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Literature Review: Table of Evidence

Name: Kimberly Boynton

Problem Statement:

Older adults are at risk have several complex medical and social needs that are fatal and can result in high increased mortality rates among older adults if care management for these adults is not efficient and effective. However, due to poor care management practices in hospitals, there has been an increase in the rate of rehospitalization rates which has been alarming. One of the strategies that can improve care management is pay-for-performance incentives to help reduce the mortality rates of older adults and reduce rehospitalization rates among these individuals.

Criteria	Article 1	Article 2	Article 3	Article 4	Article 5
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Donelan, K., Chang, Y., Berrett-Abebe, J., Spetz, J., Auerbach, D. I., Norman, L., & Buerhaus, P. I. (2019). Care management for older adults: The roles of nurses, social workers, and physicians. Health Affairs, 38(6), 941-949. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00030	Bookey‐Bassett, S., Markle‐Reid, M., Mckey, C. A., & Akhtar‐Danesh, N. (2017). Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: a concept analysis. Journal of advanced nursing, 73(1), 71-84. https://onlinelibrary.wiley.com/doi/full/10.1111/jan.13162	Hastings, S. N., Mahanna, E. P., Berkowitz, T. S., Smith, V. A., Choate, A. L., Hughes, J. M., ... & Oddone, E. (2021). Video‐enhanced care management for medically complex older adults with cognitive impairment. Journal of the American Geriatrics Society, 69(1), 77-84. https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.16819	Mendelson, A., Kondo, K., Damberg, C., Low, A., Motúapuaka, M., Freeman, M., ... & Kansagara, D. (2017). The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review. Annals of internal medicine, 166(5), 341-353. https://www.acpjournals.org/doi/full/10.7326/M16-1881	Chen, C. C., & Cheng, S. H. (2016). Does pay-for-performance benefit patients with multiple chronic conditions? Evidence from a universal coverage health care system. Health policy and planning, 31(1), 83-90. https://academic.oup.com/heapol/article/31/1/83/2363553?login=true
Article Title and Year Published	Care management for older adults: The roles of nurses, social workers, and physicians.2019	Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: a concept analysis. Journal of advanced nursing, 2017	Video‐enhanced care management for medically complex older adults with cognitive impairment. Journal of the American Geriatrics,2018	The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review. 2017	Does pay-for-performance benefit patients with multiple chronic conditions? Evidence from a universal coverage health care system. Health policy and planning 2016
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study	How does practice allocate staff for care management activities? The purpose of this study of the study was to determine how different practices allocate staff to care management for frail adults	How does interprofessional collaboration impact chronic disease care management for older adults? The researcher's purpose was to conduct a concept analysis of interprofessional collaboration and in the care management of older adults who have chronic diseases.	What is the feasibility of the use of video-enhanced care management in older veterans? The study aims to determine the feasibility of video enhance care in the management of older veterans	What are the effects of P4P programs on the process of care and patient outcomes? The purpose of the stud is to determine the effects of pay for performance programs in the healthcare delivery process and their impact on patient outcomes	What is the impact of P4P programs on healthcare provision and healthcare outcomes? The study aimed to assess the impacts of P4P programs for diabetes care on healthcare provisions and healthcare outcomes
Design (Quantitative, Qualitative, or Other)	Quantitative	A qualitative concept analysis	Quantitative	Qualitative	Qualitative
Setting/Sample	The sample consisted of 410 clinicians from 363 practices	Review of 400 articles obtained from different databases	Durhams Veterans Affairs Healthcare system	Sixty-nine studies were used	The setting was Taiwan
Methods: Intervention/Instruments	Questionnaire	Data was obtained from CINAHL, Medline, Heatlhstar, EMBASE, PsychINFO, Angeline, and Cochrane Databases	Observation	Data were obtained from PubMed, MEDLINE, PsycInfo, and CINAHL	The researchers used a large-scale natural experiment where there was a four year follow up period
Analysis	The researchers examined the relationships between staffing in different practices and care management provision activities. The authors used chi-square tests to compare the activities that had been configured into different practice groups.	The authors used the Rodgers evolutionary method of concept analysis	The researcher used descriptive statistics to assess the characteristics of the participants and their outcome measures.	The author did not carry out a meta-analysis of the data	The authors used a difference in difference analysis which was carried out using a generalized estimating equation model to determine the effects of pay for performance programs.
Key Findings	The study determined that when the practices had both registered nurses and a social worker, the role of physicians and NP clinicians differed when it came to chronic care management and care coordination activities. The second finding is that registered nurses were more involved in care management and coordination during transitions.	The first key finding is that interprofessional collaborations are important to ensure proper care management of adults with chronic diseases.	The study determined that the use of video for the care management of older adults was rated higher fr eh participants who were familiar with the use of technology. The use of videos for care management also resulted in greater engagement, communication, and interaction which improved the care management process	The use of pay for performance programs results in the improvement of the care process.	The pay-for-performance programs increased the number of necessary examinations and tests and resulted in the improvement of the continuity of care
Recommendations	The researchers have recommended practices to registered nurses and social workers to improve the care management offered to frail adults.	The authors recommend that the nurses and other team members have a common understanding of interprofessional collaboration's meaning and its purpose when it comes to delivering care to older adults who have chronic conditions.	The researcher recommended the provision of a user guide that has instructions on the person to contact for problems and troubleshooting video telehealth to ensure effective care management	The researcher did not provide any recommendations	The authors' recommendation is for healthcare authorities to establish policies that are needed to increase participation in P4P programs and ensure a continuous improvement in healthcare outcomes.
Explanation of How the Article Supports Your Identified Barrier or Issue in Health Care	This article supports the issue of healthcare management by determining the reasons as t why there is a poor care management and identifying how this issue can be solved.	The article supports the issue of care management by identifying how poor care management can be addressed, which in this care is interprofessional collaboration.	The article supports the issue of care management by providing an alternative way to ensure effective care management among older persons.	The research article is relevant to the issue of care management since it assesses the feasibility of using pay for performance programs to improve the care management process.	It supports the issue that I want to address by assessing the effectiveness of pay for performance programs in improving healthcare and continuity of care.

Criteria	Article 1	Article 2	Article 3	Article 4	Article 5
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Hewner, S., Casucci, S., & Castner, J. (2016). The Roles of Chronic Disease Complexity, Health System Integration, and Care Management in Post‐Discharge Healthcare Utilization in a Low‐Income Population. Research in nursing & health, 39(4), 215-228. https://onlinelibrary.wiley.com/doi/full/10.1002/nur.21731	McHugh, J. P., Shield, R. R., Gadbois, E. A., Winblad, U., Mor, V., & Tyler, D. A. (2021). Readmission reduction strategies for patients discharged to skilled nursing facilities: a case study from 2 hospital systems in 1 city—Journal of nursing care quality, 36(1), 91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266704/	Tang, V., Choy, K. L., Ho, G. T., Lam, H. Y., & Tsang, Y. P. (2019). An IoMT-based geriatric care management system for achieving smart health in nursing homes. Industrial Management & Data Systems. https://www.emerald.com/insight/content/doi/10.1108/IMDS-01-2019-0024/full/html?casa_token=NkAzsFWU-aAAAAAA:JxAbHCM6IaEQUmrcMjpux1tYALhECb_LtEmdjDCmwwthB2w4TvdfHvzrHKMA9prGaoRiB-RPpeFTGeSBVCOIPOOl8aRz5gYTA732xSEI8e9zNLLOfiA	Zendehtalab, H. R., Vanaki, Z., & Memarian, R. (2021). Improving the Quality of Geriatric Care for the Healthy Elderly in Comprehensive Health Centers in Iran. Iranian Journal of Ageing, 15(4), 428-439. https://salmandj.uswr.ac.ir/browse.php?a_id=1958&slc_lang=en&sid=1&ftxt=1&html=1	Kelly, M. E., Duff, H., Kelly, S., Power, J. E. M., Brennan, S., Lawlor, B. A., & Loughrey, D. G. (2017). The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review. Systematic reviews, 6(1), 1-18. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-017-0632-2
Article Title and Year Published	The Roles of Chronic Disease Complexity, Health System Integration, and Care Management in Post‐Discharge Healthcare Utilization in a Low‐Income Population. 2016	Readmission reduction strategies for patients discharged to skilled nursing facilities. 2021	An IoMT-based geriatric care management system for achieving smart health in nursing homes. 2019	proving the Quality of Geriatric Care for the Healthy Elderly in Comprehensive Health Centers in Iran. 2021	The impact of social activities, social networks, social support, and social relationships on the cognitive functioning of healthy older adults.2017
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study	The research question for the study is what is the relationship between chronic disease complexity, the integration of the health system, availability of care management interventions in an organization that manages care, and ninety-day post-discharge healthcare utilization. The purpose of the study is to assess the relationship that exists between chronic disease complexity, health system integration, and the availability of care management interventions	What are the approaches that can be used to reduce readmission rates? The purpose of the study was to analyze the different approaches that aim to reduce readmission rates for the patients who have been discharged to skilled nursing facilities .	How can the global concerns on thein increasing demand for elderly care services in nursing homes be addressed? The purpose of the study is to develop an internet of medical things based geriatric care management systems, integrating IoMT and care based reasoning to address the global concerns on geriatric care management	How can the quality of care provided to the older patient be improved in comprehensive health centers in Iran? The study aims to improve the quality of integrated geriatric care which is provided in comprehensive care centers	What are the effects of social activities, networks, and social support on the cognitive functioning of older adults? What are the differential effects of aspects of social relationships? The purpose of the study is to analyze the impact of social activities, social networks, and social support on the cognitive functioning of older adults
Design (Quantitative, Qualitative, or Other)	Quantitative	Mixed research	Qualitative	Mixed research	Qualitative
Setting/Sample	The sample consisted of 114 295 individuals; the setting was New York	Two hospitals on each of the eight geographically located markets in the united states	The setting of the research was in Taichung, Taiwan	The sample consisted of eleven healthcare providers, fifty-four older patients, and fifty-four family members	The sample consisted of 39 studies.
Methods: Intervention/Instruments	Data were obtained from the NewYork State Medicaid Data Warehouse for the exploration of complex factors that are associated with post-discharge utilization	The authors used a case study methodology to compare two hospitals and compare clinical and administrative staff interviews and the reported rehospitalization rates.	The I-GCMS was created under an IoMT environment to collect biometric data in realtime for total health monitoring	Quantitative data collection methods include focus groups, interviews, and note taking while quantitative data was collected through the use of a questionnaire	The researchers carried out a literature review of 39 studies where 34 were observational, two genetic studies, and three were randomized control trials
Analysis	The Cox proportional hazards regression models were used for data analysis	The researcher utilized deductive and inductive approaches for qualitative data analysis and used difference-in-difference regression analysis in quantitative data analysis	The researchers did not identify the data analysis methods they used.	Content analysis	The authors did not conduct a meta-analysis of the data
Key Findings	There were lower rehospitalization rates for patients in managed care organizations and accountable care organizations. The research also found out that the use of transition care strategies that improve continuity of care between two settings resulted in a decrease in rehospitalization rates	The study determined that the provision of detailed discharge information and education of the skilled nursing facilities staff on care protocols resulted in a decline in hospital readmission rates	The authors determined that under the IoMT environment, the time-saving in executing total health monitoring improved the care management effectiveness and efficiency. The study also found out that the proposed system helped in the modification of a care plan for the older patients as their health status underwent changes	The care management of older adults can be improved through the use of the dynamic care model	The study determined that there was a relation between social relationships and the cognitive functioning of older adults.
Recommendations	The authors recommend that future studies be conducted in different regions, timeframes, and age groups to validate whether the relationship that the authors had observed was replicated.	The researchers did not offer any recommendations	The author of the articles did not make any recommendation	The authors did not provide any recommendation	The author did not provide any recommendations.
Explanation of How the Article Supports Your Identified Barrier or Issue in Health Care	This article supports the care management issue in healthcare by assessing the relationship between care management and rehospitalization rates.	This study supports the care management issue by assessing if education healthcare professional care management protocols will help reduce rehospitalization rates.	It is related to the issue of care management since it identifies a care management system for older adults.	The study is related to the care management issue in older adults since it assesses how the quality of geriatric care can be improved.	The article is related to the issue of care management by addressing the social support part of the PICOTquestion.

Criteria	Article 1	Article 2	Article 3	Article 4	Article 5
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Smith, G. L., Banting, L., Eime, R., O'Sullivan, G., & Van Uffelen, J. G. (2017). The association between social support and physical activity in older adults: a systematic review. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 1-21. https://link.springer.com/article/10.1186/s12966-017-0509-8	Ju Kim, S., Han, K. T., Kim, S. J., & Park, E. C. (2017). Pay-for-performance reduces healthcare spending and improves the quality of care: Analysis of target and non-target obstetrics and gynecology surgeries. International Journal for Quality in Health Care, 29(2), 222-227. https://academic.oup.com/intqhc/article/29/2/222/3605391?login=true
Article Title and Year Published	The association between social support and physical activity in older adults: a systematic review. 2017	Pay-for-performance reduces healthcare spending and improves the quality of care.2017
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study	What is the relationship between social support in older adults and physical activity? The purpose of the study was to carry out a review of research articles assessing the relationship between social support and physical activity and to investigate whether the relationship between social support and physical activity changes across physical exercise domains	Does pay for performance result in the improvement in quality of care and reduce medical costs? The study aims to assess whether the condition-specific performance of the pay-for-performance results in the measurable improvement in quality of care and reduced medical costs.
Design (Quantitative, Qualitative, or Other)	Qualitative	Qualitative
Setting/Sample	The review consisted of twenty-seven research papers	The researchers used data sets collected from the BHI between 2012 to 2014
Methods: Intervention/Instruments	Quantitive studies on social support, loneliness, and physical activity were selected from MEDLINE, PsycINFO, SportDiscus, CINAHL, and PubMed.	The researchers used a generalized estimating equation model to determine the relationships between quality assessment and the length of stay.
Analysis	The author did not identify the data analysis method they used.	The analysis model was used is the Poisson regression analysis to evaluate readmission rates
Key Findings	The study determined that social support made it likey for older persons to do LTPA	The study determined that the use of pay for performance indicators results in din a decrease in the length of stay in the hospital, reduction in medical costs, and a decrease in the number of thirty-day readmissions
Recommendations	The author failed to provide a recommendation	The authors recommend using alternative strategies to reduce between instate quality gap for the institution with low performance.
Explanation of How the Article Supports Your Identified Barrier or Issue in Health Care	The article is related to the issue of care management since it addresses the social support part of the PICOT question, which was formulated to identify the right intervention method.	The article is related to the issue of care management by assessing the effectiveness of pay for performance programs in improving the quality of care and reducing hospital readmission rates.