Literature Review
Prevention of readmissions and repeated hospitalizations is a primary task of contemporary healthcare. This issue is related to both the improvement of the quality of care and reduction of costs spent during repeated hospitalizations. Early hospital readmissions occurring within a 30-day post-discharge period are of the greatest interest for researchers. Leppin et al. (2014) investigate strategies aimed at the prevention of 30-day hospital readmissions. Their systematic review synthesizes the existing evidence of interventions’ effectiveness for reducing early hospital readmission involving such aspects as patient’s ability to provide self-care in the post-discharge period and treatment compliance. The study reveals that more complex interventions involving enhancement of patient’s ability for self-care in the transition from hospital to home care are more effective compared to simple strategies (Leppin et al., 2014).
Another proof of the effectiveness of transitional care interventions is provided in the study by Feltner et al. (2014). The researchers investigated measures applied to patients with heart failure and came to a conclusion that such strategies as home-visiting programs and multidisciplinary hospital interventions for heart failure positively influenced the reduction of readmissions of different etiology and patient mortality. Also, structured telephone support proved to be effective for reducing heart failure-specific readmissions (Feltner et al., 2014). Verhaegh et al. (2014) investigate the use of transitional care interventions for preventing hospital readmissions in short, intermediate, and long terms in adults with chronic diseases. The study revealed such interventions as a comprehensive assessment of patients at admission to a hospital, education interventions for improving self-management during the admission process, the involvement of caregivers as secondary recipients of the intervention, and nursing care coordination. The research findings are that high-intensity interventions are beneficial for the reduction of short-term readmissions while the lower intensity of transitional care interventions can have a positive impact on long-term (181-365 days) and intermediate-term (31-180 days) hospital readmissions of patients with chronic diseases (Verhaegh et al., 2014).
Reasons for 30-day readmissions are the subject of the study by Dharmarajan et al. (2013). The researchers analyze Medicare fee claims related to readmissions because of heart failure, acute myocardial infarction, and pneumonia in the period of 30 days after discharge. The study reveals that the major cause for readmissions was the patient’s diagnosis while demographic factors such as age, gender, or race do not influence readmission rates.
A particular role in readmission rates is given to nurses and nursing care. Thus, McHugh and Ma (2013) investigate the impact of hospital nursing and 30-day readmission among patients with pneumonia, heart failure, and acute myocardial infarction. Hospital nursing in this research implies nurse work environment, staffing policy and level, and education of nurses. The researchers reveal that understaffed units result in an increase in readmission rates (McHugh & Ma, 2013). Also, the unfavorable work environment is associated with an increase in 30-day readmissions. Consequently, strategies involving advances in nurses’ work environment as well as thoughtful staffing policies can be effective in reducing and preventing hospital readmissions. Another contribution to the study of hospital strategies aimed at the reduction of 30-day hospital readmissions is provided by the study of Bradley et al. (2013).
Their research revealed the following hospital strategies that result in lower readmission rates. Thus, the introduction of partnerships with community physicians or physician groups to shorten readmission rates, cooperation with local hospitals and other healthcare facilities that can favor the reduction of readmissions, involvement of nursing responsibility for medication reconciliation, organization of follow-up appointments for patients before discharge, developing processes to empower sending discharge documentation or electronic summaries to be used by the patient’s primary physician, and defining the responsible staff members to control the results of laboratory tests that return already after the patient’s discharge, result in significantly lower rates of 30-day hospital readmissions (Bradley et al., 2013). Moreover, the authors conclude that complex interventions are more effective than single ones.
Methodology and Design
To answer the identified research questions, this research will combine descriptive and exploratory design and employ both qualitative and quantitative methods of data collection. To address the first research question about the main definitions and causes of hospital readmissions, the literature review can be used. It will involve the analysis of clinical trials and previous studies about the causes of readmissions. Descriptive statistics will be used to analyze the findings of the literature review. The same methodology will be used to define the consequences of the readmissions problem regarding patients, nursing, and healthcare as a whole, which is the second research question. Also, Medicare reports can be studied to investigate the impact of readmissions on the healthcare system.
Moreover, an interview-based survey can be conducted to assess the impact of readmissions on the nursing staff. To answer the third research question about interventions to address the problem of repeated hospitalizations, a search in the scholarly literature will be provided. The studies on the interventions with the potential for reducing readmission rates will be included in the analysis. This stage is expected to reveal the most effective interventions that will be evaluated during the assessment phase. To measure the effectiveness of potential interventions associated with discharge planning, the experiment will be involved. The experimental design of this part of the study provides an opportunity to assess the effectiveness of the selected interventions through measuring readmission rates in a 30-day period after discharge for patients involved in these interventions compared to those discharged on a regular basis without post-discharge support.
Sampling Methodology
For literature reviews, samples will include research articles published within the period of five years in peer-reviewed journals. Specialized databases will be used to conduct a search, such as EBSCO, Cochrane Library, Medcom, and MEDLINE. To limit the search range, keywords and phrases will be used. To select a sample for the first research question, the major search phrase will be “causes of hospital readmissions.” For the second question, the search will be focused on articles dedicated to the consequences of readmissions for patients, nursing staff, and the healthcare system. Finally, to answer the third question, the search will involve a paper5s dedicated to the effectiveness of readmission prevention strategies. After defining the most effective strategies, two or three of them will be selected to be assessed in the final experimental stage.
Necessary Tools
Every stage of the study demands effective tools to support the research and allow answering the formulated research questions. First of all, a search in research databases will be conducted. It will allow selecting the scholarly articles on the problem under consideration to empower further data extraction and analysis. For the stages implying literature review, a descriptive statistics tool will be applied. It is a powerful instrument that gives an opportunity to analyze the extracted data and provide their description. Descriptive statistics allows summarizing a certain data set.
In the context of this research, it will be used to reveal the major causes of hospital readmissions, defining the prevalent consequences of readmissions for patients, nursing, and the healthcare system, and find effective interventions to address the problem of repeated hospitalizations. For the experimental stage, a cohort of patients will be involved. The study will limit the patient group by diagnosis to avoid research bias. Since the majority of studies dedicated to readmission rates choose heart problems in the context of readmission because they make the most frequent reason for repeated hospitalizations, the sample of the study will include patients with heart failure hospitalized for the first time. To compare the results of the experimental group, information from patient health re3cords about readmissions for a similar period of time will be extracted.
Research Algorithm
This algorithm provides a general picture of the research structure and corresponds to the identified research questions. In case this structure is followed, the study will be conducted logically because one stage will provide the basis for the other. Thus, identification of major reasons for hospital readmissions will allow narrowing the search of consequences and help to link those aspects. Also, the search for effective preventive interventions will provide information for the experimental phase allowing the identification of strategies that work for patients with heart failure and can reduce their readmission rates.
References
Bradley, E., Curry, L., Horwitz, L., Sipsma, H., Wang, Y., Walsh, M., … 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. Web.
Dharmarajan, K., Hsieh, A., Lin, Z., Bueno, H., Ross, J., & Horwitz, L., … Krumholz, H. M. (2013). Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA, 309(4), 355. Web.
Feltner, C., Jones, C., Cené, C., Zheng, Z., Sueta, C., Coker-Schwimmer, E., … Joans, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure. Annals of Internal Medicine, 160(11), 774-785. Web.
Leppin, A., Gionfriddo, M., Kessler, M., Brito, J., Mair, F., Gallacher, K., … Momtori, V. M. (2014). Preventing 30-day hospital readmissions. JAMA Internal Medicine, 174(7), 1095. Web.
McHugh, M., & Ma, C. (2013). Hospital nursing and 30-day readmissions among medicare patients with heart failure, acute myocardial infarction, and pneumonia. Medical Care, 51(1), 52-59. Web.
Verhaegh, K., MacNeil-Vroomen, J., Eslami, S., Geerlings, S., de Rooij, S., & Buurman, B. (2014). Transitional care interventions prevent hospital readmissions for adults with chronic illnesses. Health Affairs, 33(9), 1531-1539. Web.