1

Intervention Plan Design: Lowering Readmission rates for Head and Neck Cancer Patients at University of Miami Hospital

Name

Capella University

Professor

August, 2022

Intervention Plan Design

Lowering Readmission rates for Head and Neck Cancer Patients at University of Miami Hospital

Research shows that approximately 20% of all head and neck oncology patients are readmitted within 30 days postoperatively. Some significant risk factors for 30-day readmission include transition to home or nursing facility care, wound infections, type of surgical procedure, lower socioeconomic status, tobacco smoking, and congestive heart failure (Goel et al., 2019). High head and neck oncology readmission rates are associated with increased healthcare costs, recurrent disease, emotional turmoil, and mortality. Additionally, the 30-day readmission rate is a significant surrogate measure of healthcare quality as it affects patient satisfaction. Based on these findings, it is crucial for healthcare providers to develop perioperative interventions to reduce the readmission rate for head and neck cancer patients. In an effort to reduce the readmission rate, this paper presents a holistic intervention plan that outlines the core components of an intervention plan. The paper further discusses the ethical and legal implications and the theoretical foundations relevant to the intervention. Finally, the paper highlights the stakeholders, regulations, and policies pertinent to the proposed intervention.

Intervention Plan Components

Defining the Major Components

This intervention plan will be implemented at the Head and Neck oncology unit at the University of Miami Hospital. This multidisciplinary intervention plan is bundle care consisting of two major components: comprehensive patient education and post-discharge phone-based care and follow-up.

One major cause of head and neck oncology readmissions is wound infections or complications (Chiesa-Estomba et al., 2022). Patient education plays a vital role in wound care and proper management of the surgical site. This is because head and neck oncology patients have unique post-operative needs that require specialized skills (Jabbour et al., 2017). The patient education component addresses post-operative care topics such as wound, tracheostomy, and gastrostomy care. Patient education also ensures that the patient and caregivers understand the diagnosis and treatment plan. For optimal outcomes, patient education will be delivered to the patient, family members, and any caregiver involved in the patient’s care. A personalized patient education plan ensures that the patient and caregiver have the skills, knowledge, and attitudes to promote post-operative healing. This reduces readmissions as it fosters positive patient outcomes, decreases anxiety, and increases patient satisfaction.

The patient post-discharge care plan consists of telephone follow-up calls within 72 hours after discharge from the oncology surgical unit. During this telephone encounter, the nursing staff uses a post-discharge survey to inquire about the patient’s health and address any emerging patient concerns. Questions asked in the telephone survey will address areas such as pain management, fever, alarm symptoms such as nausea or vomiting, and any patient concerns. The provider will also use the call to schedule and confirm any post-operative appointments. To augment the telephone call, patients will have an opportunity to share wound and surgical site photos or request for videoconference consultation with the provider. The post-discharge telephone follow-up calls are expected to reduce the 30-day readmission rate for head and neck cancer patients. This is because they allow the provider to review the patient’s recovery progress and identify complications before they worsen.

Impact of Cultural Needs

It is crucial to understand the impact cultural needs and characteristics of a target may have on an intervention. Head and neck cancer patients have a multitude of cultural needs and values that should be considered in the intervention. For instance, head and neck patients may experience emotional turmoil like other oncological patients. To accommodate their emotional needs, the intervention’s telephone follow-up survey will ask about the patient’s psychological and emotional status. Appropriate mental health referrals will be made for patients who require psychological support.

Awareness of cultural aspects of caregiving that may impact the patient’s post-operative care is crucial. For instance, the post-discharge plan should be home-based if a family has a collectivist culture and negative attitude towards nursing home care. The provider should also determine whether an individual or the whole family will carry out the patient’s post-operative care. Who is responsible for the medical and other caregiving tasks? Who provides the patient’s meals? Who handles the patient’s financial needs? Who is responsible for scheduling follow-up appointments? To ensure optimal patient outcomes and reduced readmission, this intervention plan ensures the participation of all caregivers in the education intervention.

Theoretical Foundations

Evaluation of Theoretical Nursing Theories and Technologies

One of the theoretical nursing models that underpin this intervention plan is Orem’s Self-Care Deficit Nursing Theory. This theory postulates that a patient’s ability to self-care significantly enhances their health outcomes and well-being (Yip, 2021). Based on this theory, this intervention plan provides comprehensive patient education as a strategy to address self-care deficits and reduce readmission. Another relevant theory is Leininger’s Transcultural Nursing Theory. This theory underscores the importance of providing culturally competent care. These intervention plan components provide culturally congruent care by considering the patient’s cultural practices, beliefs, and values. One of the healthcare technologies relevant to this intervention plan is telemedicine. The second intervention plan component requires the use of telemedicine in post-operative follow-up. All participants will receive phone-based follow-up and optional teleconference consultations to address patient or wound care concerns.

Justification of Intervention Components

Based on Orem’s Self-Care Deficit Nursing Theory, a personalized patient education plan reduces the patient’s and caregiver’s self-care deficit. The patient and caregiver will have the skills, knowledge, and attitudes to promote post-operative healing. Patients with knowledge of wound care and self-care routines have lower rates of infections and complications (Turkdogan et al., 2022). A study by Graboyes et al. (2017) demonstrated a direct association between patient education, adherence to the treatment plan, and reduced hospital readmission rates.

Through the videoconferencing and phone-based component, the provider can provide timely diagnosis and adjust the patient’s treatment plan to reduce complications. By providing culturally competent care, the provider will provide wound care while reducing unnecessary ER visits or readmissions. A quality improvement study by Shah et al. (2021) demonstrated the efficacy of phone-based wound care and patient follow-ups in reducing head and neck cancer readmissions and ER visits. These two intervention plan components will reduce readmissions as they foster positive patient outcomes, increase patient education, decreases anxiety, and increases patient satisfaction.

Stakeholders, Policy, and Regulations

Various stakeholders, regulations, and policies may impact the proposed intervention plan components. Internal stakeholders of the intervention include the nursing and medical staff in the surgical oncology unit, such as nurses, nurse managers, physicians, surgeons, oncologists, and other clinical assistants. Other clinicians involved in ancillary support include nutritionists, psychologists, and physiotherapists. The internal stakeholders are crucial in implementing the intervention within the selected setting and target population. The hospital’s management will be vital in providing leadership and resources to facilitate the intervention plan. Some of the external stakeholders of this intervention plan include the patients and healthcare insurance providers. The patients’ participation is crucial as they are the end consumers of the intervention plan components. At the intervention, patient outcomes, such as the 30-day readmission rate, will determine the project’s success.

One of the intervention plan components entails the use of videoconferencing as a patient follow-up strategy. Before implementing this intervention, it is crucial to determine whether the healthcare insurer reimburses for telehealth consultations. It is also essential to determine the modalities allowed as some providers only cover videoconferencing, not teleconsultation. The State of Florida allows the provision of telehealth services (Malouff et al., 2021). Out-of-state providers can provide telemedicine services if they acquire the required licenses. The University of Miami Hospital is a crucial stakeholder as the intervention will be carried out in this setting. The hospital has telehealth services through its UHealth Virtual Clinics (UHealth Virtual Clinics, n.d.). These telemedicine regulations at the state and organizational levels make it possible to use telemedicine in the intervention’s post-operative follow-up component.

Ethical and Legal Implications

This implementation plan is expected to comply with and adhere to various legal and ethical implications of healthcare practice. These legal and ethical implications are crucial in protecting the patient’s rights during the intervention. Some considerations include patient autonomy, confidentiality, nonmaleficence, beneficence, and justice (Varkey, 2021). The intervention will seek authorization from the institution’s IRB before implementation. The intervention will demonstrate beneficence and nonmaleficence by showing that the intervention’s benefits far outweigh any risks to the patient. Before receiving patient education and enrolling in the phone-based follow-up, all participants must give informed consent. To ensure patient autonomy, all participants will be informed about all the potential benefits and risks of participating in the intervention. To ensure patient confidentiality and privacy, the identity of all participants will be anonymized using identifiers (Shenoy & Appel, 2017). To comply with the ethical principle of justice, participants will be randomly selected and assigned to the intervention and control groups.

At the organizational level, the nursing ad medical staff will be trained and educated on how to comply with these legal and ethical considerations during the intervention. The healthcare team will be trained to implement the intervention without compromising patient confidentiality. They will also be trained to safeguard patient information to ensure only authorized personnel has access. To ensure that the intervention plan is holistic and patient-centered, the organization will provide collaborative channels and resources that comply with ethical and legal issues.

References

Chiesa-Estomba, C. M., Sistiaga-Suárez, J. A., González-García, J. Á., Sarasola, E. L., Vilanova, A. V., & Altuna, X. (2022). Unplanned Hospital Readmission and Visit to the Emergency Room in the First Thirty Days after Head and Neck Surgery: A Prospective, Single-center Study.
International Archives of Otorhinolaryngology,
26(01), e103–e110. https://doi.org/10.1055/s-0041-1730340

Goel, A. N., Raghavan, G., St John, M. A., & Long, J. L. (2019). Risk Factors, Causes, and Costs of Hospital Readmission After Head and Neck Cancer Surgery Reconstruction.
JAMA Facial Plastic Surgery,
21(2), 137–145. https://doi.org/10.1001/jamafacial.2018.1197

Graboyes, E. M., Kallogjeri, D., Zerega, J., Kukuljan, S., Neal, L., Rosenquist, K. M., & Nussenbaum, B. (2017). Association of a Perioperative Education Program With Unplanned Readmission Following Total Laryngectomy.
JAMA Otolaryngology–Head & Neck Surgery,
143(12), 1200–1206. https://doi.org/10.1001/jamaoto.2017.1460

Jabbour, J., Milross, C., Sundaresan, P., Ebrahimi, A., Shepherd, H. L., Dhillon, H. M., Morgan, G., Ashford, B., Abdul-Razak, M., Wong, E., Veness, M., Palme, C. E., Froggatt, C., Cohen, R., Ekmejian, R., Tay, J., Roshan, D., & Clark, J. R. (2017). Education and support needs in patients with head and neck cancer: A multi-institutional survey.
Cancer,
123(11), 1949–1957. https://doi.org/10.1002/cncr.30535

Malouff, T. D., TerKonda, S. P., Knight, D., Abu Dabrh, A. M., Perlman, A. I., Munipalli, B., Dudenkov, D. V., Heckman, M. G., White, L. J., Wert, K. M., Pascual, J. M., Rivera, F. A., Shoaei, M. M., Leak, M. A., Harrell, A. C., Trifiletti, D. M., & Buskirk, S. J. (2021). Physician Satisfaction With Telemedicine During the COVID-19 Pandemic: The Mayo Clinic Florida Experience.
Mayo Clinic Proceedings. Innovations, Quality & Outcomes,
5(4), 771–782. https://doi.org/10.1016/j.mayocpiqo.2021.06.006

Shah, M., Douglas, J., Carey, R., Daftari, M., Smink, T., Paisley, A., Cannady, S., Newman, J., & Rajasekaran, K. (2021). Reducing ER Visits and Readmissions after Head and Neck Surgery Through a Phone-based Quality Improvement Program.
Annals of Otology, Rhinology & Laryngology,
130(1), 24–31. https://doi.org/10.1177/0003489420937044

Shenoy, A., & Appel, J. M. (2017). Safeguarding Confidentiality in Electronic Health Records.
Cambridge Quarterly of Healthcare Ethics: CQ: The International Journal of Healthcare Ethics Committees,
26(2), 337–341. https://doi.org/10.1017/S0963180116000931

Turkdogan, S., Roy, C. F., Chartier, G., Payne, R., Mlynarek, A., Forest, V.-I., & Hier, M. (2022). Effect of Perioperative Patient Education via Animated Videos in Patients Undergoing Head and Neck Surgery: A Randomized Clinical Trial.
JAMA Otolaryngology–Head & Neck Surgery,
148(2), 173–179. https://doi.org/10.1001/jamaoto.2021.3765

UHealth Virtual Clinics. (n.d.). Retrieved August 31, 2022, from https://umiamihealth.org/en/treatments-and-services/virtual-clinics

Varkey, B. (2021). Principles of Clinical Ethics and Their Application to Practice.
Medical Principles and Practice,
30(1), 17–28. https://doi.org/10.1159/000509119

Yip, J. Y. C. (2021). Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem’s Self-Care Deficit Nursing Theory.
SAGE Open Nursing,
7, 23779608211011990. https://doi.org/10.1177/23779608211011993

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Implementation Plan Design

Name

Capella University

Professor

September, 2022

Implementation Plan Design

The purpose of intervention plans is to utilize an evidence-based approach to achieve practice change and improve patient health outcomes and satisfaction. A successful implementation plan design requires a sound and reasonable approach to translating evidence-based research into clinical practice. This intervention addresses the clinical question of the high 30-day readmission rate for head and neck oncology surgical patients at the University of Miami Hospital. This paper presents an intervention plan design that outlines the management, leadership, delivery technology, stakeholders, policy regulations, and timeline considerations.

Management and Leadership

This intervention requires the collaboration of a multidisciplinary team involved in the management of head and neck oncology patients. Research has established that when compared to fragmented health care, multidisciplinary surgical care results in better health outcomes, reduced healthcare outcomes, and better patient-reported outcomes (Davis et al., 2021). The multidisciplinary team involved is the surgical oncology unit’s nursing and medical staff. These include nurses, nurse managers, physicians, surgeons, oncologists, and clinical assistants. Other clinicians involved in ancillary support include nutritionists, clinical psychologists, and physiotherapists. Some of the leadership and management strategies required to promote multidisciplinary collaboration include:

· Collaborative communication: Effective communication channels are required to ensure the success of this intervention plan (Kumar et al., 2019). The project will create communication channels that foster teamwork, morale, and team trust. Some skills that will be encouraged include empathy, active listening, and positive reinforcement through rewards.

· Collaborative practice: All interdisciplinary care team members will have an opportunity to contribute their skills, expertise, and experience to the implementation plan. This ensures that all aspects of the intervention are holistic and patient-centered.

· Shared and collectivistic leadership: This ensures that all resources within the organization are maximized, and individuals with diverse backgrounds are given an opportunity to lead and apply professional judgement (Aufegger et al., 2020). Decisions will be made in an open, honest, and democratic manner, where the common goal is to improve patient outcomes.

Collaboration of a multidisciplinary surgical care team is required to promote the delivery of individualized and high-quality patient care to head and neck cancer patients. Through shared leadership, collaboration, and collectivistic leadership and management strategies, the patients will benefit from the experience and education of different providers (Reid et al., 2021). For instance, the nursing and nutrition team may collaborate to design a treatment plan that promotes wound care and recovery. There will also be decreased medical errors and workflow redundancies, and potential health complications will be identified before they worsen.

Delivery and Technology

This project’s organization uses a clinic-based head and neck discharge and follow-up plan. This intervention plan proposes an evidence-based discharge and follow-up bundle with two major components: comprehensive patient education and post-discharge phone-based care and follow-up. To increase project effectiveness, this project will be delivered in four phases. Phase 1 will involve a needs assessment to identify the staff and patient population attitudes and health literacy levels. Phase 2 involves testing and tailoring the proposed head and neck discharge and a follow-up plan to the identified staff and patient needs. Phase 3 involves staff education and training to ensure they understand how to implement the intervention. Phase 4 involves the actual project implementation at the Head and Neck oncology unit. One of the key assumptions of this intervention plan is that the hospital will provide all the resources required to implement the four project phases. These resources include dedicated staff, time, equipment, and resources. Another assumption of the intervention plan is that the needs assessment will demonstrate willingness among the staff to implement a practice change project.

Phases 2 and 3 of this implementation plan require using the internet and internet-based devices. This is because the needs assessment will be conducted using online surveys, while the staff training will be on an online web-based platform. Phase 4 (implementation) entails using a phone-based follow-up call and videoconferencing (optional). Current telemedicine technologies (telephone and video consultations) will be crucial in enhancing the delivery of the intervention plan. During the phone-based follow-up call, the nursing staff uses a post-discharge survey to inquire about the patient’s health, schedule post-operative appointments, and request videoconference consultation if needed. One of the emerging healthcare and digital technologies that may support this proposed intervention plan is artificial intelligence (AI). Several studies have established the role of image-based artificial intelligence (AI) algorithms in optimizing wound assessment, care, and healing (Anisuzzaman et al., 2021).

Stakeholders, Policy, and Regulations

The implementation of this intervention plan requires the collaboration of various stakeholders. The internal stakeholders, such as the nurses, surgeons, oncologists, nutritionists, and clinical psychologists, will be responsible for implementing the intervention in the target population and setting. The external stakeholders, such as the patients and healthcare insurers, will be crucial in facilitating the intervention implementation plan design. The patients are core stakeholders of this intervention as they are the target population. Therefore, patient needs must be considered in the intervention plan design. For instance, the patient needs assessment will determine whether the phone-based follow-up will be carried out via phone calls or SMS.

This intervention utilizes post-discharge phone-based care and follow-up intervention, with the option of requesting a videoconference consultation. Because the intervention plan requires telemedicine technology, it must be implemented based on two policy regulations: The Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009 and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These two federal regulations ensure that patient health information is protected and kept confidential (Moore & Frye, 2019). Additionally, the project will seek approval from the University of Miami Hospital IRB by demonstrating adherence to ethical principles and standards. These existing policies will ensure that the intervention plan protects the rights and privacy of the patients. 

Timeline

This intervention plan will be implemented for a period of four months (16 weeks) at the Head and Neck oncology unit at the University of Miami Hospital. The first four (4) weeks will be dedicated to conducting a departmental needs assessment, staff education, and troubleshooting the proposed bundle care. The next eight (8) weeks will be allocated for the project execution and implementation. This involves identifying project participants, implementing the oncology unit’s discharge and follow-up bundle care, and collecting patient outcomes. Some of the project’s primary patient outcomes include the 30-day readmission rate and compliance to wound care protocols. The next four (4) weeks will be allocated for analyzing the collected patient health outcomes to determine the impact of the intervention. During this period, the results of this project will be presented and disseminated to various stakeholders within and outside the organization. Some factors that may negatively impact my projected timeline include institutional bottlenecks, staff resistance, high project attrition rate, lack of required resources, and poor compliance with the project protocol.  

References

Anisuzzaman, D. M., Wang, C., Rostami, B., Gopalakrishnan, S., Niezgoda, J., & Yu, Z. (2021). Image-Based Artificial Intelligence in Wound Assessment: A Systematic Review.
Advances in Wound Care. https://doi.org/10.1089/wound.2021.0091

Aufegger, L., Alabi, M., Darzi, A., & Bicknell, C. (2020). Sharing leadership: Current attitudes, barriers and needs of clinical and non-clinical managers in UK’s integrated care system.
BMJ Leader,
4(3), 128–134. https://doi.org/10.1136/leader-2020-000228

Davis, M. J., Luu, B. C., Raj, S., Abu-Ghname, A., & Buchanan, E. P. (2021). Multidisciplinary care in surgery: Are team-based interventions cost-effective?
The Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland,
19(1), 49–60. https://doi.org/10.1016/j.surge.2020.02.005

Kumar, H., Morad, R., & Sonsati, M. (2019). Surgical team: Improving teamwork, a review.
Postgraduate Medical Journal,
95(1124), 334–339. https://doi.org/10.1136/postgradmedj-2018-135943

Moore, W., & Frye, S. (2019). Review of HIPAA, Part 1: History, Protected Health Information, and Privacy and Security Rules.
Journal of Nuclear Medicine Technology,
47(4), 269–272. https://doi.org/10.2967/jnmt.119.227819

Reid, M., Lee, A., Urbach, D. R., Kuziemsky, C., Hameed, M., Moloo, H., & Balaa, F. (2021). Shared care in surgery: Practical considerations for surgical leaders.
Healthcare Management Forum,
34(2), 77–80. https://doi.org/10.1177/0840470420952485

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Lowering Readmission rates for Head and Neck Cancer patients at University of Miami Hospital

Name

Capella University

Professor

September, 2022

Lowering Readmission rates for Head and Neck Cancer patients at University of Miami Hospital

3

Lowering Readmission rates for Head and Neck Cancer patients at University of Miami Hospital

Name

Capella University

Professor

August 2022

Lowering Readmission rates for Head and Neck Cancer patients at University of Miami Hospital

This paper examines a problem statement that focuses on presenting information associated with the Problem-Intervention-Comparison-Outcome-Time (PICOT) approach to nursing research. The paper also presents a brief literature review, which backs the need recognized in the problem statement and the suitability of the broad intervention approach.

Problem Statement

This section is split into various subsections, including the need statement, population and setting, intervention overview, comparison of approaches, initial outcome draft, and time estimate.

Need Statement

This paper addresses interventions that can assist in the reduction of readmission rates for head and neck cancer patients within the University of Miami Hospital. This need is crucial because head and neck cancer patients include populations that are at risk for readmissions because of several elements, comprising need for complex postoperative care, insurance status, high mortality, and recurrent disease (Yang et al., 2022). According to the American Cancer Society (2022), head and neck cancer is responsible for approximately 4% of all cancers within the United States. In 2022, about 66470 individuals, comprising of 17,950 women and 48,520 men will be diagnosed with head and neck cancer. In 2020, 562,328 individuals were diagnosed with head and neck cancer globally. Additionally, it is approximated that 15,050 deaths, including 4,110 women and 10,940 men for head and neck will occur within the U.S. in 2022. In 2020, about 277,597 deaths were recorded globally from the illness (American Cancer Society, 2022). Therefore, neck and head cancer shows a significant need that should be examined in order to identify appropriate interventions.

Population and Setting

The study by Stoyanov et al. (2017) established that out of the 180 head and neck cancer cases, 72.22% were males, while 27.78% were females. The mean diagnosis age was 63.67 ± 12.9 years and the median age was 65 years. Additionally, the study by Dhull et al. (2018) sampled 9,950 head and neck cancer patients. According to age classification, patients ages ranged between 20 to 70. Patients aged from 21 to 30 was a total of 241. Those aged between 31 and 40 were 1,127, those aged 41 to 50 were 2,783, those aged between 51 and 60 were 3,091, those aged from 61 to 70 were 2,055, and above seventy years old were 613. Therefore, based on these findings, this study will include a population of individuals aged between 40 and 70 years old. The population must be head and neck cancer patients.

The study setting will be within a hospital, particularly the University of Miami Hospital. The hospital delivers leading-edge patient care by the area’s best doctors, backed by groundbreaking research from the University of Miami Leonard M. Miller School of Medicine. It is the only university-based medical system in South Florida; therefore, it is a crucial component of the community. Through the hospital records, the researcher will examine the number of admissions and readmissions of patients within 30 days. This information will help calculate the readmission rates of the patients.

Intervention Overview

Treating Institution

Factors motivating head and neck cancer patients to seek chemoradiation or radiation in the community versus in an academic center are not completely understood, combined with the impacts of site of treatment on survival and treatment completion. Lassig et al. (2012) compared treatment completion and survival rates between patients in the community and at an academic center. The findings established that there was no statistically significant difference in the rate of planned treatment completion between academic and community centers. However, patients in the academic centers received concurrent chemotherapy. On the other hand, the 5-year survival rate was 53.2% for academic centers and 32.8% for community hospitals. Therefore, determining the kind of institution to seek Head and Neck cancer treatment affects the outcome of the treatment of the disease.

This intervention fits my target population because in the study the researchers’ sampled individuals with head and neck cancer with the median age of 58 for community center patients and the median age of 56 for academic center patients. The intervention fits my target setting because it is an academic-based hospital. The intervention effectively addresses head and neck cancer since it improves survival rate and treatment outcomes.

Comparison of Approaches

Monitoring quality and reporting Outcomes

Head and neck cancer needs high level multidisciplinary care to accomplish maximum outcomes. Certain health services have instigated the reporting of quality indicators (QIs) to enhance quality of care. Chilkuri et al. (2021). It examined the quality of care offered to patients with head and neck cancer within a single institution by investigating compliance with QIs and analyzing the utility and feasibility of the data collection. The findings established that compliance with post-, pre-, and treatment QIs was high. The 5-year overall survival was 69.4% and the cumulative locoregional relapse incidence for the whole study cohort was 18%. Therefore, monitoring quality and reporting outcomes with a multidisciplinary care team was effective in enhancing survival rate.

This intervention utilizes a multidisplinary care team in addressing head and neck cancer, while the institution type does not utilize an interprofessional care techniques. Both the interventions fit my target population since they sampled patients with head and neck cancer within the stated age. The earlier intervention is based on an academic hospital setting while this intervention utilizes a single institution retrospective chart review. This intervention is more effective in managing patients’ survival rates at 69.4% compared to the earlier intervention that achieved a survival rate of 53.2%.

Initial Outcome Draft

The one outcome the study seeks to accomplish is to decrease the readmission rates for head and neck cancer patients at the University of Miami Hospital using a tested and recognized intervention. The reduction of the readmissions will significantly improve the hospitals quality and experience of care and safety since the relevant stakeholders will be working to ensure the patients are not discharged prematurely or through conditions that will warrant a readmission.

Time Estimate

To develop the intervention, the researcher will require one month. This time will be used to decide the steps to take, collect relevant information concerning the level of the problem, discussing with the end users (care practitioners) and potential clients (patients) of the intervention, and recognize the problems or issues the intervention will try to solve. One significant challenge would be convincing the patients to participate in the study. Accessing patient information will require various permissions from the hospital and the patients. The researcher will have to get ethical approvals, which can take longer to access.

The implementation will take three months. The first month will involve identifying root causes, developing activities and objectives, and setting the selection criteria. The second month will include applying selection criteria and rating and selecting intervention alternatives. The third month will comprise planning and implementing interventions and monitoring and evaluating interventions. Challenges that might affect the timeframe include acquiring a sample that sufficiently represents the population and the stakeholders’ schedules since nurses can be busy.

Literature Review

This section reviews various peer-reviewed articles and journals relating to the research topic. The researcher utilized various search words, including head and neck cancer, decreasing readmissions of head and neck cancer, and interventions for addressing head and neck cancer. These were searched in various databases such as ResearchGate, Xplore, Wiley Online Library, and National Library of Medicine.

Demographics of Head and Neck Cancer Patients

Head and neck cancer includes a diverse classification of oncological entities, emerging from different organ localizations and tissue types situated within the topographical section of the neck and head (Argiris et al., 2008; Davies & Welch, 2006). The Neck and head section is the sixth most frequent region for malignancies (Hoffman et al., 1998). It also represents one of the few medical practices permitting for an uncomplicated diagnostic biopsy and endoscopy via a natural orifice in almost every case; therefore, ensuring detailed pretreatment staging and diagnostic (Ang et al., 2001). The global head and neck cancer incidence is about 3% of every cancer case, with men representing approximately 90% of the affected and epithelial neoplasms representing over 85% of every cancer type (Marur & Forastiere, 2008; Sturgis & Cinciripini, 2007). The most frequent factors for developing this disease are alcohol consumption and smoking. Use of topical substances, occupational exposures, e-cigarettes, and marijuana are also associated with head and neck cancer. Measures such as vaccination, smoking cessation, screening, and oral hygiene decrease the morbidity and incidence of head and neck cancers (Cohen et al., 2018).

Stoyanov et al. (2017) conducted a single institution retrospective study aimed at determining the head and neck cancer patient demographics and classifying the individual head and neck malignancies’ incidence, concerning primary histopathological type and organ origin. The researcher reviewed every histologically verified cases of head and neck cancer from one tertiary referral center in a descriptive retrospective approach. The data sampling period lasted for 47 months (Stoyanov et al., 2017). The findings indicated that male to female ratio of the registered cases of head and neck cancer was 3.24:1. Mean age was 63.84 ± 12.65 years. The most frequent head and cancer locations comprise the salivary glands 10.94%, pharynx 20.03%, oral cavity and lips 29.08%, and the larynx 30.37%. The primary histopathological comprise adenocarcinoma 6.14% and squamous cell carcinoma 76.74% (Stoyanov et al., 2017). Though head and neck cancer is considered rare, it represents a different group of oncological entities with specific and individual demographic features.

Reducing Readmission of Head and Neck Cancer

Hospital readmissions within thirty days of discharge have developed into a surrogate determinant of patient care quality. The notion is that substandard care or premature discharge during the index hospitalization may escalate readmission risks. Studies have established that if 20% of beneficiaries are readmitted in thirty days of being discharged, Medicare system cost increases by 26 billion dollars each year (Jencks et al., 2009).

Yang et al. (2022) conducted a study examining readmission rates before and after multidisciplinary quality enhancement initiatives that major on staff and patient education, utilizing targeted skilled nursing amenities, and suitable usage of patient observation status. The study was conducted from October 2015 to September 2018 when the head and neck oncology service reviewed its discharge practices for patients undergoing reconstructive or extirpative surgery. The changes, included improving patient education, escalating the usage of skilled nursing amenities with directed personnel education and patient handoffs by advanced practice nurses, and suitable usage of 23-h observation status for returning patients (Yang et al., 2022). The researchers sampled 449 patients, 35.9% were examined before the practice change, while 64.1% after the practice change. The results indicated that readmission risks decreased by 41.4% from the pre-intervention period. Patients at high or moderate risk of death were 2.31 times more probable than the patients at minor risk of death to readmit in thirty days. Additionally, patients with persistent or recurrent cancer were 3.33 times more probable than the patients undergoing first curative surgical cancer management to readmit in thirty days (Yang et al., 2022).

The Affordable Care Act

This act was signed into law in March 2010. Section 3025 denotes that newly formed Hospital Readmissions Reduction Program would hold hospitals financially responsible for every 30-day readmissions (Weinick & Hasnain-Wynia, 2011). The Medicare and Medicaid Centers required that hospitals report and track hospital readmission rates for five diagnoses, including elective total hip and total knee replacements, chronic obstructive pulmonary disease, pneumonia, congestive heart failure, and acute myocardial infraction. The reimbursements would be determined founded on adjustment factor established by the institutions projected versus observed 30-day readmission rate for the five diagnoses. The institutions that displayed higher than anticipated readmission rates would invite financial penalties (Weinick & Hasnain-Wynia, 2011). Although otolaryngology-precise processes are not within the present Centers for Medicare and Medicaid readmission policy, section 3025 encompassed a clause that allowed for expansion of the policy to more conditions in the future (Weinick & Hasnain-Wynia, 2011).

Interventions for managing Head and Neck Cancer

According to Lassig et al. (2012), factors motivating head and neck cancer patients to seek chemoradiation and radiation within an academic center versus community centers are not fully understood. The researchers conducted a historic cohort study within tertiary academic center and community facility settings. The study involved patients with mucosal HNCA recognized by International Classification f Disease, Ninth Revision (ICD-9) (Lassig et al., 2012). The researchers examined treatment completion rates and conducted multivariate and univariate analyses of various treatment outcomes. The study sampled 388 patients with 210 completing treatment at the academic center and 145 at the community center (Lassig et al., 2012). The results indicated that patients who underwent radiation at the academic center had more progressive disease and were more probable to get concurrent chemotherapy. The academic center had higher percentage of oropharyngeal tumors, higher median income, and higher proportion of noncurrent smokers (Lassig et al., 2012). There was no statistically significant difference between the academic and community centers in terms of planned treatment completion rates. The 5-year survival rate for the academic center was 53.2%, while for the community center was 32.8% (Lassig et al., 2012).

Chilkuri et al. (2021) examined the quality of care offered to patients with head and neck cancer within a single institution by investigating quality indicators (QIs) and to analyze the utility and feasibility of data collection. The study method was a single institution retrospective chart review of every patient with squamous cell head and neck cancer at Townsville Hospital treated with curative intent from June 2011 to June 2019. The researchers sampled 537 patients for the study (Chilkuri et al., 2021). The findings displayed that compliance with pre-treatment, treatment, and post-treatment QIs was high, excluding time to post-operative radiotherapy, post-treatment dental review, and smoking cessation support. The intervention’s 5-year general survival rate was 69.4%. The cumulative locoregional relapse incidence for the entire study cohort was 18% (Chilkuri et al., 2021). Gathering and assessing quality metrics is feasible and assists in recognizing sections for improvement. Head and neck treatment centers should endeavor to monitor quality against benchmarks and practice transparency regarding data results.

Conclusion

Head and neck cancer is a serious condition that affects the victims significantly. Statistics indicate that it kills numerous people globally. Most head and neck cancer patients are readmitted to hospitals within 30 days of discharge, which leads to more harm to their health and finances. Therefore, it is crucial to develop interventions that would effectively decrease the readmission rates of such patients. Decreasing readmission rates improves quality of health, safety, and better treatment experience.

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