Research Design, Hypothesis, Variables
The purpose of this project is to estimate a particular impact on the rate of readmissions among patients diagnosed with chronic obstructive pulmonary disease (COPD) or heart failure. A mixed research method will be employed. On the one hand, it aims at measuring certain variables and examining the correlation between them with the help of statistical tools (Parahoo, 2014). On the other hand, it is also important to obtain exact insights of the stakeholders to evaluate the effectiveness, or rather, possible gaps in the intervention. Qualitative analysis is instrumental in achieving this goal (Parahoo, 2014).
This information will help improve the existing intervention and shed light on potential gaps in its implication. The proposed project will involve the evaluation of the effectiveness of an intervention that implies the collection of additional data from hospitals. The hypothesis guiding this research can be formulated as follows:
H: The intervention involving the collection of additional data from hospitalists by home health (HH) nurses results in the decrease in readmission rates among COPD patients and patients with heart failure as compared to standard discharge procedures.
It has been found that medication prescriptions are often associated with errors that lead to patient readmissions (Donaho et al., 2015; Doos et al., 2014). Therefore, the data collected from hospitalists will include continuous updates concerning medication. Furthermore, HH nurses will collect such data as diagnosis, procedures recommended, and topics covered when providing educational services.
This information will enable HH nurses to provide high-quality patient-centered care. The intervention will be implemented three months after the participants’ discharge. The independent variable will be the participants’ health conditions (chronic obstructive pulmonary disease or heart failure), while the dependent variable will be the readmission rate among the patients taking part in the study. After the completion of the intervention, the data concerning the readmission rates among the members of the two groups will be collected.
At the end of the intervention, during the final visit of the home health nurse within the scope of this project, the healthcare professional will provide a brief survey to the patient. This form of qualitative data collection is chosen due to its convenience. The participants will not need a lot of time to respond, and they will be able to do it at any time during the visit or three days after it. The visiting HH nurses can write down the patients’ answers if necessary.
The participants can also complete the survey forms and send them via email. This part of the study will be voluntary, and those who want to share will provide their answers. The survey will include five briefs (both closed- and open-ended) questions that will be suggested to the participants from both groups. The preliminary version of the questions provided to the patients will be as follows:
- Were you satisfied with the home-based services you received after your discharge from the hospital?
- Do you feel your health conditions improved?
- What imperfections of care did you receive, can you name?
- What are the strengths of home-based care?
- What ideas, feelings, or recommendations would you like to share regarding post-discharge care?
The healthcare professionals involved in the implementation of the intervention will also respond to four questions. The surveys can be distributed among the healthcare professionals involved in the project through the hospital’s information system or email. The answers can be discussed during a regular meeting or the meeting devoted to the discussion of the results of the study. The following questions will be asked:
- Do you find the intervention effective? Why or why not?
- What disadvantages of the intervention can you name?
- What strengths of the intervention can you name?
- What are your recommendations on how to improve the intervention?
Population
The sample will be confined to the setting of one healthcare facility, so its generalizability is rather difficult to ensure. To check the hypothesis, a quasi-experimental design will be utilized. The patients participating in the research will be divided into two groups. The control group will get traditional discharge procedures, while the experimental group will receive similar procedures that will be facilitated by the collection of additional information from the hospital. The data will be used to make the services provided more patient-centered. HH nurses will discuss the measures undertaken by the patient and provide some recommendations in accordance with the information from hospitalists.
The recruitment process will involve the distribution of leaflets, including the major details of the research (purpose, intervention, and the like) and nurses’ requests to take part in the study. The inclusion criteria will be the diagnosis (heart failure or COPD). Since the target population is rather wide and the patients’ age, ethnicity, and other details are not taken into account, no exclusion criteria will be set.
During the first visit of the healthcare professional after the patient’s discharge, those who expressed their willingness to participate will be offered to sign written consent forms. When the number of participants reaches 400 patients, the sampling process will be over. This sample size can be sufficient to draw preliminary conclusions and identify some areas for the intervention’s improvement. The patients will be divided into two groups randomly.
The hospital setting will be used to recruit the participants and collect data. The corresponding permission will be obtained from the facility’s administration. Furthermore, HH nursing professionals will be asked to participate in the study. It is essential to make sure that people involved in the intervention have the necessary skills to complete the tasks assigned (LoBiondo-Wood, 2017). Those who agree to take part will receive brief training as to the ways to collect additional data and the type of information eliciting from hospitalists. The hospital staff will also be instructed concerning the data they will be asked to provide.
The healthcare professionals taking part in the intervention will be informed about the main points of the study as well as its expected outcomes and applicability. As for the participants among the healthcare staff, all the involved professionals will receive the surveys that will be provided through the hospital’s information system. The healthcare practitioners will complete the surveys within three days after the completion of the project.
Data Protection
Data protection is one of the central aspects of any research. The involvement of human participants is associated with the need to ensure anonymity and confidentiality of people’s personal data (Rinaldi Carpenter, 2017). The participants’ personal data will be accessed and collected with the help of the information system of the facility. The staff of the hospital having access to these data will use this information.
The proposed intervention is not associated with any health risks, but the participants will be able to withdraw from the study at any point. They will be informed about this right in the written consent form they will sign. Every case of patients’ withdrawals from the research will be noted. The reasons for such withdrawals will also be highlighted. The written consent form will also include information concerning confidentiality and anonymity so that the participants could be sure that their personal data will be safe.
Data Analysis
As has been mentioned above, the quantitative research method will be utilized. Therefore, the data will be statistically analyzed and evaluated. The readmission rate among the participants of the research will be calculated after the completion of the intervention. The use of software has become common among researchers due to its convenience and reliability (Hox, Moerbeek, & Van De Schoot, 2017). The readmission rate of the overall number of patients with COPD and heart failure before the start of the intervention and after its completion will also be estimated. This assessment will be carried out to obtain more data and evaluate wider outcomes of the intervention. SPSS will be used to calculate the readmission rates.
The collected qualitative data will be analyzed manually and with the help of content analysis software (Nvivo). The use of multiple data analysis methods will help ensure the validity and reliability of the findings (Parahoo, 2014). The most recurrent themes will be identified and explored. The answers of the healthcare staff and patients will be compared to detect similarities, if any. The perspectives of both healthcare professionals and patients on the intervention can also result in the development of an effective procedure that will reduce the rate of readmissions in the given hospital or even nationwide.
Timeline
The project will involve several stages (see table 1). The overall time needed to carry out the proposed research is 4-5 months. During this period, the data will be collected, analyzed, and presented for peer discussion. The intervention will last for three months, and one or two months will be needed to prepare for the project and analyze the received data. The dissemination process will be carried out in several steps. The data will be presented in the form of a report to the healthcare staff of the hospital. The findings will also be revealed in a scholarly article. This article will be prepared and submitted for publication in a peer-reviewed journal.
Table 1. The Project’s Timeline.
References
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.
Doos, L., Bradley, E., Rushton, C. A., Satchithananda, D., Davies, S. J., & Kadam, U. T. (2014). Heart failure and chronic obstructive pulmonary disease multimorbidity at hospital discharge transition: A study of patient and carer experience. Health Expectations, 18(6), 2401-2412.
Hox, J. J., Moerbeek, M., Van De Schoot, R. (2017). Multilevel analysis: Techniques and applications (3rd ed.). New York, NY: Routledge.
LoBiondo-Wood, G. (2017). Introduction to quantitative research. In G. LoBiondo-Wood & J. Haber (Eds.), Nursing research: Methods and critical appraisal for evidence-based practice (pp. 149-164). St. Louis, MO: Elsevier Health Sciences.
Parahoo, K. (2014). Nursing research: Principles, process and issues. New York, NY: Macmillan International Higher Education.
Rinaldi Carpenter, D. (2017). Appraising qualitative research. In G. LoBiondo-Wood & J. Haber (Eds.), Nursing research: Methods and critical appraisal for evidence-based practice (pp. 124-145). St. Louis, MO: Elsevier Health Sciences.