Research Critiques and PICOT Statement Final Draft
Research Critiques and PICOT Statement Final Draft
Congestive heart failure is a medical condition that is plaguing the healthcare system due to its association with significant levels of patient mortality, morbidity and healthcare costs. At the workplace, congestive heart failure patients experience high readmission rates, which are indicative of ineffective compliance to the recommended therapeutic regimen, poorly planned transition care, emergence of complications and unpreparedness of the family and community after being discharged. Evidently, the discharge planning approach used at the hospital has been ineffective in lowering the rates to complications 30 days after discharge and as such, has not prevented readmission and rehospitalization at the hospital among congestive heart failure patients.
An effective discharge planning approach should incorporate the entire support system of post-discharge care, including the nurses, family and community, in the planning process to ensure that they are involved in the therapeutic regimen of the discharged patients. Apart from planning, the post-discharge support members alongside the patients should be conversant with the therapeutic regiment and the strategies that would make post-discharge care effective. However, the discharge strategy used at the workplace has lacked specificity and inclusivity making it difficult to evaluate how well the congestive heart failure patients and their families understand the post-discharge therapeutic regimen. The discharge plan used at the hospital currently does not accommodate the training and educating of the patients and their families on proper care of patients, administering of medication, requirements for nutrition and restricted physical activities. The IDEAL discharge planning technique may be able to resolve the high readmission rates of congestive heart failure patients experienced with the discharge planning approach being used currently at the hospital. However, its efficacy has not been tested against that of the current discharge planning strategy.
The PICOT question that addresses the healthcare issue is; For congestive heart failure patients being discharged from hospital (P), what is the effectiveness of the IDEAL discharge planning (I) in reducing the readmission rate in the hospital (O) compared with the discharge planning that is currently used in the cardiac unit (C) after implementation within one year?
Qualitative research critique
Two articles are considered in this critique. The first one is Hayes et al. (2015) and is titled, ‘A qualitative study of the current state of heart failure community care in Canada: What we can learn for the future?’ and the second is by Wong et al. (2014) and is titled, ‘Barriers to effective discharge planning: A qualitative study investigation the perspectives of frontline healthcare professionals’.
Background of the study.
Hayes et al. (2015) identified the rarity of the perspectives of non-specialist stakeholders such as hospital and clinic administrators, and general practitioners in studies on the care of heart failure patients. This motivated the exploration of the current state of community-based care of heart failure patients in Canada as perceived by various healthcare stakeholders. On the other hand, Wong et al. (2014) considered the discharge planning policy in Hong Kong was fragmented and involved physicians only, and therefore was not system-wide and well established despite the availability of guidelines for good practices from other countries. Therefore, the study sought to identify the current discharge planning techniques used by healthcare professionals in rehabilitation and acute care hospitals alongside the perceived barriers impeding the success of the existing system.
Method of study.
Both studies are qualitative with Hayes et al. (2015) undertaking an exploratory study using semi-structured telephone interviews while Wong et al. (2014) used focus-group discussions.
Results of the study.
Hayes et al. (2015) found substantive themes that emerged from the study, including i) the persistent challenge with heart failure risk assessment and early diagnosis, ii) challenges in transitioning from the acute-care setting to the community setting, iii) challenges in the management of heart failure patients and provision of optimal treatment among primary care providers and iv) challenges in promoting the delivery of holistic healthcare services.
Wong et al. (2014) revealed that Hong Kong health sector lacked a standardized discharge planning approach and policy, which presented barriers like lack of follow-up by clinicians, lack of home healthcare services, lack of empowerment among healthcare providers, and lack of knowledge among patients about proper care. Low affordability of healthcare services and large workloads among healthcare practitioners presented system barriers.
The study by Hayes et al. (2015) was approved by an Institutional Research Board with the participants being offered research honoraria in line with the applicable ethical regulations. Participant privacy was protected through the confidentiality of a personal link to the online questionnaire and individual telephone calls. Likewise, the study by Wong et al. (2014) was approved by the Clinical Research Ethics Committee of the Hospital Authority and informed consent sought to ensure confidentiality.
Hayes et al. (2015) concluded that the transition from tertiary-based care to community-based outpatient services for heart failure in Canada experienced challenges and therefore there was need to develop a better coordinated approach for improving the care of heart failure patients beyond the hospital setting. In the same vein, Wong et al. (2014) concluded that hospital discharge experienced barriers that hindered the development of robust structures and processes of a discharge planning system. While suggestions for building an effective discharge planning process were provided, communication and coordination among healthcare stakeholders emerged are being pertinent to this end.
Quantitative research critique
The two articles critiqued are that by Bradley et al. (2013) titled, ‘Hospital strategies associated with 30-day readmission rates for patients with heart failure’ and that by Donaho et al. (2014) titled, ‘Protocol‐driven allied health post‐discharge transition clinic to reduce hospital readmissions in heart failure’.
Background of the study.
Bradley et al. (2013) considered the limited evidence on strategies used by hospitals to lower readmission rates and sought to identify these strategies for addressing the readmission rates among heart failure patients. Bradley et al. (2013) contended that the readmission rates remained high despite the incentives provided by the Patient Protection Affordable Care Act of securing reimbursements. Meanwhile, Donaho et al. (2014) considered the numerous unmet needs of heart disease patients from the transitional care interventions in existence, which prompted the analysis of data obtained from the Memorial Hermann Pharmacy Wellness Clinic. The healthcare facility had implemented a new healthcare service for congestive heart failure patients.
Method of study.
Bradley et al. (2013) undertook a cross-sectional study using a web-based survey of hospitals that had participated in national quality initiatives between 2010 and 2011. The data was subjected to a multivariant linear regression model to determine the readmission lowering strategies in the hospitals that were associated with the risk-standardized 30-day readmission rates. However, Donaho et al. (2014) used a protocol-driven study to test the ability of physical examination, medical and education reconciliation, and laboratory evaluation to lower the rates of readmission among discharged congestive heart failure patients. Patients were followed up two visits timed between 1 and 6 weeks after discharge.
Results of the study.
Bradley et al. (2013) found that 14 out of the 599 hospitals surveyed lacked data on their risk standardized 30-day readmission rates. Partnerships with community physicians, conducting of medication reconciliation, follow-up visits for outpatients and regular calls to patients were some of the strategies identified to reduce readmission of heart failure patients. Contrastingly, Donaho et al. (2014) found that the two-protocol visit and the related interventions reduced the readmission rate from its previous level by 44.3 %. The study revealed the importance of establishing a visit protocol, which would influence nursing practice by structuring their post-discharge visits to discharged congestive heart failure patients.
Bradley et al. (2013) obtained the approval of the Internal Review Board, which exempted the researchers from obtaining participant consent as the personal information of participants was not required. Likewise, Donaho et al. (2014) obtained an approval for their study from the institutional review board at Memorial Hermann Hospital, which waived the need for individual informed consent of the participants.
Bradley et al. (2013) concluded that there were several strategies that lowered the hospital readmission rates of heart failure patients although these strategies were not adequate for lowering the readmission rates to above 850,000 patients. In the same vein, Donaho et al. (2014) concluded that transition care for post-discharge patients that was protocol driven could deliver significant reductions in readmission rates. In addition, the effectiveness of the transition care relied on allied health professionals that were highly skilled, which emphasized the need to have highly skills nurses as part of the healthcare team.
Bradley, E. H., Curry, L., Horwitz, L. I., Sipsma, H., Wang, Y., Walsh, M. N., … & Krumholz, H. M. (2013). Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circulation: Cardiovascular Quality and Outcomes, 6(4), 444-450. Retrieved 5 August 2019 from https://www.ahajournals.org/doi/pdf/10.1161/circoutcomes.111.000101.
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. Retrieved 5 August 2019 from https://www.ahajournals.org/doi/pdf/10.1161/JAHA.115.002296.
Hayes, S. M., Peloquin, S., Howlett, J. G., Harkness, K., Giannetti, N., Rancourt, C., & Ricard, N. (2015). A qualitative study of the current state of heart failure community care in Canada: what can we learn for the future? BMC Health Services Research, 15(1), 290-300. Retrieved 5 August 2019 from https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-015-0955-4.
Wong, E. L., Yam, C. H., Cheung, A. W., Leung, M. C., Chan, F. W., Wong, F. Y., & Yeoh, E. K. (2011). Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals. BMC Health Services Research, 11(1), 242-252. Retrieved 5 August 2019 from https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/1472-6963-11-242.