Chronic Obstructive Pulmonary Disease: Reducing Readmission

Research Design

The proposed EBP project implies the use of the mixed-method design. The study will involve the implementation of an intervention aimed at reducing the readmission rate of patients suffering from a chronic obstructive pulmonary disease (COPD) or heart failure. The major focus will be on quantitative data collection and analysis, while the qualitative component will involve eliciting the participants’ ideas on the intervention. The quasi-experimental research design will be employed to address the research question, while qualitative data will be collected through brief surveys. Moule, Aveyard, and Goodman (2016) note that the mixed method design is instrumental in evaluating interventions as it involves the analysis of different types of data. The validity and reliability of the findings are also high.

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Sample

The convenience sampling method will be utilized as it can be rather difficult to achieve the necessary level of randomization. The present research will involve patients with heart failure or COPD as well as home health (HH) nurses and hospitalists. All the patients receiving care in the clinical setting will be invited to take part in the study. On the day of their discharge (or several days earlier), the patients will receive leaflets containing the central points of the research, including a brief description of the intervention and data collection methods.

Those who agree to participate will receive informed consent forms and, on these documents signing, they will become the participants of the proposed study. The inclusion criterion will be the diagnosis (COPD or heart failure), and there will be no exclusion criteria. As soon as 400 patients sign informed consent forms, the recruitment process will be terminated.

As for the healthcare professionals, the corresponding practitioners will be informed about the study details, and those who volunteer will take part in the study. Home health nurses will be the primary healthcare professionals whose contribution will be central. However, the attitudes of the hospital’s personnel are also essential as these people’s perspectives and motivation can affect their performance and the overall outcomes of the project. The sample is not large, but it is sufficient to gain preliminary insights into the matter.

The patients who will take part in the study will be divided into two groups. The participants in the experimental group will receive the intervention, while those in the control group will undergo standard discharge procedures. Those in the experimental group will also complete questionnaires at the end of the intervention.

Setting

The intervention will involve a hospital’s staff and home health nursing practitioners. The project will be carried out in an urban hospital in Florida. This choice is justified as the participants will be approached more easily as compared to those treated in rural healthcare facilities. A letter of support from the facility will be received prior to the commencement of the research.

Research Protocol

As has been mentioned above, the patients with COPD and heart failure discharged from the hospital will be included in the study. These people will be approached by nurses who will provide leaflets and answer all questions that may arise. Nursing practitioners will encourage patients to take part in the research. The possible health outcomes will be the primary motivational factor. Nurses will be provided with certain statistical data and findings described in other studies. This information will help patients make evidence-based decisions. No monetary reward will be offered to patients.

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When recruiting nurses, it can be effective to make an emphasis on the possible improvements in the quality of the provided services. The nurses who will participate in the project will receive training, which may be used as a motivational factor. Finally, it can be beneficial to contact the hospital’s administration in order to negotiate possible benefits for participating healthcare professionals. For example, additional days-off or an opportunity to work shorter shifts during the intervention can be provided. The recruitment process has been described in detail, but it is important to add that the participants will be informed about their right to withdraw from the research at any point.

Quantitative data will be collected in two phases. The readmissions rate before the start and at the end of the intervention will be elicited and compared. The data will be extracted from the hospital’s information system. This information will not be used outside the healthcare facility, which contributes to data security. The names of the participants will be encoded in order to ensure data confidentiality. Quantitative and qualitative data will be analyzed without the involvement of any third parties. Therefore, it is possible to note that confidentiality and data security will be properly maintained.

As for the qualitative phase of data collection, it will be held in the form of surveys. Both patients and healthcare staff taking part in the study will complete brief questionnaires. Since the majority of patients are likely to be older patients, the distribution of questionnaires will be implemented during HH nurses’ visits (see Appendix A). If necessary, the forms can be sent via email. No online platforms for data collection (such as Survey Monkey) will be used as it may add certain confusion and reluctance to respond to questions. The healthcare staff will complete surveys that will be distributed through (and stored on) the hospital’s database (see Appendix B).

The pretest will be used to ensure the validity of the questionnaires. This instrument implies the use of questionnaires with a group of participants in order to check their effectiveness (Moule et al., 2016). The Average Congruence Percentage will be used to validate the questionnaires. This instrument implies experts’ calculation of valid questions in the questionnaire (Irwin, 2017). If the average of all experts’ percentages is 90 or more, the survey will be deemed valid.

The intervention will involve HH nurses’ collection of additional information from hospital personnel. It is found that the provision of proper services after the patient discharge involving knowledge sharing between hospitalists and HH nurses is associated with the decrease in readmissions rates (Estrella-Holder, Schaffer, Malik, & Zieroth, 2016; Donaho et al., 2015). The proposed intervention will involve the provision of services that are shaped (if necessary) in accordance with the information received from hospitalists. Such areas as medication safety, social support availability, and advanced care planning are identified as critical for the provision of high-quality post-discharge care (Burke, Guo, Prochazka, & Misky, 2014). Home health nurses will contact the hospital’s staff to collect data after the patient’s discharge.

The hospital’s information system will be utilized as the communication channel between HH nursing practitioners and hospitalists. The major focus will be on the availability of data and the timeliness of the communication between healthcare professionals. Apart from the exchange of specific data concerning patients, healthcare professionals will be able and encouraged to discuss some issues that occur via the provided communication platform. Since the project has a limited time frame, it will focus on the period of 30 days after patient discharge. The overall project will last for eight weeks. The project will involve certain training provided to hospitalists and HH nurses participating in the study.

The training will cover such areas as the type of information to request and provide, effective communication skills, the use of technology. Three training sessions during the first week of the project will suffice to equip the healthcare professionals participating in the research with the necessary knowledge and skills. Nurses will be informed about the possibility of receiving more training during the project if necessary. The intervention will take up to three weeks, while preparation, data collection, and data analysis will require four more weeks.

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Data Analysis

Data analysis will be divided into two phases. Quantitative findings will be analyzed with the help of SPSS. The use of this statistical tool has proved to be common in nursing research (Hox, Moerbeek, & Van De Schoot, 2017). Descriptive statistics will be employed to address this component of the present study. The readmissions rates before the start and after the completion of the intervention will be assessed. Clearly, various factors may affect people’s health conditions, which undermines the validity of the findings. In order to address possible limitations of the study, the reasons for readmissions will also be noted. This additional information will help estimate the degree to which the intervention correlates with the readmissions rate.

Qualitative data will also be analyzed manually and with the help of content analysis software (NVivo). As for the manual thematic analysis, an open coding method will be utilized. The use of technology in the thematic analysis is beneficial since it optimizes the process and contributes to the validation of the reported findings. The most recurrent themes will be analyzed to identify the major strengths and weaknesses of the intervention as seen by the participants. The responses of patients and healthcare professionals will be compared and reported. The views of hospitalists and HH nursing practitioners will be analyzed. Another method to validate qualitative data is the thick description (Moule et al., 2016). Elements of this strategy will be employed to ensure findings validity.

As has been mentioned above, eight weeks will be needed to implement the study:

  • Week 1 – Prepare instruments (including informed consent forms and surveys), gain approvals from Keiser University and IRB;
  • Week 2-3 – Recruit participants, train hospital’s personnel and HH nurses;
  • Week 4-7 – Implement the intervention, collect data;
  • Week 8 – Analyze data, write a report.

Although the time frame is quite limited, eight weeks can be enough to identify some trends and attitudes that can be used in future studies.

Appendix A

Patients Questionnaire

  1. Are you satisfied with post-discharge care?
  2. How did your health conditions change after your discharge from the hospital?
  3. What are the weaknesses of the healthcare services you received after your discharge?
  4. What are the strengths of the healthcare services you received after your discharge?
  5. Would you like to share any concerns or recommendations as to post-discharge services?

Appendix B

Healthcare Professionals Questionnaire

  1. Is the intervention more effective as compared to standard discharge procedures? Why or why not?
  2. What are the weaknesses of the intervention?
  3. What are the strengths of the intervention?
  4. Was the training you received effective? Why or why not?
  5. What are possible areas for improvement?

References

Burke, R. E., Guo, R., Prochazka, A. V., & Misky, G. J. (2014). Identifying keys to success in reducing readmissions using the ideal transitions in care framework. BMC Health Services Research, 14(1), 423-442.

Donaho, E. K., Hall, A. C., Gass, J. A., Elayda, M. A., Lee, V. V., Paire, S., & Meyers, D. E. (2015). Protocol‐driven allied health post‐discharge transition clinic to reduce hospital readmissions in heart failure. Journal of the American Heart Association, 4(12), 1-10.

Estrella-Holder, E., Schaffer, S. A., Malik, A., & Zieroth, S. (2016). Improving access to heart failure care: Pilot study of a nurse practioner managed-post hospital discharge transition clinic. Canadian Journal of Cardiology, 32(10), s146.

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Hox, J. J., Moerbeek, M., & Van De Schoot, R. (2017). Multilevel analysis: Techniques and applications (3rd ed.). New York, NY: Routledge.

Irwin, M. (2017). Quantitative designs for practice scholarship. In M. P. Murphy, B. A. Staffileno, & M. D. Foreman (Eds.), Research for advanced practice nurses: From evidence to practice (3rd ed.) (pp. 115-142). New York, NY: Springer Publishing Company.

Moule, P., Aveyard, H., & Goodman, M. (2016). Nursing research: An introduction (3rd ed.). Thousand Oaks, CA: SAGE.

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