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Homework answers / question archive / A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence

Health Science

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Question Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections:

  1. Title page
  2. Introduction section
  3. A comparison of research questions
  4. A comparison of sample populations
  5. A comparison of the limitations of the study
  6. A conclusion section, incorporating recommendations for further research

Using the literature review that you did last time can you write a paper including the above?

Literature Evaluation Table Student Name: Yamil Bernard Change Topic (2-3 sentences): In patients admitted to a skilled nursing facility how does building a partnership between the skilled nursing facility and the hospital compared to no partnership impact the rates of readmission within 30 days from discharge Criteria Article 1 Article 2 Article 3 Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Kate Traynor, American Journal of Health-System and Pharmacy. DOI 10.2146/news1500 31 Lavery, A. M., Preston, L. E., Ko, J. Y., Chevinsky, J. R., DeSisto, C. L., Pennington, A. F., Kompaniyets, L., Datta, S. D., Click, E. S., Golden, T., Goodman, A. B., Mac Kenzie, W. R., Boehmer, T. K., & Gundlapalli, A. V. Morbidity and Mortality Weekly Report https://doi.org/10.1 5585/mmwr.mm69 45e2 Reginald Hislop III Article Title and Year Published Hospital Partner with SNFs to Reduce Readmissions, 2015 Research Questions (Qualitative)/Hypot hesis (Quantitative) Some hospitals are reaching out to local skilled nursing facilities (SNFs) as part of an effort to reduce 30-day readmission rates Qualitative Characteristics of Hospitalized COVID19 Patients Discharged and Experiencing Same – Hospital Readmission, 2020 Using electronic health record and administrative data from the Premier Healthcare Database, CDC assessed patterns of hospital discharge, Shafa, M., (2019). Readmission Prevention Management Program. Blacks and Hispanics receive worse care than whites; yet rate their interactions with health care providers more positively. (2006). PsycEXTRA Dataset. https://doi.org/10. 1037/e55611200 6-009 Five ways to reduce readmissions and improve care transitions (and why you should start now) 2016 How can SNFs work to reduce their readmission rate Are physicians signed off on the diagnoses that the nursing staff prepares on admission of a new patient? © 2015. Grand Canyon University. All Rights Reserved. Article 4 Strategies to mitigate readmission and rehospitalization risk 2016 readmission, and demographic and clinical characteristics associated with hospital readmission after a patient’s initial COVID-19 hospitalization Quantitative Investigating discharge patterns and hospital readmissions among large groups of patients after an initial COVID-19 hospitalization Purposes/Aim of Study Evaluation of programs at different hospitals Design (Type of Quantitative, or Type of Qualitative) Qualitativeinterview, literature reviews Quantitative observations Setting/Sample Cedars-Sinai Medical Center Los Angeles; Frederick Memorial Hospital Maryland; Interdisciplinary team case management, with the pharmacists focusing mainly on medication-related issues. Methods: Intervention/Instru ments Investigating SNF providers facing a slew of federal regulations in the coming months that focus on reducing rehospitalizations and improving transitions of care, placing more pressure on providers that still have high rehospitalization rate Qualitative observations To propose strategies on how hospitals to pay attention to their hospitalizations/rehospitalizations. Premier Healthcare Database Comprehensive Care for Joint Replacement H2 Healthcare, LLC, in Wichita, Kansas Data for this study were obtained from the Premier Healthcare Database, which includes discharge records from 865 nongovernmental, community, and teaching hospitals that contributed inpatient data Data for this study were obtained from the Comprehensive Care for Joint Replacement (CJR): The bundled payments that make up the CJR model, which kicked off in April, will Face to face Interview © 2017. Grand Canyon University. All Rights Reserved. Qualitative analysis during the study period Analysis Key Findings require all providers involved in knee and hip replacements— including SNFs—to prevent readmissions to the hospital within 90 days of discharge “I think what we’re After discharge from Under the IMPACT Act, seeing, in general, an initial COVID-19 the is a focus from hospitalization, 9% SNF Quality managing the of patients were Report Program acute care episode readmitted to the to managing the same hospital within will begin tracking several patient,” Shane 2 months of measures that noted. “We need discharge. Multiple will impact to look at how we readmissions payment in 2018, keep them well and occurred in 1.6% of including not have patients. Risk discharge to the medication- related factors for community and problems be the readmission the potentially cause of a included age ≥65 preventable 30readmission or years, presence of day postother morbidity as certain chronic discharge they leave our conditions, readmission measure for system. So, hospitalization population health within the 3 months SNFs. Data collection will is really built preceding the first begin in October around the care of COVID-19 the patient, not the hospitalization, and 2016 care of the discharge to a episode.” skilled nursing facility or with home health care. Preventable readmissions should be regarded as sentinel events. 30-day readmissions to Cedars-Sinai from the participating Readmissions occurred more often among patients discharged to a skilled nursing facility (SNF) (15%) or those needing home health care (12%) than among Hislop notes that better advanced care planning resolves multiple issues by improving communication among clinicians and initiating a © 2017. Grand Canyon University. All Rights Reserved. SNF value-based purchasing begins in July of this year with the first measurement period continuing through July 2017. Rehospitalization rates for SNFs will be measured (all cause, risk adjusted). Beginning in October 2018, CMS will reduce Medicare A payments by 2% for SNFs that perform below benchmark standards on this measure There are no appropriate strategies in the hospitals that help mitigate readmission and rehospitalization risk SNFs occurred at a rate of about 20% when the ECP began but have since declined by 25% Recommendations According to the MEDPAC report, potentially avoidable readmissions involve conditions that should have been managed in the SNF setting, such as heart failure, electrolyte imbalance or dehydration, respiratory tract infection, septicemia, urinary tract or kidney infection, hypoglycemia, anticoagulant complications, adverse drug reactions, wound infections, and hypertension. Explanation of How the Article Supports EBP/Capstone Project This article examines and produces factual information about the current programs in effect that have helped manage and decrease patients discharged to home or selfcare (7%) conversation between clinicians and family members that may push for hospital readmission if they aren’t clear about what level of care the SNF can provide After hospitalization Sourcing out resource for COVID-19, the developed by most common FAU called “Go primary discharge to the Hospital or diagnoses from hospital readmission Stay Here?” that were diseases of the can serve as a decision guide circulatory, for residents and digestive, or families. respiratory systems. Understanding frequency of, and potential reasons for, readmission after a COVID-19 hospitalization can inform clinical practice, discharge disposition SNFs looking to build on readmission initiatives will need to focus on kick-starting behavioral and process changes that can © 2017. Grand Canyon University. All Rights Reserved. Reducing hospitalizations/reh ospitalizations is an organization-wide initiative. Every discipline has a role, and when the root causes of transitions are analyzed, it becomes clear how many little or seemingly minor pieces contribute to reducing this risk element There have been a wide variety of strategies to do with hospitalizations/reh ospitalizations for some time. The researcher, after the face-to-face readmission rates in decisions, and public skilled nursing health priorities, facilities. such as health care resource planning. Criteria make a sizable impact in a matter of six months, says Reginald Hislop III, PhD, managing partner and CEO of H2 Healthcare, LLC, in Wichita, Kansas. interview director of postacute education at HCPro in Danvers, and Frosini Rubertino, notes the problem and proposes appropriate strategies Article 5 Article 6 Article 7 Author, Journal (PeerReviewed), and Permalink or Working Link to Access Article Kate Traynor DOI 10.2146/news150031 Sharon Worcester Article Title and Year Published Hospitals partner with SNFs to reduce Readmissions 2015 Research Questions (Qualitative)/Hypothesis (Quantitative) Some hospitals are reaching out to local skilled nursing facilities (SNFs) as part of an effort to reduce 30day readmission rates. Hospital-SNF Partnerships Prevent Readmissions 2015 – Partnerships between skilled nursing facilities and hospitals are helping to improve hospital readmission rates, according to findings presented at the AMDA Annual Conference. Young, J., Cheater, F., Collinson, M., et al., “Prevention of Delirium (POD) for Older People in Hospital: Study Protocol for a Randomized Controlled Feasibility Trial,”2015. Reducing SNF Readmissions Through Hospital-SNF Collaboration At the time of the study, an out-of-town contracted medical group was charged with medical authority at Thornapple Manor. Midlevel practitioners from the © 2017. Grand Canyon University. All Rights Reserved. Purposes/Aim of Study Some hospitals are reaching out to local skilled nursing facilities (SNFs) as part of an effort to reduce 30day readmission rates. How the Partnerships between skilled nursing facilities and hospitals are helping to improve hospital readmission rates, according to findings presented at the AMDA Annual Conference. Design (Type of Quantitative, or Type of Qualitative) Quantitative analysis Qualitative analysis Setting/Sample CMS announced it would be posting six new quality measures to Nursing SNFs. Clinical protocols Methods: Management, with Intervention/Instruments the pharmacists focused mainly on medication-related issues. CHF protocol was revised based on case reviews that identified over-diuresis as a medical group provided coverage three times per week and physicians performed site visits twice monthly. The Affordable Care Act includes several provisions aimed at improving the quality of U.S. health care and reducing its cost, including one focused on preventing avoidable readmissions, which is an important goal that has challenged providers across the nation. Quantitative analysis Descriptive data from SPH for calendar year 2014 indicated that 28 percent of the hospital’s readmissions came from Thornapple Manor, with mean charges per admission of $19,328 The group was charged with using the PlanDo-Check-Act (PDCA) © 2017. Grand Canyon University. All Rights Reserved. Analysis According to data presented by ECP staff at scientific meetings, 30-day readmissions to Cedars-Sinai from the participating SNFs occurred at a rate of about 20% when the ECP began but have since declined by 25%. cause of some unplanned rehospitalizations; patients were developing hypotension and acute renal insufficiency as a result of overdiuresis One such partnership between Johns Hopkins University hospital and five nearby SNFs used a centralized database to analyze the most frequent causes of rehospitalizations from the SNFs. Clinical protocols were then developed by medical, nursing, and administrative leaders for the two most common reasons for rehospitalization: congestive heart failure (CHF) and chronic obstructive pulmonary disorder (COPD), according to Stefan David, MD, who described the program in a poster at the conference methodology to analyze the two organizations’ data and processes In October 2014, an executive at SPH who had been leading the hospital’s readmissions reduction efforts and the administrator from Thornapple Manor met to review data on readmissions to SPH from the SNF, and they concluded that the numbers posed a very real concern. Descriptive data from SPH for calendar year 2014 indicated that 28 percent of the hospital’s readmissions came from Thornapple Manor, with mean charges per admission of $19,328. The two leaders immediately initiated discussions on how to address this problem © 2017. Grand Canyon University. All Rights Reserved. Key Findings Within four months, it was so evident that it was an effective program that we got funding for half of a position, which holds doing this work,” Shane said. “It’s an outstanding example of team-based care.” Recommendations Backes said the hospital’s physicians aren’t required to perform medication lists sometimes contain errors or lack important information, such as the need to discontinue a home medication if a new prescription for another drug in the class was added to the regimen An analysis of data for the period prior to implementation in 2012, and for the period after implementation – from September 2013 to August 2014, showed that the number of discharges from the acute care hospital to the SNFs declined by 29% after implementation of the protocols (from an annualized 2,268 to 1,615), Dr. David, of Johns Hopkins Bayview Medical Center, Baltimore, said in an interview An analysis of readmission data following implementation of the collaboration found that readmissions declined by 90.6 percent, correlating with in a statistically significant drop (p-value 0.000) in actual hospitalization PEPPER data. Monetarily, from August 2014 to June 2016, these readmissions were valued at a median of $19,328 per admission, adding up to a savings of $927,744 over the study period. Promoting the Through Quality of Care increased dayProvided in to-day Assisted Living interactions, Communities medical This resolution practitioners designates that develop deeper AMDA formally relationships recommend that with patients, various nursing and having such organizations and a close other stakeholders familiarity “support a obviates the mandatory need for a minimum practitioner to exposure to the perform post-acute and additional long-term diagnostic tests care setting in to “get to © 2017. Grand Canyon University. All Rights Reserved. schools of nursing or both pre-licensure and advanced practice nursing students Explanation of How the Article Supports EBP/Capstone Researchers reported in Health Affairs in 2010 that 24% of Medicare beneficiaries who were discharged from a hospital to a SNF during 2006 were rehospitalized within 30 days. More recently, the March 2015 Medicare Payment Advisory Committee (MEDPAC) report to Congress stated that 15% of fee-forservice Medicare beneficiaries who were discharged from a hospital to a SNF during 2013 were readmitted to the hospital during the SNF stay or within 30 days after SNF discharge Infections were the most common reason for rehospitalization (33% of cases), followed by CHF, nonCHF/ non-infectious respiratory compromise, cardiac conditions other than CHF, and delirium, which accounted for 6% to 8% of re-admissions. Patients admitted to the SNFs with a primary diagnosis of CHF experienced relatively high 30-day rehospitalization rates of 22%, but less than 8% were re-hospitalized for CHF exacerbations know” each patient, allowing for deeper patient-provider discussions over time regarding treatment options and goals. The collaboration between SPH and Thornapple Manor to prevent avoidable readmissions is a creative and economical solution to a difficult problem, and its clear benefits make it worthy of being emulated by other hospitals and SNFs. By replacing out of-town medical providers with medical providers from the hospital’s hospitalist group, the approach appealingly aligns local resources and organically connects the two organizations while improving communication between them © 2017. Grand Canyon University. All Rights Reserved. and closing the continuum of care loop I decided that the last article was unrelated to the topic and did not provide information useful for my capstone change project. I have not included it in the literature review to prevent confusion. © 2017. Grand Canyon University. All Rights Reserved.

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