Year Window Living Question & Answer Guide (With Explanation)

This question focuses on applying theory to practical scenarios.

What This Question Is About

This question relates to year window living and requires a structured academic response.

How to Approach This Question

Focus on explaining concepts clearly and supporting them with examples.

Key Explanation

This topic involves year window living. A strong answer should include explanation, application, and examples.

Original Question

Mrs. B. was a 66 year-old window living on a fixed income. She had been diagnosed with high blood pressure and osteoporosis. Her private doctor knew her well. When Dr. C selected the medication with which to treat her high blood pressure, they took into account her age, the fact that she had osteoporosis, and other issues. They chose a drug that had proven beneficial for patients such as Mrs. B and had minimum side effects. Mrs. B did well on the medication for ten years. Her insurance covered the cost of her medications, except for a small out-of-pocket copayment. The last time Mrs. B went to her local pharmacy to refill her prescription, the pharmacist informed her that her insurance company had contracted with a pharmacy benefits management (PBM) company. One of their services was to decide which drugs an insurance company will pay for and place them on their preferred product list called a formulary. If Mrs. B wanted to continue on the same medication, it would cost her five times her usual copayment. She was quite disturbed because she could not afford this price increase and did not fully understand her insurance company’s new policy. The pharmacist offered to call Mrs. B’s doctor, explain the situation, and asked whether Dr. C would change her prescription to the PBM preferred brand. When the physician was contacted, Dr. C was not aware of the PBM company’s’ action and was not completely familiar with the preferred product. The pharmacist discussed Mrs. B’s predicament with the physician and described the financial consequences of continuing to receive her original prescription. After this discussion with the pharmacist, the physician concluded that the only option was to approve the switch, which was done. Mrs. B began taking the new brand of high blood pressure medicine. One week after starting on the new drug, she developed a persistent cough that aggravated her osteoporosis and caused her rib pain. When the cough and pain continued for another week, Mrs. B began to take over the counter medicines for the pain. She unknowingly opened herself to a reaction between her blood pressure medication and the pain medication: orthostatic hypotension. One morning on her way to the bathroom, she fainted, fell, and broke her hip. She was admitted to the hospital for surgery, where she developed a urinary tract infection (CAUTI/HAI). The infection spread to her repaired hip, which resulted in sepsis that eventually led to her death. Questions What were the system characteristics that contributed to this dynamic complexity and how are they expressed within the case (interdependencies are an example)? What quality goals (2-3 by the SMART framework) would you set for the Accountable Care Organization (ACO)? Note: the practice, pharmacy and hospital are contractual part of the ACO legal entity. Who would be on your QI Team (attach a completed QI Charter – you can use any standard format) What quality improvement tools would your team use to examine the inter-relationships and dependencies? Discuss and illustrate at least one such tool (example might be workflow and process mapping, spaghetti diagram or a SWOT analysis. What barriers would you anticipate might occur and how what strategies would you use to address them?

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