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California National University for Advanced Studies Diabetes Research Proposal
Please write a 2-4 page introduction to your research proposal. In this section you will include the following information:
- Statement of the problem (What healthcare issues are you addressing in your research proposal)
- Significance of the topic and and explanation of why this should be studied(supported with evidence and statistics)
- Target population (who are you studying)
- Example:
- Introduction
- The
emergency department (ED) is a critical, fast-paced environment that is
susceptible to medical errors. Medical errors are defined as a “preventable
adverse event or near miss due to the failure of a planned action to be
completed as intended or use of a wrong plan to achieve an aim” (Pham et al.,
2012, p. 448). They are the cause of 98,000 annual deaths in the United States.
Per the Institute of Medicine (IOM), preventable adverse drug events (ADE) were
one of the most prevalent sources of avoidable medical errors with an annual
occurrence of 1.5 million events. ADEs are also one of the most expensive
errors, costing approximately $3.5 billion each year in the United States in
2006 (Pham et al., 2012). Adverse events were found to take place in 5 to 10% of
health incidents with half of the incidents being avoidable (Watters &
Truskett, 2013). Among these medical
errors are diagnostic errors (incorrect diagnosis or failure to diagnose),
which are the leading sources of error in emergency departments (Brown,
McCarthy, Kelen & Levy, 2010). Some examples include the medication
administration errors, false positive lab test results, unnecessary costs,
tests and treatments (Schuur, Hsia, Burstin, Schull, & Pines, 2013). Per a
national database of physician malpractice insurers, the payout for diagnostic
errors was more than $347 million, which accounted for 46% of emergency
department malpractice claims (Brown, McCarthy, Kelen & Levy, 2010).
Diagnostic errors alone account for nearly 40,000-80,000 annual deaths in the
United States (Pham et al., 2012). Factors in the ED such as psychological
stress, fatigue, time pressure, distractions, overwhelming workloads, lack of
immediate and complete patient health information can increase the rate of
diagnostic errors (Mirvis, 2015). Overcrowding can cause errors such as
erroneous documentation and malfunctioning administrative processes in
emergency care (Ben-Assuli & Leshno, 2013). Another factor is information
overload, which can generate so much anxiety that even coping strategies may
become ineffective. Emergency nurse practitioners (ENPs) overwhelmed by these
factors can increase the clinical risk to ED patients and increase the risk of
ineffective communication (Burley, 2011).
System-related
interventions such as health information technology (HIT) have the potential to
significantly reduce the rates of diagnostic errors, complications, mortality
and costs. In 2005, the Congressional Budget Office (CBO) reported that the HIT
implementation could result in net annual savings of $80 billion (Encinosa
& Bae, 2011). HIT has also been reported to save the United States nearly
$88 billion in costs over 10 years. Some examples of HIT include bar-coded medication administration
(BCMA) systems, computerized physician order entry (CPOE), clinical decision support systems
(CDSS), electronic medical records (EMR) and electronic health records (EHR). (Agrawal, 2009).
HIT can also
notably improve the quality and efficiency of a hospital. After a 41% increase in HIT system
adoption, one hospital’s readmission rates decreased by 41% in 2008 through
2012 (Ben-Assuli, Shabtai & Leshno, 2013). In terms of quality, one
study from a Latter-Day Saint (LDS) Hospital showed a 55% statistically
significant decrease in non-intercepted serious medication errors because of
computerized provider entry use. A second study with a time-series design
showed an even more significant reduction of 86% in non-intercepted serious
medication errors. In terms of efficiency, one study from the Regenstrief Institute
found that alerting physicians using computerized order entry resulted in an
11% decrease in treatment delivery time (Chaudhry, 2006). These computer
systems can provide a safety net to healthcare providers by lessening their
cognitive load. They also back up important patient health files and documents
through the aggregation of patient information and feedback assistance (Pham et
al., 2012).
Purpose
This systematic
analysis aims to provide a deeper understanding of HIT to healthcare providers,
organizations and the public. It considers how diagnostic errors can be reduced
in emergency department patients by supplying evidence of positive and negative
impacts of HIT from previous academic literature. Providing both perspectives
will hopefully assist healthcare providers in becoming more informed about
investing in HIT in their organization.