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Readmission Intervention in Implementation Phase

The current project is aimed at revealing the ways of reducing or eliminating hospital readmissions among patients with chronic diseases. The major focus is on low-income patients with diabetes because this population group is at a higher risk of early readmissions (Rubin, 2015). Research is designed in a way to analyze the existing interventions that prove to be effective for the improvement of individuals’ health outcomes.

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The idea is to select the most efficient methods and develop a program that can be utilized by caregivers and result in a significant reduction or elimination of readmissions for chronically ill patients. This part of the research project is dedicated to developing instructions that will be used during program implementation, outlining the time frame for the program, and analyzing the sources and tools that can be necessary for the project.

Instructions on Program Implementation

Careful planning contributes to the successful implementation of the project. It is necessary to consider all of the stakeholders involved and plan every step to ensure the effectiveness of the program. For the current project on the reduction or elimination of readmissions for chronically ill patients, the following instructions about the program implementation should be considered.

  1. Before the program can be implemented, it is important to select and prepare the sample. For this program, the sample will include chronically ill patients with low income because this population group demonstrates a higher prevalence of early readmissions. Demographic characteristics of the sample members will be collected and analyzed to empower further data analysis and generalization.
  2. The program should be based on the findings of the research. It is important to consider the conclusions of researchers and the implications they provide about the use of interventions that are included in the program. It is likely to increase the effectiveness of the program and improve patient outcomes. Moreover, interventions that are supported by research evidence can be more positively accepted by both patients and healthcare providers.
  3. It is advisable to involve family members during the program implementation. Although the major role in transitional interventions belongs to healthcare professionals, the success of transitional care depends on how patients are treated at home and the extent to which they follow the recommendations. It frequently becomes the responsibility of relatives because patients with chronic diseases during the post-discharge period cannot provide efficient self-care.
  4. It is important to remember that the intensity of interventions influences the effectiveness of transitional care. Thus, transitional care, on the whole, has a positive impact on intermediate-term and long-term readmissions, while short-term readmissions can be reduced through high-intensity interventions (Verhaegh, 2014). Consequently, the range of readmissions that are expected to be influenced should be taken into account when planning the intensity of interventions.
  5. It is crucial to consider the age of the patients involved in the program because usually, certain interventions will be more or less effective with definite age groups. For example, transitional care has proven effective with older adults resulting in lower mortality, a decrease in emergency department visits, and a lower rate of readmissions (LeBerre, Sourial, Maimon, Guériton, & Vedel, 2017).

Time Frame

The project is expected to be implemented within seven months. One month will be dedicated to the research and preparatory stage, and the other six months are necessary to implement the program. All the stages of this project are presented in the table.

# Stage Description Time Needed
1. Research that involves literature review of studies dedicated to the problem under analysis is conducted. The suitable interventions with a proved effectiveness are selected. 2 weeks
2. Based on the selected interventions, the program is developed. 2 weeks
3. Sample selection During stages 1 and 2
4. Program implementation 6 months
5. Assessment and analysis of program effectiveness 1 week

It is necessary to note that the stage of program implementation will include some separate steps. To check the efficiency of interventions, it is necessary to provide regular assessments of readmission rates. These assessments will be conducted after one month, three months, and six months of program implementation. This approach allows evaluating the effectiveness of selected interventions for both short-term and long-term readmissions.

Required Resources and Tools

This project is a systematic quantitative review, which is aimed to analyze and synthesize the findings of randomized controlled trials and other reviews involving the issue of readmissions among patients with chronic diseases. Since it is a systematic review that does not presuppose any experiments, work on this project does not require many resources. Thus, the researchers will need computers with access to the Internet and such online databases that contain studies on diverse medical problems as PubMed, Science Direct, Medline, and EBSCO.

Also, software applied for literature reviews can be utilized to empower access to the mentioned databases. Moreover, it is possible to involve tools for informed conclusions such as Distiller SR or Meta-Disc. Meta-analysis can be applied to process data obtained from the selected literature. This statistical technique allows combining and summarizing the results of some independents investigations included in the research sample that are relevant to the identified topic and address the clinical problem in the focus of this project (Shantikumar, 2018).

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A meta-analysis is a suitable tool for evaluating the effectiveness of health interventions, which correlates with the goal of the current project to discover the efficient methods of reducing or eliminating readmissions for chronically ill patients. The general effect of interventions will be calculated through the use of weighted averages of the data obtained during multiple trials (Shantikumar, 2018). For this project, the model of random effects will be applied because random-effects meta-analyses are preferable the studies included in the review are heterogeneous.


To summarize, it should be mentioned that the current project is dedicated to a significant problem faced by contemporary healthcare providers. Readmissions of patients with chronic diseases have a negative impact on both patients themselves and care providers as well. Consequently, there is a need for programs able to reduce readmission rates and thus improve patient outcomes. The selection of interventions should be research-based because clinical trials presented in studies prove efficiency or the lack of effect from certain approaches to reducing readmission rates among patients with chronic diseases.

While implementing the program aimed at readmission shortening, it is important to provide regular checks of effectiveness and alter the interventions that are applied depending on patient outcomes. On the whole, the implementation of such interventions should be carefully planned and performed by highly-qualified healthcare professionals. Moreover, the involvement of family members of a patient with chronic diseases can be effective during the post-discharge period when patients are particularly vulnerable and cannot provide efficient self-care.


LeBerre, M., Sourial, N., Maimon, G., Guériton, M., & Vedel, I. (2017). Transitional care effectiveness for chronically ill older adults: Systematic review and meta-analysis. Innovation in Aging, 1(suppl. 1), 699-700.

Rubin, D. J. (2015). Hospital readmission of patients with diabetes. Current Diabetes Reports, 15(4), 17.

Shantikumar, S. (2018). Systematic reviews, methods for combining data from several studies, and meta-analysis. 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.

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