physician habits, improve patient outcomes, and decrease per capita medication costs for elderly veterans diagnosed with chronic pain unrelated to cancer.
Purpose of the Initiative: To use complementary alternative medicine in managing chronic pain amongst elderly veterans to reduce rates of prescription opioid medication addiction and improve the patient’s quality of life.

References

Benzeval, M., Bond, L., Campbell, M., Egan, M., Lorenc, T., Petticrew, M., & Popham, F. (2014). How does money influence health?

Clinton-Lont, J., Kaye, C., & Martinson, A. (2016). A Primary Care Approach to Managing Chronic Noncancer Pain. Federal Practitioner, 33(12), 39.

Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid crisis: no easy fix to its social and economic determinants. American journal of public health, 108(2), 182-186.

Mills, T., Lawton, R., & Sheard, L. (2019). Advancing complexity science in healthcare research: the logic of logic models. BMC medical research methodology, 19(1), 55.

National Safety Council (2019) PRESCRIPTIONNATION2018; Facing America’s opioid epidemic URL: https://www.nsc.org/Portals/0/Documents/RxDrugOverdoseDocuments/RxNation-2018-web.pdf Retrieved on May 25th, 2020.

New York Health Foundation (2018) Tackling the Opioid Crisis in New York State URL: https://nyshealthfoundation.org/grantee-story/tackling-the-opioid-crisis-in-new-york-state/ Retrieved on May 25th, 2020.

Peterson, K., Anderson, J., Bourne, D., Mackey, K., & Helfand, M. (2017). Evidence brief: Effectiveness of models used to deliver multimodal care for chronic musculoskeletal pain. In VA Evidence Synthesis Program Evidence Briefs [Internet]. Department of Veterans Affairs (US).

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