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Capella 4900 Assessment 2

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    Capella 4900 Assessment 2

    Capella 4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Consideration

    Student Name

    Capella University

    NURS-FPX 4900 Capstone Project for Nursing

    Prof. Name



    Every healthcare system aims to provide the best quality care treatments which should enhance patient safety and reduce costs to the systems and patients. Chronic diseases like diabetes, hypertension, and cardiovascular diseases need life-long treatment and management strategies. Providing ongoing quality treatment to patients suffering from chronic disease is challenging for healthcare systems. This report is the extension of the previous assessment in which the case of Joey was taken and explored.

    In this report, further analysis of Joey’s health problem i.e. coronary heart disease is conducted in terms of its impact on quality of health, safety, and cost incurred by this condition to the patient and the system providing healthcare services. Furthermore, it is analyzed how the governmental and nursing standard board policies create their impact on quality, safety, and cost in terms of coronary heart disease. Lastly, the evidence-based strategies are proposed that can improve the patient quality of health, and patient safety and reduce the costs in this case of health problems.

    Impact of Coronary Heart Disease on Quality, Safety, and Costs

    In my two-hour practicum at the ward, I got the opportunity to interact with Joey. He suffers from the complications of coronary heart disease including angina and made another visit for a checkup. This shows that the quality of care provided to him is inappropriate or insufficient. Coronary Heart Disease (CHD) is one of the cardiovascular diseases characterized by plaque formation in the coronary artery of the heart leading to an insufficient supply of oxygen to the heart. This may lead to severe complications such as angina, heart failure, stroke, arrhythmias, and even death. In America, about 18.2 million American adults suffer from CHD which makes it to be the most common type of cardiovascular disease in the US (National Heart, Lung and Blood Institute, 2022). 

    Factors that influence the quality of care in the case of Coronary Heart Disease may be provider-related or patient-related. In provider-oriented factors, long waiting times at hospitals, lack of trained nurses, and increased burden of cardiovascular patients are contributing factors that negatively impact the quality of care to CHD patients (McIntyre & Chow, 2020). Joey and his family mentioned how the quality of care provided is not up to the standard. He has to wait in long queues for his regular checkup. His low financial status makes it hard for him to buy multiple medications and follow the regimen properly. All of this creates a negative impact on the quality of health. 

    His condition needs intricate and keen management and treatment approaches as any changes in his comorbidities of diabetes and hypertension can lead to severe complications of CHD. Lack of proper education on medication adherence contributes to the poor management of Joey’s CHD condition and results in his hospital revisits. Medication therapy is significant in treating and preventing secondary complications in CHD. If the medication regimen is not followed, CHD will only progress more worsening the patient’s quality of health. CHD can be treated and managed effectively when nurses and patients both cooperate and communicate about medication adherence and implement it (Thomson et al., 2020).   

    When the patient’s condition of CHD is well managed with a joint effort of patients, nurses, and clinicians, patient safety is assured. Patient safety in the case of CHD patients depends on how well-controlled their condition is. If the symptoms of CHD are minimized and the patient’s heart rate and heart rhythms are regular, patient safety is ensured. But in most cases, including Joey’s case, this is far from reality. Joey’s increasing chest pain shows that his condition and symptoms are not well-managed and can have lethal implications on his health contributing to reduced patient safety. Joey has to make visits to clinics due to his unmanaged condition of CHD and is more vulnerable to catch further illness at the hospital further compromising patient safety. Poor health management due to poor lifestyle also creates a negative impact on Joey’s health.  

    According to CDC, treatment and management of cardiovascular problems such as CHD create an immense economic burden on both the health care systems and patients. In the US, about $219 billion are spent on these problems annually. These costs are related to the expenditures of healthcare services, medication, and premature death (CDC, 2021). In the case of Joey, being a retired postman and having a low income from pension, he faces challenges in procuring costly medications needed to treat his disease. He often misses his medication doses due to unavailability resulting in revisits to hospitals for associated complications as a result of poor management of CHD. 

    Impact of Nursing State Board and Governmental Policies on Quality, Safety, and Cost

    Preventive Cardiovascular Nurses Association plays an important role in improving the quality of health in patients with CHD and other cardiovascular ailments. This nursing state board provides guidance to nurses to implement various authentic resources for managing and treating CHD. Additionally, it impacts patients’ quality of health by providing educational resources to patients in managing their disease and improving the quality of health. This is a non-profit organization influencing cardiovascular patients’ lives positively by delivering them educational handouts on their diseases at no cost.

    This results in improved quality of care and patient safety and reduced costs to the patients (Preventive Cardiovascular Nurses Association, n.d.). These guidelines provided by PCNA are helpful for nurses as they gain accurate and credible information about managing and treating CHD patients and improve patient safety by enhancing the quality of health. The guiding tools about interventions specific to the symptoms experienced by patients of CHD will make effective clinical-decision. For example, in the case of the angina experienced by Joey, nurses can use the valuable handouts for getting information about angina management from the clinical resources of PCNA.

    Numerous governmental policies have been launched which help patients and healthcare systems to sustain a healthy community by creating ease in providing healthcare facilities and financial assistance. One such policy made by the government is the Affordable Care Act (ACA) enhancing the quality of health, and patient safety and reducing costs incurred by patients in acquiring medical treatment. The ACA ensures that every citizen of America gains health insurance. A patient suffering from chronic disease including cardiovascular diseases such as CHD cannot be rejected insurance by the health insurers. This act also provides prevention services for free and patients cannot be charged more than their health condition requirement (Huguet et al., 2019). The ACA forces nurses to be the main stakeholders by maintaining transformational leadership, and care coordination and keep innovating in order to provide improved quality of care, cost reduction, and enhances access (Cleveland et al., 2019).   

    Another policy helpful in improving the quality of health and patient safety in patients with coronary heart disease is Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH of 2009 ensures that federal governments implement guidelines and policies in their healthcare systems to practice Electronic Health Records (EHRs) and related health technologies for better health provision. This permits the use of health information technologies like remote patient monitoring, telehealth, EHR, etc., and reduces the costs incurred to patients.

    Patients who cannot afford frequent health clinic visits find this highly beneficial in terms of decreasing their financial burden. Patients can get informative sessions online comfortably at their homes. This not only reduces cost but also improves patient safety by reducing the probability of patients’ getting infected by other patients at hospitals (Lu et al., 2022). Nurses’ role in providing treatment and management strategies through Health Information Technologies (Health information technology (HIT) is quite challenging as there is a lack of knowledge in utilizing EHR and other health technologies. In this regard, nurse informaticists can play their role in educating fellow nurses about the use of these health information technologies to make the most use of them and create ease for both the hospitals and the patients.

    These policies enhance the scope of nursing practices by advancing their knowledge on implementing correct interventions according to the needs of the patients. Enhanced competencies of nurses with the provision of these policies promote the scope of their nursing practices. These policies act as a tool to hone on their nursing practicing skills and with the guidelines provided, they can deliver correct and timely interventions and care treatments to patients with CHD.

    Strategies to Improve Quality, Safety, and Cost

    Numerous strategies have been developed to implement which promise improved quality of health, enhanced patient safety, and decreased costs in Coronary Heart disease. Utilizing telehealth is one of these advanced strategies which has various advantages. Nurses and patients can exchange information and patient data through the usage of digital platforms such as smartphone applications and patient-web portals. With the rapid advancements in technology, it is high time that healthcare setups make the most use of them and brings effective health outcomes such as improved quality of life, better patient safety, and reduced costs in healthcare treatments. 

    With telehealth, patients suffering from CHD can get treatment and management at home by using internet-run digital apps (Takahashi et al., 2022). Nurses and other health professionals coordinate and communicate with patients through these digital apps. They can stay connected and exchange information related to symptoms, medication, and overall health. By controlling the risk factors such as diabetes and hypertension through telehealth, the progression of CHD can be inhibited (Soliman, 2020). This improves the quality of health for patients with CHD and those who are unable to visit clinics after every fluctuation in these risk factors.

    Continuous connectivity of CHD patients with nurses and the healthcare team enhances patient safety as the improved quality of care is ensured. Using telehealth also reduces the costs to healthcare systems and patients. In healthcare organizations, there will be less patient load, emergency visits, readmissions, and patient mortality and fewer resources will be utilized to accommodate patients. Patients can also save their finances by preventing them from traveling to hospitals. This overall reduces costs to both the healthcare setups and patients (Snoswell et al., 2020).

    Capella 4900 Assessment 2

    Medication adherence is a key component in treating and managing CHD. Non-compliance of patients with their medication regimen poses the onset of complications associated with CHD. Nurses should employ different strategies to ensure medication adherence by patients. This can be done by enhancing patient education, providing tools to enhance medication adherence such as reminders, use of smart pill box, making medication available to them for free, and involving other healthcare team members to streamline medication dosage regimens (Simon et al., 2021).

    Nurses can also utilize mobile health for promoting medication adherence. By delivering patients with SMS reminders to take medication and providing apps for medication checklists where patients can notify nurses about medication adherence. This strategy will improve the quality of health by controlling the disease progression and maintaining risk factors under control. Ultimately patient safety is enhanced and costs to treat further complications as a result of poor management of CHD are also declined (Kim et al., 2020).

    Chronic diseases like CHD can not be managed unless lifestyle modifications are practiced. These lifestyle modifications are changing diet to a healthy one, incorporating physical activity, monitoring the risk factors, and keeping them under control through healthy life and medication (Allegrante et al., 2019). Nurses can provide self-care management education programs to patients of CHD and enhance their health literacy level so they know what the progressing factors are to CHD and what practices they should implement to have a great quality of health with CHD management. They can educate them about practicing daily physical activity, having healthy meals with less intake of a high fat diet, stress management strategies and continuing follow-up for improved quality of health. This will enhance patient safety and reduce costs to patients and healthcare systems by minimizing emergency visits and hospital readmissions (Abdelwanees, 2023).

    I have documented the practicum two hours spent with Joey and his family in the CORE ELMS Volunteer Experience form and all the information gained from this interaction with my patient are available there. From the impact of CHD on his life, finances, and emotional stress to the future strategies to implement for improvement in health, safety, and cost reduction, everything was explored and documented briefly. 


     Patients suffering from chronic diseases like diabetes, hypertension, and coronary heart disease are often burdened a lot in the form of physical, financial, and emotional stress. The CHD patients have a negative impact on their lives. In this assessment, the case of Joey, a CHD patient with comorbidities such as hypertension and diabetes, is explored and analyzed with the perspective of impact on quality of health, patient safety, and cost. It was found that disease puts a major negative impact on the quality of Joey’s health and reduced patient safety burdening him with heavy expenditures. Later, governmental policies and nursing state boards that can help Joey in improving his quality of life, safety, and cost reduction were analyzed.

    PCNA, ACA, and HITECH policies played a positive impact on enhancing patient quality of health and safety along with declining the financial burden that caused hindrances in seeking healthcare services. Telehealth, medication adherence strategies, and Self-management education program strategies are some of the evidence-based approaches which improve the quality of healthy and patient safety and reduce costs.


    Abdelwanees, A. (2023). Effect of implementing an educational program on life style practices among patients with coronary artery disease. International Egyptian Journal of Nursing Sciences and Research, 0(0). 

    Allegrante, J. P., Wells, M. T., & Peterson, J. C. (2019). Interventions to support behavioral self-management of chronic diseases. Annual Review of Public Health, 40(1), 127–146. 

    CDC. (2021). Health topics – heart disease – POLARIS. Centers for Disease Control and Prevention. Retrieved from. 

    Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable care: Harnessing the power of Nurses. OJIN: The Online Journal of Issues in Nursing, 24(2). 

    Huguet, N., Angier, H., Hoopes, M. J., Marino, M., Heintzman, J., Schmidt, T., & DeVoe, J. E. (2019). Prevalence of pre-existing conditions among community health center patients before and after the Affordable Care Act. The Journal of the American Board of Family Medicine, 32(6), 883–889. 

    Capella 4900 Assessment 2

    Kim, J., Kassels, A. C., Costin, N. I., & Schmidt, H. (2020). Remote monitoring of medication adherence and patient and industry responsibilities in a learning health system. Journal of Medical Ethics, 46(6), 386–391. 

    Lu, Y., Melnick, E. R., & Krumholz, H. M. (2022). Clinical decision support in cardiovascular medicine. BMJ, e059818. 

    McIntyre, D., & Chow, C. K. (2020). Waiting time as an indicator for health services under strain: A narrative review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 57, 004695802091030. 

    National Heart, Lung and Blood Institute. (2022). Coronary heart disease – what is coronary heart disease? | NHLBI, NIH. Retrieved from. 

    Preventive Cardiovascular Nurses Association. (n.d.). Clinical resources. PCNA. Retrieved from. 

    Simon, S. T., Kini, V., Levy, A. E., & Ho, P. M. (2021). Medication adherence in cardiovascular medicine. BMJ, n1493. 

    Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if telehealth can reduce health system costs: Scoping review. Journal of Medical Internet Research, 22(10), e17298. 

    Capella 4900 Assessment 2

    Soliman, A. M. (2020). Telemedicine in the cardiovascular world: Ready for the future? Methodist DeBakey Cardiovascular Journal, 16(4), 283–290. 

    Takahashi, E. A., Schwamm, L. H., Adeoye, O. M., Alabi, O., Jahangir, E., Misra, S., & Still, C. H. (2022). An overview of telehealth in the management of cardiovascular disease: A scientific statement from the american heart association. Circulation, 146(25). 

    Thomson, P., Rushworth, G. F., Andreis, F., Angus, N. J., Mohan, A. R., & Leslie, S. J. (2020). Longitudinal study of the relationship between patients’ medication adherence and quality of life outcomes and illness perceptions and beliefs about cardiac rehabilitation. BMC Cardiovascular Disorders, 20(1).