Applying Care Transition Programs for Patients with Chronic Illnesses

Applying Care Transition Programs for Patients with Chronic Illnesses

The proposed project is centered on applying care transition programs during care transition for patients with chronic illnesses. It is based on the precinct that care transition programs considerably reduce hospital readmission for patients transitioning to home-based care from inpatient management of chronic diseases. This paper evaluates the project against its stated objectives.

Expected Outcomes

The project seeks to evaluate the effectiveness of a care transition program in lowering hospital readmission for patients with chronic illnesses. The expected outcomes of the project are expected to recommend whether healthcare organizations implementing the chronic care models should integrate chronic care programs into their normative care continuum processes. The findings from the project will also inform specific care transition programs that can help improve the clinical and healthcare outcomes of patients with chronic illnesses transitioning from inpatient to home-based care. The project will also give insight into the feasibility of the care transition program, highlighting the resources required for effective and seamless implementation of a care transition program in already established care organizations.

Data Collection Tools

The selected research design is quantitative. The project seeks to apply quasi-experimental methods to address the study concerns and answer the PICOT question. The data collection tool that would be effective for the identified research design is survey forms. Data collection surveys allow the researcher to interrogate other people’s knowledge, behaviors, or opinions (Maida et al., 2022). In this project, survey forms will be used to interrogate the level of adherence to the care transition programs. The survey questionnaire used in the project is valid as it reflects what the research intended to measure. The components that formulate the survey form are extrapolated from the research question and aligned with the problem the research is trying to resolve. The survey questionnaire used in the study is also reliable, as can be used across multiple settings without any significant variations in the outcomes. It is also applicable to the project as it adopts diverse components of the project in its construction.

A Statistical Test

The statistical test best suited for the study is the regression test. Regression tests allow the determination of a cause-and-effect relationship between two or more variables and can be used to determine the effects of one or more continuous variables on another (Ali & Younas, 2021). In the project, the identified continuous variables are the aspects of the care transition program, such as care coordination, follow-up visits, medication reconciliation, and discharge education. This project will use the multiple linear regression model. The multiple linear regression model is favored as it allows the measurement of the relationships between a set of variables using a straight line (Bzovsky et al., 2022). This approach allows a simplistic view of the analyzed data and may lead to a more accurate understanding of the nexus between each identified variable and the outcomes. This informed its use in the project.

Methods of Data Collection

Data collection is integral to research processes. In the proposed project, the data collection method that will be employed is a survey. The survey method is a quantitative data collection method that allows the researcher to obtain the participants’ opinions, knowledge, or behavior on the topic under research. An advantage of the survey methodology in data collection is that it is relatively easy to administer, can be developed and modified in less time, and has a wide capability to obtain data from larger populations (Creswell & Hirose, 2019).

The project outcomes will be measured upon synthesis of the data collected from the survey forms. By analyzing the patient outcomes of hospital readmission as identified from the survey forms, the researcher will be able to determine whether the care transition program was effective. The outcomes of the project will be evaluated against the stated objectives. In this case, the project is expected to affirm that care transition programs are effective in reducing 30-day readmission for patients with chronic illnesses transitioning to home-based care. The project will be said to be successful if it proves that care transition programs reduce the 30-day readmission rates. An analysis of the the survey reports on hospital readmission rates after application of the care transition program can provide insight into whether the transition program is effective, and the extent of its effectiveness.

Strategies to be Used if Outcomes are not Expected

Several strategies will be used if the findings are not as expected. Firstly, the research processes will be investigated to ascertain that each step was correctly executed. This is particularly important as poor execution of research processes such as data collection and analysis may considerably distort the findings. The second strategy is to revise the research questions and the research objectives. Another strategy will be to modify the research design and data analysis techniques. These strategies may help in refining the findings toward what is expected.

Plans to Maintain, Extend, Revise, and Discontinue a Proposed Solution

Upon implementation of the proposed solution, a post-implementation plan that integrates revision, maintenance, extension, and discontinuation processes should be initiated. The maintenance and extension plans will seek to reinforce the messaging in the proposed solution. A revision plan may be initiated if it is established that some aspects of the solution should be altered. A discontinuation plan becomes crucial when the proposed solution is no longer feasible, obsolete, or inaccurate. A focused communication on these plans may be important. As supported Alazmi & Alazmi, (2022), deliberate communication especially to the involved stakeholders, will allow the researcher to maintain, extend, revise, and even discontinue the solution.

References

Alazmi, A. A., & Alazmi, H. S. (2022). Closing the gap between research and policy-making to better enable effective educational practice: A proposed framework. Educational Research for Policy and Practice, 22(1), 91–116. https://doi.org/10.1007/s10671-022-09321-4

Ali, P., & Younas, A. (2021). Understanding and interpreting regression analysis. Evidence-Based Nursing, 24(4), 116–118. https://doi.org/10.1136/ebnurs-2021-103425

Bzovsky, S., Phillips, M. R., Guymer, R. H., Wykoff, C. C., Thabane, L., Bhandari, M., Chaudhary, V., Sivaprasad, S., Kaiser, P., Sarraf, D., Bakri, S. J., Garg, S. J., Singh, R. P., Holz, F. G., & Wong, T. Y. (2022). The Clinician’s Guide to interpreting a regression analysis. Eye, 36(9), 1715–1717. https://doi.org/10.1038/s41433-022-01949-z

Creswell, J. W., & Hirose, M. (2019). Mixed methods and survey research in Family Medicine and Community Health. Family Medicine and Community Health, 7(2). https://doi.org/10.1136/fmch-2018-000086

Maida, C. A., Xiong, D., Marcus, M., Zhou, L., Huang, Y., Lyu, Y., Shen, J., Osuna-Garcia, A., & Liu, H. (2022). Quantitative data collection approaches in subject-reported oral health research: A scoping review. BMC Oral Health, 22(1). https://doi.org/10.1186/s12903-022-02399-5

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In 750-1,000 words, develop an evaluation plan to be included in your final evidence-based practice project proposal. You will use the evaluation plan in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Applying Care Transition Programs

Provide the following criteria in the evaluation, making sure it is comprehensive and concise:

Discuss the expected outcomes for your evidence-based practice project proposal.
Review the various data collection tools associated with your selected research design and select one data collection tool that would be effective for your research design. Explain how this tool is valid, reliable, and applicable.
Select a statistical test for your project and explain why it is best suited for the tool you choose.
Describe what methods you will apply to your data collection tool and how the outcomes will be measured and evaluated based on the tool you selected.
Propose strategies that will be used if outcomes do not provide positive or expected results.
Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.
Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document, located in Class Resources for an overview of the evidence-based practice project proposal assignments.

You are required to cite a minimum of five peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Complete the “APA Writing Checklist,” located in Class Resources, to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.