Homework 5

Final Research Evaluation

Final Research Evaluation

Ryan Messinger, Maria Henriquez, Kayla Horace, Shy Russell, Kaisy Ovalles

University of Central Florida

LOGIC MODEL

NEED/RISK The needs that are being addressed/ At what system level(s)?	· Following up with clients for 60 days post-discharge. Currently the follow up is 30 days but increasing the days for follow up in efforts to decrease readmission rates. · Needs being addressed are making sure clients have the resources they need to achieve goals and not have to be re-admitted into the hospital on a micro and mezzo level
RESOURCES (INPUT) In order to accomplish our objectives, we need the following resources:	Resources such as: · Case managers being provided a company cell phone so that the patients will receive text updates about appointments, etc. · Allowing case managers their own office so the patients will have somewhere to go directly if needed. · More funding (possible grant) · More staffing so that each social worker can really focus on their caseload and follow-up with each client. · Bus passes and other forms of transportation such as lyft available to clients if they do not have transportation to get to appointments.
ACTIVITIES What we need to do the following activities:	· Texts to remind clients about upcoming appointments. · Home visits to assess needs and if current discharge planning is effective. · Telehealth · Providing resources such as affordable healthcare clinics
OUTPUTS Countable products of our efforts include:	· Community outreach with tabling events at 15 community agencies so that individuals know that this resource is offered at the hospital. · Community resources · Appointment setting · Screening 100 patients for REACH 2.0 program.
OUTCOMES Measurable changes in attitudes, beliefs, behaviors, knowledge, skills, status, conditions:	· Collaborate with each patient on what they would like to accomplish so they will visit the hospital less. · Collectively set up a schedule of what days, times, activities, etc. will be the follow up protocol.
GOAL Desired impact:	· Provide patients with information and extra care post discharge to ensure less readmission rates. · Stable housing for patients that re-admit due to homelessness. · Proper psychological care for those that want it/need it. · Minimize readmission rates.

Population and Samples

For the methods section of the Evaluation Research Proposal, the sampling approach is going to be a non-probability method since surveys will be the form of measurement. The sampling frame would include individuals that have been diagnosed with heart disease co-occurring with substance abuse. For this research proposal, the sample size will be 100 individuals from Orlando Health where the REACH program is currently being implemented. The sampling would include any gender, race, culture, sexual orientation- as long as they are 30 years old or over and have been diagnosed with heart disease co-occurring with substance abuse.

Study Design

The selected study design to assess the progress of REACH 2.0 will be the quasi-experimental research design, the nonequivalent control group design. The design of the two comparison groups will be assessed separately and compared (Reichardt, 2001). REACH and REACH 2.0 will be assessed separately with focus groups that involve patients who are diagnosed with heart failure as a result of substance abuse. Data will be collected from the first group in REACH after 30 days and second group REACH 2.0 after sixty days, and later compared. There is an expectation that patient progress of interventions will be higher for patients in REACH 2.0 compared to REACH. In the assessment, O1 represents the first assessment, and O2 represents the second assessment. The following design is as followed:

O1 X O2

O1 O2

Formative evaluation is used to manage and direct new programs (Royse, Thyer, & Padgett, 2016). The study is conserved as a formative evaluation to suggest an extension of following up with patients for community resources from thirty days to sixty days. Formative evaluation is used to form a new program, and it is a form of evaluation that can be presented to agency staff members (Royse, Thyer, & Padgett, 2016). Through the collection of data of intervention based on the increase of time frame, proof can be provided to management and funders, with the evidence of readmission rates at hospital for patients who have been diagnosed with heart failure due to substance abuse. If the data demonstrates the outcome when comparing the assessed group from REACH and REACH 2.O for the focus group, the need to extend the number of days for social workers to assist the assigned patients with community resources can be implemented for heart failure patients with history of substance abuse, and furthermore, patient with other types of diagnoses. The following design is as followed with the representation of comparison from REACH and REACH 2.0:

REACH1 X REACH 2.02

REACH1 REACH 2.02

Measures

The program that is discussed is the REACH program and the REACH 2.0 program. The REACH program follows up with patients after they have been discharged from the hospital for thirty days while the REACH 2.0 program follows up with patients for sixty days following discharge. The follow ups that social workers do in the REACH program and the REACH 2.0 program is to make sure the patients have the resources and help they need in order to ensure the patients are making progress and lessen their chances of hospital readmission. Resources would include but are not limited to nutritional assistance, ensuring the discharged patient has safe shelter, assistance in finding and securing governmental assistance like SSI, Medicaid, or food stamps along with telephone follow ups, coordinating outpatient appointments, home visits when necessary, and providing support and encouragement to both the patient and the caregivers of the patient.

The main outcome being assessed is the REACH 2.0 program when compared to the REACH program in preventing hospital readmissions for patients who have conditions which are at higher risk for hospital readmission and subject to penalty under the Hospital Readmissions Reduction Program (HRRP). CMS (2020) lists the high risk conditions for hospital readmittance to be Acute Myocardial Infarction, Chronic Obstructive Pulmonary Artery Disease, Heart Failure, Pneumonia, Coronary Artery Bypass Graft Surgery, and Total Hip and/or Knee Arthroplasty. Records regarding patients discharged from the hospital having had one of these six conditions will be monitored for six months post discharge to assess if or when a hospital readmittance was necessary. A retrospective study design will be used to measure the impact of the 60 day REACH 2.0 program when compared to the 30 day REACH program in reducing patient hospital readmissions for a six month period. Ranganathan & Aggarwal (2018) describe the retrospective study design as one that can be done by gathering data that has already occurred from existing records or interviews. In this instance hospital records will be used to compare the impact of REACH 2.0 patients with REACH patients on hospital readmittance numbers for a period of six consecutive months beginning on the day of hospital discharge.

Furthermore after the follow-up and assessments are complete the patients will have the opportunity to complete a survey about the experience and effectiveness of the program. The survey will consist of likert scale as well as true and false questions. The survey will have a total of 5 short questions in efforts for the participants to answer the questions truthfully.

Procedures

For this study the researchers will conduct the evaluation by comparing and assessing the completed surveys. The surveys will be completed by the client or caregiver of both REACH and REACH 2.0. The survey will consist of a few questions in regards to the clients experience and the effectiveness of the program. The researchers will begin their study by selecting a total of one hundred individuals who have heart failure co-occurring with substance abuse and that are 30 years of age or older. The researchers will separate the individuals equally into two groups, one representing REACH and the other representing REACH 2.0. After 30 days the REACH group surveys will be assessed and then at 60 days the REACH 2.0 will be assessed. Once all the data is collected the researchers will compare and assess the two groups. The researchers will also compare the readmission rates for both sample groups to review if the rates increased or decreased.

Data Analysis Plan

For the improved REACH -- REACH 2.0 the way the data will be analyzed using quantitative data that involves statistical analysis. The reason being is that is the most effective way to monitor the effectiveness of the new program. These statistics will help monitor our practice, evaluate the interventions, and allow us and the general public to receive the reports. Furthermore, it will help us not only see where we are strengthened at but provide insight to where we need to improve. Bivariate statistics will be the method REACH 2.0 analysis because we will be comparing REACH to REACH 2.0 in efforts to lessen readmission rates. Bivariate statistics is useful when 2 variables are present as well as deciding which is most significant. The level of measurement will be nominal in hopes to find that REACH 2.0 is more effective.

Conclusion

There are several limitations to research study for REACH 2.0. A limitation to be considered is the duration of interventions during following up with patients. Even though follow ups will increase from thirty days to sixty days, the duration of time for following up with patients who are diagnosed with heart failure due to substance abuse may be needed to be extended to more than sixty days for effective prevention of readmission into the hospitals. In addition, a limitation may occur as the study may not transcend to other group categories, such as, patients diagnosed with anxiety, diabetes, wound care, and other types of diagnoses. A study that is focused on a specific group may not be generalized if the absence of research study lacks in different types of categories.

Replications of the studies of interventions within a variety of patients in REACH 2.0 may be necessary to ensure credibility of the extension of follow up with patients. Distinguishing patterns that are repeated for measures can reduce threats to internal validity within single-subject designs (Engel, & Schutt, 2014). To ensure the data provided for improvement of interventions within the patients in the study, the research will need to be implemented multiple times before determination of extension of number of days needed to follow up with patients diagnosed with heart failure due to substance abuse. One can suggest the implementation of research to be performed four times and compare the data within the targeted group. Also, it can be further implemented with patients of different diagnosed categories within REACH 2.0.

There are many benefits to the study of the REACH program and the REACH 2.0 program that can leave a lasting impact for patients who have been discharged from the hospital. Perhaps the greatest benefit to REACH 2.0 program when compared to the REACH program is how much more time will be spent ensuring patients who have been discharged from the hospital have the resources they need and are on the right path to prevent a readmission from occurring. Because the REACH 2.0 program will provide patients with 60 days of follow-up care following discharge, the patients will be more likely to maintain their health. This can also impact clinical practice because social workers will have more opportunities to interact with the clients to see if they have what they need and allow them to be able to offer immediate assistance before regression can occur. This can also impact future research because comparing the REACH program and the REACH 2.0 program will provide evidence as to the numbers of hospital readmissions that occur and how long after discharge they occur. Overall, the plan for this proposal is to see health improvements among patients who have been discharged from the hospital. The impact of this proposal is seeing readmission rates decline and seeing stronger and healthier clients who do not relapse and have to be readmitted to the hospital.

References

CMS. (2020, August 24). Hospital readmissions reduction program. CMS.

Engel, R.J., & Schutt, R.K. (2014). Fundamentals of social work research (2nd ed.). Thousand

Oaks, CA: Sage Publications.

Ranganathan, P., & Aggarwal, R. (2018). Study designs: Part 1 – An overview and classification. Perspectives in Clinical Research, 9(4), 184–186.

Reichardt (2001). Nonequivalent group designs. International Encyclopedia of the Social & Behavioral Sciences. https://www.sciencedirect.com/topics/computer-science/nonequivalent-group-design.

Royse, D., Thyer, B. A., & Padgett, D. K. (2016). Program evaluation: An introduction to an evidence-based approach (6th). Cengage Learning.

Engel, R.J., & Schutt, R.K. (2014). Fundamentals of social work research (2nd ed.). Thousand

Oaks, CA: Sage Publications.