How many different medications do you currently take? o 1-2 o 3-4 o more than 4

Identify the nursing practice issue or problem that you have noted from your clinical nursing experience.
January 7, 2019
Compare patient discharge surveys before change and after initiation of change.
January 7, 2019

Cost analysis and funding of our program:


Anticipated expenses includes

Fixed Costs [this is all unclear to me. Who are the coordinators, etc.?]

• Salary – monthly cost of hiring local coordinator on per diem basis – The Team projects an approximately 6 hours of work/ per local coordinator/week at $20/hour. For the initial phase about 10 local coordinators will be hired.

Variable Cost

• Cost of deliverables: These include the cost of educational pamphlets and other souvenirs to be given to expected enrollees

• Cost of seminar: This includes the cost for organizing seminars, conferences or health fair for the purpose of screening and recruiting diabetes patients into Gotham diabetes program.

• Cost of screening: This includes the actual cost of screening for diabetes. Supplies needed will include glucometer and testing strips


Source of Fund for program

The Team recommends the following as a source of funding for the project

• Federal Funding

• PPACA/ACO shared saving program

• National Institute of Diabetes, Digestive and Kidney disease funding for Special community.

• State Funding – New York State Diabetes Prevention and Control program

• Agencies

• Lion Club International Foundation Core 4 diabetes Initiative

• America Diabetes Association

• Free donations from community for diabetes prevention

Projected Statement of Operation


Funding and

Community donations $88,600

Total Revenue $88,600

Operating Expenses

Salaries, wages and Compensation $59,600

Transportation and Logistics $2,000

Deliverables $,10,000

Seminar, Recruitment programs $4,000

Screening Test $10,000

Supplies $3,000

Total Expenses $88,600 Net Profit — – – – – –


The ACA signed into law was intended to accomplish three fundamental elements: increase access, improve quality and reduce cost. The ACO provision of the ACA is a channel that focuses on improving quality and cost reduction through coordinated care reimbursed via bundled payment and VBP. The health reform legislature has implication for both providers and the uninsured/underinsured patients in their community. Gotham Hospital is no exception. With the full implementation of the ACA in 2014, most uninsured and underinsured in the Bronx will have access to one form of health insurance coverage or the other mostly through Medicaid/Medicare. [will this translate into utilization?] Furthermore Gotham Hospital which is a tax exempt is required by the ACA to do a CHNA every three years to maintain its tax exempt status. Therefore Gotham Hospital has the overriding interest to ensure that its target population stays healthy to ensure adequate reimbursement through PFP and the maintenance of its not-for-profit status.

Using the Diabetes Program at Gotham as a yardstick to assess the effect of the ACA/ACO on Gotham Hospital and its target underinsured/uninsured population, it is evident that Gotham Hospital needs to do more if it must remain in compliance with the ACA mandate. The major challenge the Hospital faces is in getting the underserved members of the community who need their services to utilize. Of the approximately 120,000 diabetes patients in the Bronx, less than 8% are using the diabetes care services at Gotham. The remaining 92% does not utilize these services in spite of the availability. [You need to focus on them first and then the undiagnosed].

This problem had been in place pre ACA and has persisted Post ACA. It is worthy of note that the hospital operating budget has not shown any significant improvement post ACA. There was slight reduction in Medicare/Medicaid reimbursement post ACA. [Discuss, be more specific]

Assessing the impact of the ACO provision in improving the quality and access to care is still a bit premature. As at the time of writing this paper, the ACO structure at Gotham Hospital has been in place for less than a year. Therefore, no conclusive answer can be given on how the ACO will impact the challenge of underutilization at Gotham Hospital. However, based on the current existing ACO structure at Gotham, this capstone group anticipates that the problem is likely to persist unless a proactive measure is taken to address this issue specifically. Hence, the recommendation for local coordinators who can greatly assist in convincing the uninsured/underinsured diabetes patients in their community to be enrolled in the diabetes program at Gotham. [You can’t build your improvement/outreach/service effort around these coordinators. There are many more infrastructure and service issues to address first. This is potentially one small component]. Additionally, the stimulus package fund made available to Gotham Hospital can also be proactively used to institute community-based diabetes preventive care program that targets the younger generation who are more in tuned with HIT as a long term strategy to prevent diabetes. This presents an avenue to increase their qualification status in line with the stimulus package fund reimbursement.

Table A

Social Demographic Comparisons: Bronx, White Plains and Westchester County

Statistics of Health Care AccessBronx*Westchester County**White Plains***
Income (Median)32,578103,49070,714
% Black Living in Poverty25.82019.1
% White Living in Poverty1316.64.6
% Hispanic Living in Poverty35.42015.9
% Total Living in Poverty28.596.7
African American505,200138,1187,447
Unemployment Rate11.76.76
Education 25 Years Older H.S.62.383.682
Education 25 Years Older BA14.640.942
Adult Diabetes %
Obesity %25.419.113.4
Low Income Obesity %15.417.812.5
Children Uninsured %1563
Uninsured Adults %22102
Medicaid194,00071, 2342,626
Median House/Condo393,600544,700500,525

Exhibit 7



1 Name ________________________________ Age ______________

2 Address ___________________________________________________________________

3 Marital status: o Single o Married o Divorced o Lives with Partner

4 Number of Children ________

5 Employment status: o Employed o Unemployed o Seasonal Employment

6 Financial status:

o less than $12,000/annum o $12,000 – 24,0000 o $25,000 – 50,000 etc.

7 Do you have health insurance?

o Yes o No


1 Do you smoke tobacco?

o Yes o No

2 What type of tobacco do you smoke?

o Cigarette o Cigar o Others

3 If yes, how many sticks of cigarette/Cigar do you smoke per day?

o 1-5 o 5-10 o greater than 10

Sedentary life style

1 How often do you exercise?

o about 30 minutes per day o 2-3 times per week o once a week o once a month

o never

2 How far is the nearest gym to your home?

o Within one mile o 1-5 miles o 6-10 miles o > 10miles

Nutritional habit

1 How regularly do you drink sodas?

o Daily o about 3 times a week o once a week o never

2 How often do you eat vegetables and fruits?

o Daily o about 3 times a week o once a week o never

3 How often do eat cooked food?

O Daily o about 3 times a week o once a week o Never

Family history

1 Has anyone in your family been diagnosed of diabetes, high blood pressure or heart disease?

o Yes o No

2 Is there any history of sudden death in your family?

o Yes o No

3 Has any one died of Heart disease in your family?

o Yes o No

Associated medical disease

1 Are you currently diagnosed as having high blood Pressure?

o Yes o No

2 Are you currently diagnosed as having heart disease?

o Yes o No

3 Do you feel any tingling sensation on your hands or foot?

o Yes o No

4 Do you have problem seeing properly?

o Yes o No

5 Do you have any difficulty passing urine?

o Yes o No

6 Do have any leg ulcer that has lasted more than a month?

o Yes o No

Medication compliance

1 How many different medications do you currently take?

o 1-2 o 3-4 o more than 4

2 How often do you take your medications per day?

o once o twice o three times o four times

3 How often do you miss or forget to take your medications?

o Often o rarely o never


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