Congestive Heart Failure Medicare Paper
One of the most challenging aspects of EBP is to actually identify the answerable question.
—Karen Sue Davies
Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.Congestive Heart Failure Medicare Paper
In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.
To prepare:
Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.
Review the section beginning on page 71 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.
Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.
Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.
Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?
Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.
Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.Congestive Heart Failure Medicare Paper
To complete:
Write a 3- to 4-page paper that includes the following:
A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
The 5 questions you have generated and a description of how you analyzed them for feasibility
Your preliminary PICOT question and a description of each PICOT variable relevant to your question
At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections.
Instructor (Linda Robinson)
Rubric:
Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.
27 (27%) – 30 (30%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.
18 (18%) – 20 (20%)
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice
Introduction
The purpose of this project is to identify if discharge planning can reduce the rate of readmissions of previously hospitalized Congestive Heart Failure Medicare patients as compared to conducting follow-up through telephone calls. The time period of 30 days starts immediately the day the patient is discharged from the hospital.
Summary of the Area of Interest
As an outpatient nursing care manager in a rural primary care setting, my job description includes conducting follow-up for Medicare patients discharged from inpatient hospitals and oversee a successful transition in care from the clinical settings to home settings and ensure that all of their needs are addressed to prevent frequent readmissions (Zuckerman, et al., 2016). The care for most patients is managed through face to face conversations, assessments conducted via phone, patient education and follow-up schedules with their respective primary care providers. The choice of this area of interest was influenced by my roles in clinical practice and readmissions reduction program that was set forth by the Centers for Medicare and Medicaid Services after the implementation of the Affordable Care Act. According to this Act, starting the year 2012, the CMS is expected to reduce the payments made to hospitals that experience excess readmissions (Hobbs et al., 2016).Congestive Heart Failure Medicare Paper
Identification of the Selected Problem
Heart failure is a gradually growing problem across the globe, in the United States and in my current healthcare setting that leads to frequent admissions and readmissions. Heart failure is basically characterized by intermittent exacerbations alternating with periods of medical stability. In the United States, up to 6 million adults live with heart failure, projections that are expected to increase by the year 2020 (Ziaeian & Fonarow, 2016). According to a report that was published by the Center for Medicare and Medicaid Services, hospitalizations from heart failure contribute to the largest amounts and expenses approximated at $30.7 billion. It is for this reason that reduction and prevention of heart failure is an increasing priority for the United States through clinicians, the Department of health, researchers and other stakeholders in the health sector. Among these patients, compliance with medications and appropriate diets is an issue (Zuckerman, et al., 2016). Data from the Center for Disease Control reveals that up to 90% of CHF readmissions are related to poor compliance to drugs and diet which also increase the mortality and morbidity rates yet they can be prevented. Research suggests that discharge planning is a highly effective solution in this case and this involves activities such as patient education on nutrition, diet and medication compliance with the help of a pharmacist and dietician and advocating for behavior change in consuming alcohol and smoking tobacco (Ziaeian & Fonarow, 2016).
The significance of This Problem for Nursing Practice
Patients diagnosed and hospitalized with heart failure have an approximated daily risk of being readmitted which is highest on the 3rd-day post discharge. Readmissions have also been associated with poor quality care which increases mortality and morbidity risk. It is for this reason that quality indicators are used as the best assessment measures to determine the extent to which patient safety, clinical outcomes and quality of life affect a patient (McHugh, 2013). In an attempt to address this issue, the financial accountability for preventing readmissions in healthcare settings has increased since the implementation of the Affordable Care Act.
The increased interests to identify interventions that can help to reduce preventable readmissions have yielded approaches such as increased staffing to improve the work environments of nurses. However, these approaches have not yet yielded tangible outcomes. Readmissions continue to contribute to deteriorating health status of patient’s and increase their morbidity and mortality risk. As part of the solution, nurses are expected to engage in the ongoing evidence-based practice to identify practical solutions that can be used to reduce readmissions in this population (Ziaeian & Fonarow, 2016). The most ideal interventions that prevent readmission have proven to be those that increase patient support at the time of discharge and improve communication before, during and after discharge.
Five PICO Questions Generated and Feasibility Analysis
After carefully analyzing the problem of interest initially discussed, it was important to analyze its feasibility through the following criteria: what benefits are likely to exist from the study findings, can the findings be applied in clinical practice, based on the currently existing theory, will the findings either support or extend it, can the current policies or practices in clinical nursing practice be supported of changed by the findings? A thorough analysis revealed that the problem of interest met the outlined criteria and thus feasible. Therefore, in formulating the evidence-based practice questions, the following PICOT variables were used:Congestive Heart Failure Medicare Paper
Population-Medicare Patients discharged with a diagnosis of Congestive Heart Failure
Intervention-Discharge planning
Comparison-Follow-up telephone calls
Outcome-30-day readmission reduction
Time-31 days after discharge from hospital
Preliminary PICO Question and Descriptions
Since congestive heart failure patients receive critical care while in hospital, using the PICOT template provided by the American Association of Critical Care Nurses on their website aaacn.org was preferred. Therefore, the following PICOT questions were formulated.
PICOT question: Among Medicare patients discharged with a diagnosis of CHF (P) how does discharge planning (I) compared to follow-up via telephone calls(C) prevent readmission within 30days (O) post discharge?
Intervention PICOT question: Among adult Medicare patients previously hospitalized with CHF (P), how does discharge planning (I) compared to follow-up telephone calls(C) affect the rate of readmission to hospital(O) within 30 days post discharge(T)?
Therapy PICOT question: Among adult Medicare patients (P), what is the effect of discharge planning (I) compared to follow-up telephone calls (C) on readmissions (O) within 30 days post-discharge (T)?
Etiology PICOT question: Are adult Medicare patients previously hospitalized for CHF (P) whose discharge has been planned (I) compared to those followed up through telephone calls (C) are at high risk for readmission(O) within 30 days post discharge(T)?
Diagnostic PICOT question: Among adult Medicare patients (P), are patients whose discharge has been planned (I) compared to those followed up through telephone calls(C) more accurate in realizing signs and symptoms of CHF (O) within 30 after discharge(T)?
Prevention PICOT question: Among Adult Medicare patients with CHF (P), what are the variations in compliance (I) among patients whose discharge has been planned (I) and those followed up through telephone-calls (C) among patients readmitted to hospital (O) within 30 days post discharge (T)?
Prognosis PICOT question: Among adult patients with CHF (P), how does discharge planning (I) compared to follow-up telephone calls(C) influence the likelihood of hospital readmission(O) within 30 days post discharge(T)?Congestive Heart Failure Medicare Paper
Meaning PICOT question: How do adult Medicare patients diagnosed with CHF and discharged from the hospital (P) perceive discharge planning (I) within30 days (O) post-discharge (T)?
Keywords for Conducting Literature Search
In order to conduct a highly effective, comprehensive and specific literature search that will yield journals that discuss the key concept of this research topic the use of keywords is mandatory. Keywords are simply a breakdown of the research question to use for searching databases (Robeson et al., 2010). During the search process, there is a high likelihood to develop new ideas and search terms. In other instances, a researcher can put phrases and keywords together by using joining words such as NOT, AND, OR or Boolean logic (Yensen, 2013). The latter helps in conducting more refined searches and tend to reveal the relationship that exists between sets and how the relationships are recognized by electronic search tools (Davies, 2011). For this PICOT search, the following keywords were chosen:
Congestive Heart Failure and discharge planning
CHF and 3—day readmission
Transitioning care for CHF
Preventing hospital readmissions in patients with CHF
Follow-up telephone calls for CHF patients
ACA and readmissions reduction
HEDIS measure 2017
CHF and the American Heart Association
CHF and CMS reduction program
With the continuation of the research, it is expected that the search strategy will also evolve.
References
Davies, K. S. (2011). Formulating the evidence-based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80.
Hobbs, J. K., Escutia, D., Harrison, H., Moore, A., & Sarpong, E. (2016). Reducing hospital readmission rates in patients with heart failure. Medsurg Nursing, 25(3), 145.Congestive Heart Failure Medicare Paper
McHugh, Ph.D., JD, MPH, RN, M. D., & Ma, Ph.D., RN, C. (2013, January). Hospital Nursing and 30-Day Readmissions Among Medicare Patients With Heart Failure, Acute Myocardial Infarction, and Pneumonia. Medical Care, 51(1), 52-59. Retrieved September 9, 2017, from doi:10.1097/MLR.0b013e3182763284
Robeson, P., Dobbins, M., DeCorby, K., & Tirilis, D. (2010). Facilitating access to pre-processed research evidence in public health. BMC Public Health, 10, 95.
Yensen, DR, J. (2013, October 13). PICO Search Strategies. Online Journal of Nursing Informatics, 17(3).
Ziaeian, B., & Fonarow, G. C. (2016). The prevention of hospital readmissions in heart failure. Progress in cardiovascular diseases, 58(4), 379-385.
Zuckerman, R. B., Sheingold, S. H., Orav, E. J., Ruhter, J., & Epstein, A. M. (2016). Readmissions, observation, and the hospital readmissions reduction program. New England Journal of Medicine, 374(16), 1543-1551.Congestive Heart Failure Medicare Paper