Evidence-Based Practice Project- Literature Review

Evidence-Based Practice Project- Literature Review

Comprehensive management of patients is an elaborate process that sometimes requires the transition of the patients across multiple care setups and at home. While there is a convergence on the need to maintain the safety and quality safeguards when managing patients, care transition processes sometimes produce considerable compromises to the quality and safety safeguards in patient management. Poor care transition has been implicated in significant patient injuries accustomed to medical and medication errors, falls, disease complications, and other adverse events. Rammohan et al. (2023) note that poor care transition is an underlying causal factor for increased hospital readmission, increased risk of functional decline, and avoidable debilitation in patients with chronic illnesses. This highlights the need to address the problem.

The pursuit of high-quality and safe care consistently fronts effective care transition as a preventive measure against preventable patient readmission. Value-based systems such as the Hospital Readmission Reduction Program (HRRP), under the Center for Medicare and Medicaid Services (CMS), implore care organizations to implement care transition programs to help maintain quality and safety safeguards during care transition. These programs have been found to considerably reduce the risk of injuries and other safety compromises during care transition (Rammohan et al., 2023). This paper analyzes the literature on the significance of transitional programs in the care transition and continuum.

PICOT Question

In adult patients at a community inpatient hospital (P), does the implementation of transitions of care program involving discharge education, medication reconciliation, follow-up appointment assistance, and care coordination (I) compared to “usual care” practices (C), reduce 30-day readmission (O) rates over 6 months (T)?

Search Methods

A search strategy was developed and used to locate the articles used for the review. To begin with, Psych Info, PubMed, Cochrane, and EMBASE databases were identified as reputable sources for diverse articles. These databases contain diversified peer-reviewed biomedical research articles that are relevant to the study. A research question was also developed to help define the search process. In this respect, the search process utilizes the research question: Does care transition improve the healthcare outcomes for adult patients under care transitions?

The second strategy was to identify the key search terms to be used in locating the article. The search terms used include care transition programs, hospital readmission, and whether care transition programs reduce hospital readmission. Boolean operators, “OR” and “AND” were also included during the search process to refine the process and elucidate the most relevant articles. Through this, a total of ten articles were located that were relevant to the study.

The identified articles were further analyzed using the currency, relevance, authority, accuracy, and purpose (CRAAP) criteria to identify the most suitable articles. Currently, it deals with the publication age of the articles, while relevance refers to how well the article answers the research question. Accuracy, on the other hand, states how reliable the information in the article is, while authority details the source of information. Purpose is the reason the information found in the journal exists. The selected articles were current, relevant as they addressed the research question, and authoritative, as they outlined the source of the information published therein. They were purposeful as well, as they clearly stated their objectives and were accurate.

Synthesis of Articles

The first article by Kripalani et al. (2019) is a quantitative research that explores the transition care coordinator model in lowering hospital costs and readmission. Transition care models were found to reduce 30-day and 90-day hospital readmission. Low-level interventions, such as the integration of telehealth in monitoring patients after discharge, were found to be effective in this respect. The subject of the research was healthcare facilities with inpatient care services. The research interrogated their rates of readmission 30-90 days after discharge and whether simple transition programs such as monitoring via telephone could lower readmission rates.

The study used qualitative research with a quasi-experimental design. Quantitative data collection from electronic health record systems and patient surveys using questionnaires were the principle data collection methods used in the research. The data was analyzed using inferential and descriptive statistics, and the findings were synthesized. The study demonstrated that patients assigned to a transition care coordinator had significantly lower hospital readmission rates than those not assigned to a transition care coordinator.

In this research, the transition care coordinator symbolized a transition care program. The article showed that transition care programs are effective in lowering hospital readmission rates in patients under care transition. The article addresses the PICOT components of Outcome, Interventions, Populations, and Time. The research demonstrated that in patients under care transition, the implementation of transition care programs reduced hospital readmission by 30-90 days.

The second article by Hansen et al. (2011) analyzed the interventions to reduce 30-day hospitalization after discharge. The article is a systematic review that explores findings from other sources to elucidate interventions used by different healthcare facilities to minimize hospital readmission after discharge. From the 43 articles analyzed, pre-discharge interventions, such as medication reconciliation, discharge planning, patient education, and scheduling for post-discharge appointments, and post-discharge interventions, such as patient-activated hotlines and routine telephone calls, were found to be effective in lowering 30-day readmission rates.

The article elaborately addresses the intervention, outcome, and time aspects of the PICOT formatted questions. The hospital readmission rates for patients discharged from inpatient care were found to be reduced by diverse components of transition care programs. These included medication reconciliation, discharge planning, and routine communication with the patient post-discharge, all of which contributed to 30-day hospital readmission rates. This further affirmed the research hypotheses used in the case.

The third article by Leland et al. (2019) analyzes the care transition process that can help attain a successful community discharge after post-acute care. The author sought to define specific processes during the care transition that could make the community discharge processes smooth and lessen the occurrences of other adverse events of hospital readmission. The article is a scoping review that analyzes findings from 35 studies. In this case, a care transition process that integrates self-management, medical self-management, scheduled follow-ups, and telephone follow-ups was found to facilitate a smooth discharge process with minimal eventualities.

The article elaborately covers the intervention aspects of the PICOT question. It details specific interventions that make up a care transition program and explains how the interventions can help facilitate a smooth care transition. Medication self-management, self-management, and follow-ups were found to be effective in facilitating a smooth care transition. This explains why the article was considered.

The fourth article by Annora (2020) analyzed the effectiveness of rational care programs among hospital adults with chronic illnesses in reducing hospital readmission. Transitional care components such as home visits and follow-up phone calls after discharge allowed caregivers and care institutions to identify adverse events, thereby enabling their address. Additionally, pre-discharge interventions such as medication reconciliation help in preventing potential adverse vents after discharge.

The article is a systematic review that analyzed ten articles to elucidate how care transition processes help minimize potential hospital readmission after 30 days of discharge. Effective and timely transitional care programs were found to lower 30-day hospital readmission rates. They also resulted in increased quality of life and helped improve the symptoms of patients with chronic illnesses.

The article details the population, interventions, compare, outcome, and time aspects of the PICOT formatted question. The author found that in elderly patients with chronic illnesses, implementing transitional care programs was more effective in lowering the 30-day readmission rates compared to not using the transitional care programs. These findings further affirmed the significance of the transitional care programs.

Comparison of the Articles

The articles selected were compared in diverse aspects. To begin with, there are considerable similarities in the thematic concerns of the selected articles. The articles were all centered on transitional care programs and interrogated their effectiveness in lowering hospital readmission rates. All the articles met the assessed criteria as they maintain relevance in addressing the PICOT formatted questions. They, however, differed in their scope and methodology used. The article by Kripalani et al. (2019) was quantitative research, while the other three were review articles. Notwithstanding, all articles adequately addressed the PICOT question. The conclusions of the articles were also similar. All the articles opined on the need to integrate transitional care programs during care transitions.

Suggestions

There is a consensual finding on the need to integrate transitional care programs during care transition. There still exist gaps in the level of their implementation in some healthcare settings. Notwithstanding, this has not been the case in many care settings. Mitchell et al. (2023) note that in middle and low-income countries, transition care programs are rarely used. This highlights the need for a system change to enhance the use of transitional care programs in the coordination and continuum of care service in such settings.

Conclusion

Transition care programs maintain effectiveness in lowering hospital readmission rates. These innovative approaches help caregivers prevent potential adverse events for patients during the discharge process. Notwithstanding, the level of their implementation differs across settings. Research activities in transitional care programs highlight their effectiveness in lowering hospital readmission and lowering costs. This further affirms the need for such research studies.

References

Annora, W. S. (2020, March 5). Transitional care of adults with chronic diseases post-discharge from acute settings. Arizona State University Education Files.

Hannawa, A. F., Wu, A. W., Kolyada, A., Potemkina, A., & Donaldson, L. J. (2022). The aspects of healthcare quality that are important to health professionals and patients: A qualitative study. Patient Education and Counseling, 105(6), 1561–1570. https://doi.org/10.1016/j.pec.2021.10.016

Hansen, L. O., Young, R. S., Hinami, K., Leung, A., & Williams, M. V. (2011). Interventions to reduce 30-day rehospitalization: A systematic review. Annals of Internal Medicine, 155(8), 520. https://doi.org/10.7326/0003-4819-155-8-201110180-00008

Kripalani, S., Chen, G., Ciampa, P., Theobald, C., Cao, A., McBride, M., Dittus, R. S., & Speroff, T. (2019). A transition care coordinator model reduces hospital readmissions and costs. Contemporary Clinical Trials, 81, 55–61. https://doi.org/10.1016/j.cct.2019.04.014

Mitchell, D. L., Shlobin, N. A., Winterhalter, E., Lam, S. K., & Raskin, J. S. (2023). Gaps in transitional care to adulthood for patients with Cerebral Palsy: A systematic review. Child’s Nervous System, 39(11), 3083–3101. https://doi.org/10.1007/s00381-023-06080-2

Rammohan, R., Joy, M., Magam, S. G., Natt, D., Patel, A., Akande, O., Yost, R. M., Bunting, S., Anand, P., & Mustacchia, P. (2023). The path to sustainable healthcare: Implementing care transition teams to mitigate hospital readmissions and improve patient outcomes. Cureus. https://doi.org/10.7759/

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The purpose of this assignment is to write a review of the research articles you evaluated in the Evidence-Based Practice Project: Evaluation of Literature assignment in Topic 5. If you have been directed by your instructor to select different articles to meet the requirements for a literature review or to better support your evidence-based practice project proposal, complete this step before writing your review.

Evidence-Based Practice Project- Literature Review

A literature review provides a concise comparison of the literature for the reader and explains how the research demonstrates support for your PICOT. You will use the literature review from this assignment in NUR-590, during which you will write a final paper detailing your evidence-based practice project proposal.

In a paper of 1,250-1,500 words, select 4 of the 6 articles you evaluated that demonstrate clear support for your evidence-based practice and complete the following for each article:

Introduction – Describe the clinical issue or problem you are addressing. Present your PICOT statement.
Search methods – Describe your search strategy and the criteria that you used in choosing and searching for your articles.
Synthesis of the literature – For each article, write a paragraph discussing the main components (subjects, methods, key findings) and provide a rationale for how the article supports your PICOT.
Comparison of articles – Compare the articles (similarities and differences, themes, methods, conclusions, limitations, controversies).
Suggestions for future research: Based on your analysis of the literature, discuss identified gaps and which areas require further research.
Conclusion – Provide a summary statement of what you found in the literature.
Complete the “APA Writing Checklist” 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.
Refer to “Evidence-Based Practice Project Proposal – Assignment Overview,” located in the Class Resources, document for an overview of the evidence-based practice project proposal assignments.