PHASE IV
1
Phase III Results
Student's name: Yulexis Moreda
Instructor: Aciel Sagrera-Mulen
Course: Nursing Research and Evidence-Based Practice
Date: August 6, 2025
Phase III: Results (Hypothetical)
This section presents the hypothetical findings of the quasi-experimental pre-post study designed to evaluate the effectiveness of an enhanced nurse-led discharge planning and patient education protocol for individuals hospitalized with heart failure (HF). The statistics presented in this paper will entail the projected results based on the trends of the literature and the impact of the designed transition care program. The outcomes are a descriptive statistic, primary and secondary outcomes, including statistics prepared thereon, and interpretation of findings. The limitations of the study are to be discussed, as well as the recommendations for future research.
Descriptive Statistics
The population of the research consisted of 400 adult patients, with the first 200 respondents constituting the pre-intervention cohort and the remaining 200 forming the post-intervention group. Inclusion criteria were satisfied by all the participants. These inclusion criteria consisted of a confirmed diagnosis of HF and discharge home or to self-care. There were no exclusion criteria, including transfer into long-term care or marked cognitive impairment without a caregiver.
The demographic characteristics of the population covered in the research showed that the mean age was approximately 70 years. The research participants ranged from 45 to 70 years, with the smallest number of people below 45 years. The gender of the respondents in both groups was nearly the same, with males making up over half of the respondents. The average of the racially and ethnically diverse group was White/African American, followed by Hispanic/Latino, and finally, other races. Most of the insurance was Medicare, then Medicaid; some were privately insured, and the remaining were uninsured.
Clinical characteristics of the pre- and post-interventional groups of the population were equalized. The New York Heart Association (NYHA) classification revealed that most patients were in Class II or III, with a smaller subset in Class IV, indicating advanced disease (Rohde et al., 2023). The prevalence of comorbidities was similar across groups, with hypertension being the most common, followed by diabetes mellitus, chronic kidney disease, and chronic obstructive pulmonary disease (COPD). Mean ejection fractions between the two groups had no significant difference, thus suggesting that both groups had similar levels of impairment of cardiac functions. These similarities show that overall, the sample did not differ in the background characteristics or clinical outcomes, so the likelihood of a confounding factor interfering with the results is lower.
Primary Outcomes
The primary outcome of the study was the 30-day readmission rate of hospitalization due to HF exacerbation (Gangu et al., 2022). In the initial sample of the group of patients at the beginning of the intervention, 23 percent represented cases of readmission rates in the initial month of discharge. In contrast, the post-intervention sample showed a low and conspicuous readmission rate of 11 percent. Statistical analysis using the Chi-square test confirmed that this reduction was statistically significant (p = .001).
Medication adherence, measured by the Morisky Medication Adherence Scale (MMAS-8), also showed considerable improvement following implementation of the intervention. At the pre-group level, 28 percent of the patients were assigned high adherence scores, and the remaining part belonged to medium and low adherence. The post-intervention group, in turn, achieved high adherence in 54 percent of the patients, whereas the percentage of patients with low adherence drastically reduced. The Chi-square test confirmed that these changes were statistically significant (p < .001).
Patient satisfaction, assessed using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey focusing on discharge and care transition items, also improved (Bispott, 2024). The pre-intervention group's average score was 78, whereas the post-intervention group reached almost 89. Independent samples t-test analysis revealed that this increase in satisfaction was statistically significant (p < .001). These results indicate that the perception of patients subjected to the implemented intervention became better if the discharge process is considered more supportive, organized, and informative following the introduction of the intervention into practice.
Secondary Outcomes
Reduced effects of the intervention occurred in secondary outcomes. Emergency department (ED) visits for HF-related issues within 30 days of discharge decreased from 17 percent in the pre-intervention group to 8 percent in the post-intervention group, with statistical testing confirming the significance of this reduction (p = .005). This observation shows that not only was the step of hospital readmission reduced through improved discharge planning and education now, but also there was an opportunity to avoid crisis occasions, which might have required ED evaluation.
The length of stay (LOS) for the index hospitalization decreased modestly from an average of 5.8 days in the pre-intervention group to 5.2 days in the post-intervention group. While the difference did not reach statistical significance (p = .062), the trend aligns with prior research suggesting that effective discharge planning can contribute to more efficient care and earlier patient discharge without compromising safety.
Descriptive Analysis, Logistic Regression, and identification of S 30 30-day readmission. Group assignment emerged as a strong independent predictor, with patients in the post-intervention group demonstrating significantly lower odds of readmission compared to those in the pre-intervention group (odds ratio = 0.42, p = .001). High medication adherence was also associated with a lower risk of readmission (odds ratio = 0.38, p < .001). Conversely, having NYHA Class IV heart failure increased the likelihood of readmission (odds ratio = 2.14, p = .021). These outcomes prove the importance of the intervention and adherence behaviors in reducing readmission. Also, they emphasized the fact that the advanced HF patients remain at high risk even after the improvement in the discharge practices.
Interpretation of Hypothetical Findings
The research findings show that the nurse-led discharge planning and patient education intervention significantly improved clinical and patient-centered results (Amini, 2024). It is noteworthy that the 30-day readmission rate declined, especially as the indicator has been a long-established indicator of healthcare and the focus of the value-based payment initiatives in healthcare. The improvement in medication adherence suggests that it will be possible to schedule education interventions and carry them out in a way that empowers the patient to take control of their health.
The fact that the rates of satisfaction with the interventions increased significantly demonstrates that it is not only the medical component of it, but also the modality of compliance with the same tenets of the patient-centered concept. The patients reporting that they feel supported, informed, and prepared to engage in self-management once they leave the hospital have better chances of having smoother transitions and fewer complications, as well as feel more confident about their capability to manage HF on their own (Amini, 2024).
The further consequences of the research, i.e., the reduction of ED visits and the potential trend of reduced hospital stay duration, again support the cross-lingual positive influence of the holistic nature of the discharge planning. These advantages show that the intervention has potential economic benefits as well because it will likely lower the number of costs incurred due to unnecessary healthcare, since no unnecessary visits to the hospital are present, and the inpatient care remains efficient and optimized as well.
Research Limitations
The interpretation of such hypothetical results has several limitations that one should remember. The quasi-experimental design is a convenient trial to be conducted in the real-life scenario of a hospital; nevertheless, the design lacks randomization to eliminate selection bias. This limits the strength of causal inferences, since the findings may have relied on unobserved variables. Another aspect that will cast its shadow on the generalizability of the findings is the use of convenience sampling, as the sample may not be representative of a large population of HF patients in other hospitals or geographic regions.
Also, the research was based partially on self-reported measures of medication non-adherence and satisfaction, that is prone to social desirability bias and recall bias (Fahrni et al., 2022). The good acts or satisfaction may be overreported, particularly when probed by care personnel during patient release. The study was done in a single site, which implies that a variety of contextual factors peculiar to this hospital (including expertise of its staff, institutional culture, or the resources available) may have been among the contributing factors of the intervention's success.
Recommendations for Future Research
In future studies, it would also be important to consider the conduct of randomized controlled designs across various geographical locations of hospitals that would allow greater generalizability and internal legitimacy of findings to enhance the evidence base and address the identification gaps. In a bid to enhance the credibility of findings, the study population should become more representative in terms of demographic and socioeconomic groups of patients to determine whether the interventions are also equitable and effective for various patients.
A longer-term follow-up, such as after the discharge period of 30 days, would better explain the findings on whether the benefits of interventions are sustainable over more extended periods of health-related outcomes, such as 90-day readmissions, mortality rates, and health-related quality of life. Moreover, the interviews could also include cost-effectiveness analyses to enable healthcare organizations to estimate the financial consequences of adopting care units with similar nurse-led discharge planning procedures (Fahrni et al., 2022).
Lastly, specific studies of high-risk subgroups (i.e., patients with severe HF, patients with numerous comorbidities, or patients with low health literacy) may inform the creation of individualized interventions. Such possible examples might be higher telemonitoring, more frequent contact with patients during follow-ups, or cooperation with community health workers to address social determinants of health resulting in readmissions.
Conclusion
The implications of the proposed quasi-experimental study, where it is presumed that the structured nurse-led discharge planning, which is considered part of the comprehensive patient education, can significantly reduce the number of hospital readmissions for heart failure patients within the first 30 days of readmission, are pretty profound. Moreover, it implies that the intervention positively impacts medication adherence and patient satisfaction and reduces the use of emergency services. Despite a few limitations inherent in the design and scope of the conducted research, these speculative findings are consistent with existing evidence, which determines the potentially crucial role of nursing in the development of safe and effective transitions of care. The paper has revealed the significance of transitional care as a pillar of good nursing, considering both clinical and patient-oriented outcomes. Utilizing similar steps in clinical practice, underpinning the identified restrictions, could help make the life of HF patients substantially easier and reduce the scope of readmission to the healthcare system.
References
Amini, M. (2024). Nurse-led patient education to reduce hospital readmission. Umsystem.edu. https://hdl.handle.net/10355/106181
Bispott, J.-D. (2024). Effect of Medication and Discharge Instructions on Heart Failure Readmission Rates. Walden Dissertations and Doctoral Studies. https://scholarworks.waldenu.edu/dissertations/15762/
Fahrni, M. L., Saman, K. M., Alkhoshaiban, A. S., Naimat, F., Ramzan, F., & Isa, K. A. M. (2022). Patient-reported outcome measures to detect intentional, mixed, or unintentional non-adherence to medication: a systematic review. BMJ Open, 12(9), e057868. https://doi.org/10.1136/bmjopen-2021-057868
Gangu, K., Bobba, A., Chela, H. K., Avula, S., Basida, S., & Yadav, N. (2022). In-Hospital Mortality Rate and Predictors of 30-Day Readmission in Patients With Heart Failure Exacerbation and Atrial Fibrillation: A Cross-Sectional Study. International Journal of Heart Failure, 4(3), 145. https://doi.org/10.36628/ijhf.2022.0002
Rohde, L. E., Zimerman, A., Vaduganathan, M., Claggett, B. L., Packer, M., Desai, A. S., Zile, M., Rouleau, J., Swedberg, K., Lefkowitz, M., Shi, V., McMurray, J. J. V., & Solomon, S. D. (2023). Associations Between New York Heart Association Classification, Objective Measures, and Long-term Prognosis in Mild Heart Failure: A Secondary Analysis of the PARADIGM-HF Trial. JAMA Cardiology, 8(2), 150–158. https://doi.org/10.1001/jamacardio.2022.4427