Benchmark - Evidence-Based Practice

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Research Support

Kimberly Boynton

Grand Canyon University

HCA-699-Evidence-Based Research Project

Edward Paluch

10/27/2021

Research Support

Description of Search Method

A total of twelve research articles were selected for this assignment. These articles were obtained from Google Scholar, CINAHL, and the Cochrane Database. The keywords used to identify these articles are care management, social support, pay for performance incentives, and rehospitalization rates of older adults. The first inclusion criteria for the articles for the assignment were that they had to be recent within the past five years, and the articles also had to be peer-reviewed for them to be selected. The third inclusion criteria are that the articles must be relevant to the PICOT question to help inform the evidence-based practice. A total of forty-nine articles were first selected before being excluded based on the year published and relevance to the PICOT question. Thirty-seven articles did not meet the selection criteria and were excluded from the study, and twelve articles met the selection criteria.

Summary of Research Studies

Donelan et al. (2019) conducted a qualitative study to determine how healthcare practices allocate staff for care management activities. The data was collected through questionnaires, and 363 practices that offer geriatric care and 410 were studied. 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. It also found out that registered nurses were more involved in care management and coordination during transitions. There were several limitations that the authors of the article identified. The first limitation is that the data was self-reported in a national random sample, resulting in sampling error and response or non-response errors (Donelan et al., 2019). The second limitation is that data on patient-centered medical home certification was not included in the questionnaires, or the sample frames used by the authors. The data obtained on care management is reliable for patients who are 65 years old or older and might not reflect on younger patients. The group of practices with social workers was small but not compared to registered nurses with the smallest representation. The strength of the study is that it has met its purpose and is relevant to my study.

Bookey et al. (2017) conduct a systematic qualitative review of studies on how interprofessional collaborations impact care management in adults with chronic conditions. The authors determined that interprofessional collaborations are important to ensure proper care management of adults with chronic diseases. The study's limitations are that the search timeframe limits the ability of the researcher to determine differences in how interprofessional collaborations can be used over time (Bookey et al., 2017). The second limitation is that the document was grouped based on the discipline of the first author while the other authors were from different disciplines, and the studies assessed chronic conditions based on a broad context vs. specific chronic conditions. The last limitation is that the selected studies are from developed countries, making it impossible to generalize findings to developing countries. The strength of this study is its validity and reliability.

Hastings et al. (2021) conducted a qualitative study to determine the feasibility of video-enhancing care in the management of older veterans. The study determined that the use of video for the care management of older adults was rated higher for the participants familiar with the use of technology. Using videos for care management also improved engagement, communication, and interaction, improving the care management process (Hastings et al., 2021). The strength of the study is that it is reliable and valid. The limitations include evolving technology and its usage policies, small sample size, and the setting in a single healthcare system which reduces generalizability.

Mendelson et al. (2017) carry out a systematic qualitative review of 69 articles that evaluate pay for performance programs. The purpose of the study by Mendelson et al. is to determine the effects of pay-for-performance programs in the healthcare delivery process and their impact on patient outcomes (Mendelson et al., 2017). The authors determined that pay for performance programs results in the improvement of the care process. The limitation of this study is that the study used few methodologically rigorous studies. The strengths of the study are that it is reliable valid, and it allows generalizability.

The findings of Mendelson et al. are also supported by the article by Chen & Cheng, 2016. The quantitative study consisting of 114,295 participants aimed to assess the impacts of P4P programs for diabetes care on healthcare provisions and outcomes. The study determined that pay-for-performance programs increased the number of necessary examinations and tests and improved the continuity of care (Chen & Cheng, 2016). The study's limitations include the lack of inclusion of certain characteristics in the PSM GEE models, lack of consensus on how MCCs can be defined, or measured and unique factors that limit the generalizability of the study's findings. The strength of this study is that it is reliable and cost-effective.

Hewner et al. (2016) conducted quantitative research, which consisted of 114 295 participants. 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. The study determined lower rehospitalization rates for patients in managed care organizations and accountable care organizations. The research also found that transition care strategies improve continuity of care between two settings decreased rehospitalization rates (Hewner et al., 2016). The limitation of the study is that the counties that were studied have large urban areas with sizeable Medicaid populations where benefits vary from state to state, making it difficult to generalize the findings nationally. The second limitation is the changes in the United States healthcare environment due to the enactment of the affordable care act. The strengths of this study are its data collection methods and its reliability.

McHugh et al. (2021) conducted a study to analyze the different approaches that aim to reduce readmission rates for the patients who have been discharged to skilled nursing facilities. 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 limitations include the study setting where only two hospital systems in one city were assessed, affecting the generalizability of the research findings (McHugh et al., 2021). The other limitations include a limited number of qualitative interviews and differences in the baseline rehospitalization rates of the two hospital systems. The strengths include its validity, reliability, and its methodology.

Tang et al. (2019) conduct a study to develop an internet of medical things-based geriatric care management systems. The authors determined that under the IoMT environment, the timesaving in executing total health monitoring improved the care management effectiveness and efficiency. The study also found out that the proposed system helped modify a care plan for older patients as their health status changed (Tang et al., 2019). The study's limitations include the unwillingness of older adults to wear IoT devices, system blackouts, and the overreliance on domain experts' knowledge. The strengths include generalizability, reliability, and validity.

Zendehtalab et al., 2021 carry out a study on 11 different healthcare providers, with 54 older adults and 54 family members being the study participants. The study determined that the management of older adults can be improved by using the dynamic care model. The authors failed to identify the study's limitations, and the strengths include reliability, generalizability, and validity.

Kelly et al. (2017) carried out a systematic qualitative review consisting of 39 studies. The study determined that there was a relation between social relationships and the cognitive functioning of older adults. The limitation of the study includes challenges in identifying RCTs that include social relationships as interventions or active control components (Kelly et al., 2017). The strengths of the study are that it is reliable valid, and it allows generalizability.

Smith et al. (2017) conduct a systematic quantitative review of 27 articles to assess the relationship between social support and physical activity. The study determined that social support made it likely for older persons to do LTPA (Smith et al., 2017). The limitations include the inclusion of studies and the variability of outcome measures. The strength of this study is its data collection methods and its reliability.

Ju et al. (2017) conduct a quantitative study consisting of 535 289 participants. The study determined that pay for performance indicators results in a decrease in the length of stay in the hospital, a reduction in medical costs, and a decrease in the number of thirty-day readmissions (Ju et al., 2017). The study's limitations include the inability to measure patient socioeconomic status and limitations in the data set.

Description of the Validity of Internal and External Research

Internal validity refers to the degree to which a study establishes trustworthy cause and effect relationships that are not influenced by other factors or variables. On the other hand, external validity is the degree to which results from studies can be applied in other situations. The reviewed studies have internal and external validity, which can help meet the study's objectives.

Alignment to Measurable Outcomes

The objectives of the evidence-based practice are aligned to measurable outcomes, and this is because the increase or decrease of hospitalization rates can be measured. The improvement of care management can also be measured based on the health outcomes of this population.

Adjusted of PICOT

I adjusted to PICOT based on the research that I carried out to ensure the objectives and goals of the study can be met in a timely and cost-effective manner. According to my instructor's feedback, I also adjusted by incorporating and making changes in the instructor's identified areas.

References

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

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.

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

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.

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.

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.

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.

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.

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 two hospital systems in one city—Journal of nursing care quality, 36(1), 91

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.

Tang, V., Choy, K. L., Ho, G. T., Lam, H. Y., & Tsang, Y. P. (2019). An IoT-based geriatric care management system for achieving smart health in nursing homes. Industrial Management & Data Systems.

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.