Reference no: EM133634109

Problem

You are working in a primary care practice as nurse practitioner. You've noticed that there are several changes related to quality outcomes and declining provider panels.

There is a new Chief Medical Officer (CMO) at your practice. He has been advised by the Chief Executive Officer to improve the quality outcome metrics for the practice. At a recent staff meeting he has decided that a list of 12 "non-compliant" patients need to be discharged from the practice. He suggests that these patients are not following provider's advice and are not making any progress improving type II diabetes as noted by the HgbA1C.

Rick, your patient of more than 5 years, is on the list. You know that he has not refilled his insulin as regularly as desired due to cost. For the past year, he has been struggling to pay down the cost of a recent hospitalization. You are concerned that this patient would not be able to afford the copays required to go to another primary care clinic and in your area many of the practices are not taking new patients.

A. What is your first priority with this patient?

B. How can you ensure providing equitable quality care given the patient's financial situation?

C. How will you make decisions based on what you "want to do" such as a full workup vs. "need to do" given the financial situation?

D. How do you engage the spouse and other members of the health care team in this process?

E. Who should be on the team? You are the leader. Using your identified leadership style (mine is democratic, participative leader) and best practices, in what ways would you guide this group to come up with a plan for the patient and family unit?