The Effectiveness of Intervention

Criteria

Article 1

Article 2

Article 3

Article 4

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

G. Brent Hamar, Carter Coberley, James E. Pope, Andrew Cottrill, Scott Verrall, Shaun Larkin, Elizabeth Y. Rula. Australian Health Review. https://www.publish.csiro.au/ah/pdf/AH16059

Marie Lavesen, Steen Ladelund, Addie J. Frederiksen, Bjarne O. Lindhardt, Dorthe Overgaard. Danish Medical Journal. https://ugeskriftet.dk/files/scientific_article_files/2018-11/a5276.pdf

Janet D. Record, Ashwini Niranjan-Azadi, Colleen Christmas, Laura A. Hanyok, Cynthia S. Rand, David B. Hellmann, & Roy C. Ziegelstein. Medical Education Online. https://www.tandfonline.com/doi/pdf/10.3402/meo.v20.26701

Guy Mole, Mayur Murali, Sarah Carter, David Gore, Jack Broadhurst, Tim Moore, Philip Vickers and Andrew Miles. British Journal of Nursing. https://web-a-ebscohost-com.ezproxy.snhu.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=ff85cbda-58f4-4451-928f-a5438af549f2%40sessionmgr4008

Article Title and Year Published

“Effect of Post-Hospital Discharge Telephonic Intervention on Hospital Readmissions in A Privately Insured Population in Australia.” 2018.

“Nurse-Initiated Telephone Follow-Up on Patients with Chronic Obstructive Pulmonary Disease Improves Patient Empowerment, But Cannot Prevent Readmissions.” 2016.

“Telephone Calls to Patients After Discharge from The Hospital: An Important Part of Transitions of Care.” 2015.

“A Service Evaluation of Specialist Nurse Telephone Follow-Up of Bowel Cancer Patients After Surgery.” 2019.

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study

The hypothesis was that patients in My Health Guardian (MHG) program who received prompt follow-up calls post-discharge would have a lower risk of readmissions in the first 28 days after discharge in comparison to members of the MHG who were not included in the hospital discharge (HODI) calls. The purpose of the study was to determine the effect of telephone-based support to patients after being discharged in reducing rates of early readmissions.

The research question was not explicit but can be inferred from the aim of the study, which was to test whether post-discharge follow-up calls could reduce readmissions and mortality rates, and improve management of illness for chronic obstructive pulmonary disease (COPD) patients.

The study was designed to answer the question of whether patients discharged from an inpatient setting utilizing the patient-centered care (PCC) would demonstrate the enhanced quality of transition care, with a focus on the effect of post-discharge telephone calls as part of the PCC.

There is no explicit research question or hypothesis, but the aim of the study was to "assess patient satisfaction and the cost-saving realized for commissioners by use of the telephone service" (Mole et al., 2019, p. 1135).

Design (Type of Quantitative, or Type of Qualitative)

It was a cohort study employing the quasi-experimental retrospective design.

The study was a randomized controlled trial.

It was an observational cohort study

It was a quantitative service evaluation of a follow-up service

Setting/Sample

The sample consisted of MHG patients with chronic diseases who had been discharged and participated in the HODI call program and a control group of nonparticipating MHG members.

The sample size was 224 people, and they were recruited by either a primary investigator or Department of Pulmonary and Infectious Diseases from a University hospital in Denmark.

The setting was the Johns Hopkins Bayview Medical Center. The sample included 1429 patients, but only 139 patients were successfully involved in the survey, 18 in the PCC team, and 121 on the standard teams.

The research was set in the Royal Hampshire Hospital, Winchester. The sample comprised of 142 patients who had undergone curative surgery for bowel cancer.

Methods: Intervention/Instruments

The treatment group was subjected to HODI follow-up calls as soon as possible after discharge, while the control group was not subjected to similar treatment. Rate of readmission was assessed as any hospitalization occurring between days 1 and 28 since release.

It entailed a nurse-initiated post-discharge telephone-based intervention. After 30 days, participants were required to fill questionnaires detailing their health status and views about disease management. At days 30 and 84, recording of readmissions and deaths was done.

The teams tried contacting 289 patients, 44 on the PCC, and 245 on the standard teams, but finally managed to reach 139. The calls entailed asking each patient whether they were ready to talk, asking about transition experience, checking how well recommendations for progressive care were understood by the patient, and offering any needed help.

The record of patients who had undergone curative surgery in 2012 and 2013 was reviewed, and the patients who had not presented a metastasis were included in the study group. The kind and frequency of follow-ups were evaluated, in addition to the number of patients who had sought outpatient services since being discharged and the reasons for the outcome.

Analysis

Data were analyzed using independent sample t-tests, Fisher's exact statistical testing, and Chi-squared tests. The intervention effect on readmissions was estimated using the Zero-inflated negative binomial (ZINB) multivariate models

Analysis entailed presenting the continuous data in means and standard deviations, while discrete data were presented as percentages and counts. Chi-squared test and Fisher's exact test were used to compare the test and control group outcomes.

The data was analyzed using means and standard deviations for the 3-Item Care Transition Measures (CTM-3) scores for PCC versus standard care patients and also for those who received telephone calls against those who did not.

Microsoft Excel was used to analyze quantitative data, while a thematic analysis of qualitative data was performed using a template and emergent coding.

Key Findings

The test group had a 29% lower readmissions incidence within the first 28 days with 25% lower odds as compared to the control

No significant drop in readmissions was noted, but there was a significantly positive assessment of disease management, including dyspnea and lung problems, and prompt detection and communication of exacerbation to healthcare providers. Higher mortality was noted in the control group, but it was not significant.

The mean and standard deviation scores were not significantly different for the PCC and standard teams (84.7 ± 17.3 VS. 79.6 ± 17.6, p = 0.53), but in both cases, patients receiving follow up calls scored better than those who did not receive them (84.7 ± 16.0 vs. 78.2 ± 17.4, p = 0.03).

Patients gave positive feedback about the follow-up, indicating satisfaction with the quality of care offered, including continuity, convenience, and ease of access. The facility also benefited since the cost incurred in the telephone calls was considerably lower than that of the outpatient services.

Recommendations

Recommendations for future studies included the inclusion of cost analysis to compare the study intervention with hospital routine post-discharge care in regard to savings.

Authors recommend finding ways of selecting and differentiating among types of follow-up to be used.

No explicit recommendations were made by the authors.

The authors recommend the replication of the model in other institutions, provided they have the right expertise since it reduces the number of outpatient appointments made by patients after discharge as required by the NHS Long-Term Plan.

Explanation of How the Article Supports EBP/Capstone Project

This article provides sufficient evidence to support the argument that post-discharge telephone follow-ups effectively decrease readmission rates. Therefore, it confirms the PICOT question and is ideal for the capstone project.

Although the article does not directly support the argument that telephone follow-ups reduce the rate of readmissions, it shows positive outcomes in patients' disease management and ability to discuss exacerbations with the healthcare professionals, which could indirectly reduce readmissions.

This article shows a correlation between post-discharge telephone call follow up and enhanced quality of transition care, thereby reducing the rate of ED visits within 30 days after being discharged.

This study provides useful evidence that can be applied to the PICOT question for the capstone project, especially by indicating how effective telephone follow-ups can be in minimizing readmission rates.

Criteria

Article 5

Article 6

Article 7

Article 8

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

 Ebony Lewis, Sarah Samperi, Christopher Boyd-Skinner. Age and Ageing. https://web-a-ebscohost-com.ezproxy.snhu.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=bbf9fb64-1aeb-4289-8612-d2ecc90849d3%40sdc-v-sessmgr01

Mochuan Chen, Pihong Li, Feiou Lin. Patient Preference and Adherence. https://web-a-ebscohost-com.ezproxy.snhu.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=0ffc79bd-e185-4cdd-83c5-2126176b395f%40sessionmgr4007

Amanda Jayakody, Jamie Bryant, Mariko Carey, Breanne Hobden, Natalie Dodd and Robert Sanson-Fisher. BMC Health Services Research. https://web-a-ebscohost-com.ezproxy.snhu.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=9047356d-9058-4e22-a46c-394f2cec38f7%40sdc-v-sessmgr02

Gordon T. Briscoe, Catherine F. Kane, Amy Heerschap, Beth D. Quatrara.  Nephrology Nursing Journal. https://web-a-ebscohost-com.ezproxy.snhu.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=394b76c7-eac5-493c-907f-5dfcedde1d25%40sessionmgr4008

Article Title and Year Published

“Telephone Follow-Up Calls for Older Patients After Hospital Discharge.” 2017.

“Influence of Structured Telephone Follow-Up on Patient Compliance with Rehabilitation After Total Knee Arthroplasty.” 2016.

“Effectiveness of Interventions Utilising Telephone Follow Up in Reducing Hospital Readmission Within 30 Days for Individuals with Chronic Disease: A Systematic Review.” 2016.

“Using Post-Discharge Telephone Follow-Up by Nephrology Nurses to Reduce 30-Day Readmissions and Post-Discharge Complications for Adult Patients on Hemodialysis.” 2018.

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study

There was no explicit research question or hypothesis, but the aim of the study was clearly stated, which was to report on the benefits of post-discharge telephone follow-ups for older adults, with a focus on duration, optimal time intervals, content, and multidisciplinary involvement in the process.

A research question or hypothesis is not explicit in this study, but the aim is clearly stated. The purpose was to determine the effect of structured telephone calls on the level of compliance with recommendations for home care after total knee arthroplasty (TKA).

The aim of the study was to assess the effectiveness of telephone follow-ups (TFU) in achieving a reduction in readmissions in the first 30 days after discharge for cardiovascular disease, diabetes, and chronic respiratory disease patients. The study question can be derived from this purpose statement since it is not explicit in the article.

The purpose of the study was to assess how effective post-discharge telephone follow up can be in reducing 30-day readmissions and complications arising after discharge for patients undergoing chronic hemodialysis.

Design (Type of Quantitative, or Type of Qualitative)

A qualitative phenomenological study designed to assess patient post-discharge experiences with telephone follow-ups

It was a pilot, randomized controlled trial.

It was a systematic review of the literature.

It was causal-comparative research or quasi-experimental study testing a dependent variable against the independent variable

Setting/Sample

The sample consisted of older people who had been admitted to hospital for acute reasons

208 KTA patients participated and were randomly placed into either test or control group in a ratio of 1:1.

Databases reviewed include MEDLINE, EMBASE, and Cochrane Library. The systematic search yielded ten studies for review.

It was set in an academic medical center (AMC) with a capacity of 600 beds. The sample included all patients who had at least one hemodialysis treatment in the AMC during their inpatient stay.

Methods: Intervention/Instruments

The study entailed structured telephone calls to patients three months since discharge following an acute admission. The patients or their relatives were presented with five questions, with the call lasting 6 minutes on average

The participants in the intervention group received structured calls following discharge, while the control group received only the routine health care. The researchers measured the functionality, pain, depression, and quality of life before and after the TKA for both groups, with inter and intragroup differences evaluated during the course of 12 months since discharge.

The databases were searched for articles reporting on the effect of TFU on readmissions within 30 days. Only full articles fulfilling these criteria and published in English were included. The selected studies were reviewed, and their findings were considered.

The researchers measured the number of 30-day readmissions using the hospital database as the resource by considering the first day of discharge from the records. Post-discharge complications were also assessed. These outcomes were measured in relation to telephone follow-ups to determine the correlation.

Analysis

No specific analysis process appears in the article, probably since this is a qualitative study.

Statistical analysis was done using the SPSS version 15 while one-way analysis of variance (ANOVA) was done to measure differences across the groups being investigated.

Data analysis entailed extraction of sample characteristics, kind of interventions used, and the inclusion of comparison groups, the outcomes tested and the measures, and the results in terms of readmissions within 30 days.

Pre-intervention and post-intervention data were compared using retrospective analysis as well as descriptive statistics.

Key Findings

Most patients and/or their loved ones expressed a lack of awareness of the existence of various forms of professional support and expressed gratitude for the telephone calls. The follow-up provided a chance for them to expose their concerns and also learn about existing support structures. The study found various potential benefits of telephone follow-ups, including a reduction in readmissions, identification of multiple needs of patients after discharge, and lowering mortality by decreasing levels of loneliness and social isolation that often lead to negative health outcomes.

The sociodemographic characteristics of the participating groups did not present major differences in outcomes. The intervention group recorded a higher mean of home-exercise time and the number of days spent in healthy activities as compared to the control group. The intervention group also demonstrated more significant improvement in active range of motion and mental health indicators.

Five of the ten studies reported a reduction in readmissions within 30 days for the intervention group. Most studies combined TFU with other types of intervention. The researchers reported a lack of uniformity and consistency in the measuring of readmissions.

There were lower rates of emergency department admissions (59.9% pre-intervention against 55.4% post-intervention) and 30-day readmissions (28.4% pre-intervention against 24.6% post-intervention).

Recommendations

The authors recommend nurses to offer guidance and information to patients in the days following discharge. They also propose follow-up calls to assess the success of measures taken to help patients after release, in addition to providing social and emotional support.

The authors do not make specific recommendations, but they conclude that structured telephone follow-ups are effective in improving the level of adherence to home exercises following TKA and achieving an enhanced range of motion (ROM) and mental health.

The researchers recommend that the pre-discharge and intervention approaches be tailored to each patient group's needs to enhance the reliability of findings. They also propose priority to be given to the achievement of high quality in methodology. Multisite studies are also recommended for increased generalizability.

The authors recommend a longitudinal study with a longer duration coupled with patient-level analysis for a more definitive demonstration of the correlation between telephone follow-ups and rate of 30-day readmissions.

Explanation of How the Article Supports EBP/Capstone

The findings are relevant to the capstone project since they highlight the effectiveness of post-discharge telephone calls in reducing readmissions.

The article provides evidence for the impact of telephone follow-ups on the health outcomes after discharge, thus offering a basis for answering the PICOT question and supporting the capstone project.

This study is important to the capstone project since it presents an evidence basis for further assessment of the impact of TFU on lowered readmissions. The recommendations made are critical in ensuring more focused research.

The article supports the capstone project by providing findings that answer the PICOT question. It shows that for patients with terminal illnesses, telephone follow-ups could lead to reduced readmissions when compared to other interventions, such as the informal home care indicated in the PICOT question.