Research Critique

Critical Appraisal

Qualitative Research

Background of the study

The Qualitative article selected is “Meta-analysis of clinical trials that evaluate the effectiveness of hospital-initiated post-discharge interventions on hospital readmission” undertaken by Branowicki (2017). The clinical problem that motivated the study is high readmission rates, which reduces the quality of healthcare outcomes. Reducing readmission rates is important for the patients as well as the industry regulators. Its significance is improved quality of healthcare services, which will enhance the health and quality of life of the patients. The purpose of the study was to establish the effectiveness of Hospital Initiated Post Discharge Interventions in reducing hospital readmissions. Even though the author does not explicitly provide research questions, the study seeks to determine whether utilizing HIPDI reduced readmission compared to those who do not utilize the interventions. The purpose of the research question is related to the problem since the interventions are aimed at reducing readmission rates.

Method of study

The qualitative methods utilized by the researcher were appropriated in answering the research questions because of the systematic review of clinical articles provided an opportunity to understand effective and evidence-based interventions. Also, the author undertakes the research from the perspective that utilizing hospital-initiated post-discharge interventions can improve the health of the target patients, thus reducing the likelihood of readmission. Both qualitative and quantitative studies were cited by the author, which included published medical trials. Moreover, the studies are not only current but also go back 25 years, thus providing a rich source of information for informing the research questions. The researcher identified the potential risks and bias that could affect the outcomes of the study. No framework was used to explain the outcomes of the study.

Result of the study

The result of the study pointed out that hospital-initiated interventions such as home visits and follow up calls had a significant effect on hospital readmission rates. This impacts nursing because they can utilize the information to develop and implement the interventions identified to promote positive outcomes. The knowledge gained from the study contributes to nursing knowledge because utilizing the identified interventions improves the quality of healthcare services, thus promoting the desired positive outcomes for the health organizations and the healthcare industry. This means that the outcomes also affect all areas of nursing include practice, administration, and education, among others.

Ethical considerations

The study involved the review of clinical trials for the past 25 years to 2014. As such, there were no ethical considerations for the study as opposed to other research types such as interviews. The study was approved by the Journal for Healthcare Quality, which resulted in the publication of the study.

Conclusion

The hospital initiated post-discharge interventions such as follow up call and visiting patients are effective in improving patient health and reducing the risk of readmission. Understanding how best to help patients to overcome potential health challenges is a crucial aspect of improving the performance and productivity of nurses in their duties and responsibilities. Healthcare organizations must create an enabling environment for nurses and healthcare professionals to have the capacity to engage with patients post-discharge to follow up on their compliance with the recommended interventions.

Quantitative Study

Background of the study

The Quantitative study selected is titled “Risk factors for 30-day hospital readmission among general surgery patients” by Krumholz et al. (2017). Examining readmission among patients who have been admitted multiple times provides an opportunity to identify the common trends or healthcare challenges that need to be overcome to reduce readmission rates and improve patient health and quality care outcomes. The goal of the study is to examine readmission outcomes among patients who have been admitted multiple times for similar diagnosis at one or more hospitals within a given year. The research questions of the study are focused on finding out whether patients who have multiple readmissions have better outcomes compared to those with minimum or no readmission. Also, the purpose of the research question related to the problem since readmissions occur following health complications on the patients.

Methods of study

The author does not identify the specific benefits or risk that was associated with participating in the study. Consent was obtained from the healthcare organizations for providing data on Medicare and Medicaid Services. It would be appropriate to point out that the hospitals seemed to have participated voluntarily in the study. The authors did not identify and define the significant variables for the study. Data for the study was collected by reviewing hospital readmission for the hospitals between July 2014 – June 2015 by diving them into two random samples. The author believes that that data collection method is effective for finding patterns and insights on the readmission rates. Sample performance quartile was utilized to describe the characteristics of the identified hospitals. To minimize the research bias, the researchers focused on a large group of patients within the identified hospitals to increase the scope of the study.

Result of study

The results of the study pointed out that there is a significant difference in the rate of readmission when patients from a worse performing quartile seek care services from the best performing quartiles. The findings are valid and accurate in reality, and I support it because utilizing effective post-discharge interventions could be the result of the positive outcomes. Various limitations were identified by the author, which include using hospital-wide readmission, which did not focus on individual patients. Also, the study did not detect the difference between principal diagnosis and admission characteristics. The results can be used in nursing to signal the importance of readmission rates in evaluating the effectiveness of healthcare processes. Therefore, nurses will work to ensure that they continually improve these processes to promote the desired outcomes. Future studies can be undertaken to evaluate a particular hospital rather than a group of hospitals to determine their individual performance and readmission rates.

Ethical considerations

The study was approved by the United States National Library of Medicine National Institute of Health resulting in its publication. Patient privacy was protected as the information utilized by the study did not focus on private health information but rather the trends in the readmission rates. Also, the author does not identify any ethical considerations that were considered for the treatment of the target population or audience.

Conclusion

Utilizing risk-standardized readmission rates provide an opportunity to evaluate reliable hospital readmission rates that can be used to improve the quality of healthcare outcomes and the success of the healthcare industry. Standardizing risks help healthcare organizations and nurses to determine the specific areas of care that needs to be improved to realize the desired positive outcomes. Improving hospital quality is crucial for reducing hospital readmission rates by improving the health of the patients.

References