EVIDENCE-BASED PRACTICE AND THE QUADRUPLE AIM NURS 6052

With increasing healthcare demand, the healthcare system has been advancing drastically over the years, with the introduction of Evidence-based Practice (EBP) for the provision of safe and quality care. Several models such as the triple aim which has evolved to quadruple aim have also been established to promote population health with enhanced patients experience at a reduced cost (Bowles et al., 2018). Healthcare experts believe that the incorporation of EBP into current clinical practice will help reach the Quadruple Aim. As such, the purpose of the present paper is to discuss the quadruple aim and its role in evidence-based practice.

EBP and the Quadruple Aim on Patient Experience

The quadruple aim is focused on the creation of better care output among patients, at a reduced cost, with an improved experience for both the patient and the healthcare provider. With EBP, all the four measures of the quadruple aim can be achieved. For instance, utilization of EBP in the delivery of care and decision-making process on the most appropriate intervention promotes the experience of the patient, with improved care outcome (Haverfield et al., 2020). Patients tend to feel safe when clinicians utilize evidence-based treatment approaches when taking care of them.

EVIDENCE-BASED PRACTICE AND THE QUADRUPLE AIM NURS 6052

EBP and the Quadruple Aim on Population Health

Concerning population health, EBP promotes the utilization of research in better understanding the characteristics, values, needs, and preferences of a certain population, which are key elements in care delivery. For instance, common chronic illnesses such as diabetes and cardiovascular conditions have posed great challenges over the years, with increasing morbidity and mortality rates (Wagner et al., 2018). However, EBP, through research has led to the introduction of novel approaches which are time efficient and easily accessible helping populations with the highest prevalence of these comorbidities hence promoting the achievement of the quadruple aim.

EBP and the Quadruple Aim on Healthcare Cost

Additionally, with the introduction of EBP, clinicians have reported improved prognosis of several health complications with has reduced hospitalization rate hence reduced healthcare costs. Consequently, the use of proven diagnostic tools and treatment approaches has led to a reduced treatment period, hence reducing the costs associated with diagnostic tests and medication (Haverfield et al., 2020). Clinicians have also been trained to utilize cost-effective care approaches and avoid unnecessary procedures to help reach the quadruple aim.

EBP and the Quadruple Aim on Work-Life of Healthcare Providers

Lastly, despite EBP promoting patient-centered care, the experience of the healthcare workforce has also been considered for optimal care benefits. As the fourth element of the quadruple aim, EBP has ensured that clinicians are adequately trained to utilize time-saving and effective medical tools, to improve the efficiency of the care process (Haverfield et al., 2020). The current healthcare system has introduced several interventions through EBP to decrease provider burnouts, stress, and depression which would otherwise lead to poor health outcomes and decreased patient satisfaction.

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Conclusion

The healthcare system has evolved over the years towards the provision of safe and quality services. Currently, clinicians are encouraged to utilize EBP in care provision to improve the quality and efficiency of care provided at a reduced cost (Wagner et al., 2018). In the same line, the quadruple aim which evolved recently from the triple aim focuses on four main elements which can be achieved with the incorporation of EBP into current clinical practice.

References

Bowles, J. R., Adams, J. M., Batcheller, J., Zimmermann, D., & Pappas, S. (2018). The role of the nurse leader in advancing the Quadruple Aim. Nurse Leader, 16(4), 244-248. https://doi.org/10.1016/j.mnl.2018.05.011

Haverfield, M. C., Tierney, A., Schwartz, R., Bass, M. B., Brown-Johnson, C., Zionts, D. L., … & Zulman, D. M. (2020). Can Patient-Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review. Journal of general internal medicine, 1-11. https://doi.org/10.1007/s11606-019-05525-2

Wagner, E. H., LeRoy, L., Schaefer, J., Bailit, M., Coleman, K., Zhan, C., & Meyers, D. (2018). How do innovative primary care practices achieve the quadruple aim?. The Journal of ambulatory care management, 41(4), 288-297. DOI: 10.1097/JAC.0000000000000249

Evidence-based practice (EBP) has an extreme reliance on the available scientific proof in making decisions within the clinical facility. This system of practice has gained approval since its introduction in the 1990s and is currently being relied upon in the formulation of public policies, management, nursing practice, and education. Evidence-based practice adopts the available proof from the excellent scientific researches, the choices and values of clients, and the knowledge of the clinicians in making decisions concerning their patients’ care (Crabtree, Brennan, Davis, & Coyle, 2016). The evidence-based practice aims to make sure that the services availed to clients are safe and of high quality. In addition, the model of evidence-based practice emulates an inter-professional system where sharing on decision making is greatly practiced. The majority of nurses have shown a positive attitude towards the evidence-based practice model. Crabtree et al., (2016), the majority of them (nurses) are ready and willing to equip themselves with the required knowledge and skills for its implementation in the clinical practice.

There are four main goals in the quadruple aim. They include population health, reducing healthcare-associated costs, and the work-life of healthcare providers (Kim et al., 2016). To achieve the four goals, quadruple aim intends to redesign the healthcare facilities. Nevertheless, improving population health whereas reducing healthcare costs, that demand high standards of effectiveness and efficiency remains to be a great challenge.

The establishment and implementation of evidence-based practice primarily aim to improve and promote the quality of the health service provided and upholds a great value on the care of clients within the hospital facility. The work life of healthcare practitioners are affected by this model as the employees must stand out productively in order to provide a high quality healthcare services that are safe. Every healthcare facility exists to better the lives of patients as well as those of healthcare workers (Sikka, Morath, & Leape, 2015).

Patient experience

The entire evidence-based practice methodologies enable healthcare practitioners to employ research evidence in clinical practice. Healthcare workers and nurses can effectively integrate existing scientific information into clinical practice based on specific patient requirements by employing effective literature searching abilities and explicitly following the criteria that guide evidence to assess study findings (Kim et al., 2016). As a result, the quality of healthcare services provided to patients improves. Most healthcare facilities have recently adopted evidence-based practice to address clinical challenges that directly affect patient care, which has resulted in better patient care.

Population health

The aim of evidence based practice is to educate people on, cultural practices, advantages of specific therapies and health determinants. An equal allocation of resources to achieve certain goals is ensured when evidence based approaches are integrated in a variety of demographic contexts. People can be grouped based on their needs, which are determined by family support, individual health, and socioeconomic status which promote equity and effectiveness in resource distribution for the purpose of health promotion (Kim et al., 2016).

Costs

The assessment of per capita healthcare costs, which requires all healthcare costs to be recorded, indexing costs to the healthcare market and measurement of real costs is a serious obstacle for most healthcare institutions. Pricing and discounts are the frequently used methods to determine actual costs. Its really challenging for majority of the healthcare facilities strike equilibrium in providing safe quality care at a lower cost as most healthcare facilities are investing fortune in getting 21^st century technologies in order to improve quality of care and all those comes with a high price tag (Sikka, Morath, & Leape, 2015).

Work-life of healthcare workers

The important elements of a favorable healthcare working environment should promote inter-professional collaboration. This system (Inter-professional collaboration has been noted to the prognosis of patients’ health and satisfaction the healthcare workers. Additionally, it minimizes the turnover and burnout rates of practitioners, which enhances staff output. The three main components in such an environment comprise active engagement of the staff members in decision making, structural, and policy features (Kim et al., 2016).

References

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172–175. doi:10.1111/wvn.12126

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13(5), 340–348. doi:10.1111/wvn.12171

Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24, 608–610. doi:10.1136/bmjqs-2015-004160

I was really excited to see that we choose the same organization to review. I must say that I agree with your analysis of Mayo’s ability to integrate evidence based practice into it’s core business model by utilizing research studies and clinical trails to effectively test new drugs. According to our text there are two processes here that offer clinicians sources of knowledge: (1) practice-based evidence (PBE) and (2) research. These two sources of evidence fuel evidence-based practice (EBP). Their processes and outcomes overlap somewhat and are intertwined, but they are distinct in the knowledge they produce to influence clinical decision making (Melnyk & Fineout-Overholt, 2018). The Mayo Clinic works tirelessly to ensure that practice-based evidence and research is utilized to provide the best care.

I found that the Mayo Clinic are grounded on EBP. The organization prides itself in championing high-quality and rigorous healthcare research to discover solutions and cost-effective ways of caring for complex healthcare problems. Cost is a major factor in healthcare, especially in the United States, the only developed western country without a form of universal health coverage. EBP proposes cost-effective interventions in the design and delivery of optimal and efficient care (Sikka, Morath, & Leape, 2015). In short evidence has found that by delivering cost effective healthcare options organizations are able to provide better universal care to it’s patients.

References:
Melnyk, B. M. & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24(1), 608–610.

Evidence-based practice is an essential part of the healthcare system that uses scientific data, research, and patient preferences to achieve the best possible outcomes for those patients. EBP ultimately achieves better patient outcomes and reduces healthcare costs by limiting the amount of time patients are hospitalized (Melnyk & Fineout-Overholt, 2018). The healthcare organization I have chosen to review is the OSF Children’s Hospital of Illinois, where I have worked as a registered nurse for the past 6 years.

The Children’s Hospital of Illinois is one of the largest in the state and is a state-designated level 1 pediatric trauma center. The children’s hospital also offers a level IV NICU and the first small baby unit in the state, as well as one of the only congenital heart centers in the state. The mission of OSF is to serve with the greatest care and love in a community that celebrates the gift of life (OSF, n.d.). The mission of this healthcare organization does not necessarily depict evidence-based practice, however, “to serve with the greatest care” can be interpreted that if you are using the latest research and technologies to achieve better outcomes for patients then you are using EBP in your work. There were other areas of the website that contributed to EBP as well, 10% of fundraised proceeds for the Children’s Hospital go directly toward research and treatment in the care of children, while 20% of the proceeds go toward advancement services that support programs and projects. Without these donations, the hospital would lose out on a significant amount of research towards the care and outcomes of the children cared for in this healthcare organization. OSF Children’s Hospital also uses fundraising to benefit and expand the knowledge and research in member hospitals so that they are able to improve patients’ health, well-being, and future (Children’s Hospital of Illinois, n.d.).

This organization’s work is grounded in evidence-based practice. They are an accredited hospital whose outcomes are significant enough to be a nationally-ranked children’s hospital. I believe they have to be using the most up-to-date research and technology to be achieving these recognitions. The numbers are not misleading, and their work and contributions to other hospitals are proving that evidence-based practice is the best practice for all. Since I have worked at this hospital for a while now, I knew the work they were doing was for good of their patients. They truly use the best technology and practices are always changing and evolving based on research done. My perception of this organization has not changed significantly but has only grown in appreciation for the work and care they provide to our community.

Grading Rubric

Performance Category	100% or highest level of performance 100% 16 points	Very good or high level of performance 88% 14 points	Acceptable level of performance 81% 13 points	Inadequate demonstration of expectations 68% 11 points	Deficient level of performance 56% 9 points	Failing level of performance 55% or less 0 points
Total Points Possible= 50	16 Points	14 Points	13 Points	11 Points	9 Points	0 Points
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic topics.	Presentation of information was exceptional and included all of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information was good, but was superficial in places and included all of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information was minimally demonstrated in all of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information is unsatisfactory in one of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information is unsatisfactory in two of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information is unsatisfactory in three or more of the following elements Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information
	16 Points	14 Points	13 Points	11 Points	9 Points	0 Points
Application of Course Knowledge Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations	Presentation of information was exceptional and included all of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information was good, but was superficial in places and included all of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information was minimally demonstrated in the all of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information is unsatisfactory in one of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from and scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information is unsatisfactory in two of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information is unsatisfactory in three of the following elements Applies principles, knowledge and information and scholarly resources to the required topic. Applies facts, principles or concepts learned scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.
	10 Points	9 Points			6 Points	0 Points
Interactive Dialogue Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic.	Demonstrated all of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.	Demonstrated 3 of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.			Demonstrated 2 of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.	Demonstrated 1 or less of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.
	8 Points	7 Points	6 Points	5 Points	4 Points	0 Points
Grammar, Syntax, APA Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error.	The following was present: 0-3 errors in APA format AND Responses have 0-3 grammatical, spelling or punctuation errors AND Writing style is generally clear, focused on topic,and facilitates communication.	The following was present: 4-6 errors in APA format. AND/OR Responses have 4-5 grammatical, spelling or punctuation errors AND/OR Writing style is somewhat focused on topic.	The following was present: 7-9 errors in APA format. AND/OR Responses have 6-7 grammatical, spelling or punctuation errors AND/OR Writing style is slightly focused on topic making discussion difficult to understand.	The following was present: 10- 12 errors in APA format AND/OR Responses have 8-9 grammatical, spelling and punctuation errors AND/OR Writing style is not focused on topic, making discussion difficult to understand.	The following was present: 13 – 15 errors in APA format AND/OR Responses have 8-10 grammatical, spelling or punctuation errors AND/OR Writing style is not focused on topic, making discussion difficult to understand. AND/OR The student continues to make repeated mistakes in any of the above areas after written correction by the instructor.	The following was present: 16 to greater errors in APA format. AND/OR Responses have more than 10 grammatical, spelling or punctuation errors. AND/OR Writing style does not facilitate communication
	0 Points Deducted					5 Points Lost
Participation Requirements	Demonstrated the following: Initial, peer, and faculty postings were made on 3 separate days					Failed to demonstrate the following: Initial, peer, and faculty postings were made on 3 separate days
	0 Points Lost					5 Points Lost
Due Date Requirements	Demonstrated all of the following: The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT. A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.					Demonstrates one or less of the following. The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT. A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.