NUR590 Benchmark Evidence-Based Practice Project Proposal Final Paper

NUR590 Benchmark Evidence-Based Practice Project Proposal Final Paper

The pursuit of high-quality and safe healthcare systems has significantly shaped healthcare operationalizations. A technological paradigm shift coupled with sustained research in healthcare has ushered in innovative approaches toward safety and quality safeguards. With diverse health shocks such as chronic illnesses and inefficient healthcare systems still being apparent, progressivist approaches that front patient safety and high-quality healthcare remain vital. One of the identified areas that continues to poke holes on the global healthcare fabric is in chronic care (Wang et al., 2022). According to the Agency for Healthcare Research and Quality (AHRQ), patient engagement during the comprehensive management of chronic illnesses is integral to quality and safety improvements. Notwithstanding, care transition processes remain a weak link toward attaining the highlighted objectives of the chronic care model. This project explores care transition programs, analyzing their effectiveness in improving healthcare outcomes.

Background and Project Statement

Comprehensive management of chronic illnesses is an elaborate process that seeks to improve the health and healthcare outcomes of persons with these illnesses. Often, patients with chronic illnesses transition from one care setting to another depending on their presenting care needs. The chronic care model postulates best practices in chronic care that not only guarantee the safety of the patients but also depress the overall cost of managing these illnesses. As per the model, effective care transition, technology use, collaborative paradigms, self-management support, and the design of delivery systems are integral to the safe and effective management of patients with chronic illness. While there is a thought convergence on the efficacy of the provisions of the chronic care model in safeguarding the safety and quality of healthcare, some aspects of the model still lag. In the resolve to elevate chronic care, addressing these areas is necessitated.

Poor care transition has been identified as one of the concern areas in chronic care (Wachholz et al., 2021). It remains undermined in diverse care settings despite its significance in improving the health and healthcare outcomes of patients with chronic illnesses. The Centers for Medicare and Medicaid Services (CMS) defines care transition as the movement of a patient from one healthcare setting to another (Wachholz et al., 2021). Care transition processes in chronic care become apparent when patients are being discharged from inpatient care settings and during care referrals. Care transition processes considerably elevate the risks of adverse events due to their potential to produce communication gaps, as responsibility is often left to the receiving parties (Wachholz et al., 2021). This is mostly the case in hospital-to-home-based care transitions. Regardless, effective care transition surmounts high-quality care and improved health outcomes for the patients.

AHRQ defines best practices in care transition which includes care coordination, medication reconciliation, effective follow-up, and patient education (Wachholz et al., 2021). These programs significantly improve the health and healthcare outcomes of the patients being discharged by enhancing their involvement and accountability in their care process. They also enhance the safety of these patients by minimizing potential risks associated with the care transition process. Likewise, care transition programs address any miscommunications that may be apparent during the care transition process (Wachholz et al., 2021).
The use of care transition programs has been fronted extensively in the comprehensive management of patients with chronic illnesses. According to the AHRQ, diverse measures for effective care transition exist. These include the median 30-day hospital readmission rates, discharge information communication that integrates patients’ education on the follow-up plans and the disease process, and medication reconciliation (Wachholz et al., 2021). Poor scores in any of the identified areas can result in significant compromise in the health and safety of patients with chronic illnesses.

Gaps in care transition still exist. While the problem is less concerning in developed countries and effective healthcare settings, it presents significant challenges in healthcare organizations in resource-limited settings. This is usually the case in developing countries and healthcare organizations in underserved communities. In resource-limited settings, care transition programs are plagued by systems and individualized factors that include divergent opinions on the existing healthcare apparatus, healthcare staff shortages, subsequent high caregiver-to-patient rations, poor health literacy levels, and poverty, among others (Fønss Rasmussen et al., 2021). These factors jeopardize the caregivers’ ability to effectively implement care transition programs such as follow-up and adequate discharge information communications. Likewise, they may diminish the patient’s ability to self-manage.

The overarching goal of effective care transition programs is to improve the health and healthcare outcomes of the patients. Research findings reveal that poor care transition has negative impacts on the patients and the healthcare systems in its entirety (Rammohan et al., 2023). To the patients, poor care transition programs may result in significant deterioration in the health of the patients and subsequently, unplanned hospital readmission. This is the case when the caregivers fail to follow up on the patients and equip them with the right medication and disease knowledge as well as self-management skills. In such instances, problems like medication errors become apparent, compounding their primary illness (Rammohan et al., 2023). The overall result is a reduction in the quality of life of the patients and increased cost of care. These warrant concerted efforts to address the problem.

To the healthcare systems, poor care transition results in avoidable in healthcare costs. These increases are accustomed to hospital readmission and emergency department visits that are otherwise avoidable. Likewise, with increases in hospital visitations, the workload on the caregivers is likely to increase. Poor care transitions also destroy the reputations of the hospital, as well as lower their credibility scores. In value-based systems, where avoidable hospital readmissions are boldly discouraged, as in the US, poor care transition programs may result in poor accreditation scores and consequently deny the hospital CMS reimbursements, translating to lost revenue (Rammohan et al., 2023). In the pursuit of high-quality and safe care, healthcare organizations and systems should implement care transition programs.

In summation, the identified problem is poor care transition, especially among patients with chronic illnesses transitioning to home-based care. These problems result in avoidable hospital readmission accustomed to medication errors, illness progression, and a lack of post-discharge follow-up (Rammohan et al., 2023). Addressing the problem may considerably contribute to the safety and quality improvement fronts in healthcare. By implementing effective care transition programs, healthcare providers can provide follow-up assistance to their patients. This is particularly important as it ensures sustained contact between the caregiver and the patients. Implementing the care transition program may also allow the caregivers to provide discharge education including information on the disease process. This will bolster the patient’s ability to self-care and enhance their accountability for their illness. Effective discharge program also reduces medication errors through medication reconciliation. It also helps the caregivers detect any disease exacerbation or progressions and inform specific address measures (Rammohan et al., 2023). This further underpins the significance of the care transition programs.

The PICOT Question

The proposed project seeks to interrogate the effectiveness of care transition programs integrating discharge information communications, medication reconciliation, care coordination, and follow-up assistance in reducing hospital readmission rates in a local hospital. The PICOT formatted question that will guide the implementation of the project are: 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 six months (T)? The identified PICOT question is aligned with the problem statement. To begin with, it identified the target population as patients with chronic illness under inpatient care. In this project, a local hospital will be the study setting. The PICOT questions also identify aspects of care transition programs and the outcome measures, as highlighted by the Agency for Healthcare Research and Quality (AHRQ).

Organizational Culture and Readiness

Change processes within care organizations are geared towards improving the safety of the patients and the quality of care. While there is a consensus on the need to implement such progressive changes, their success depends on the organizational culture and readiness for the change. Miake-Lye et al. (2020) note that the organizational willingness to adopt a change process and its ability to support its growth directly determines the success of various change processes within care organizations. It is thus important that change leaders within healthcare organizations scrutinize the environment and determine the organizational culture and readiness for change before implementing meaningful changes within care organizations.

An analysis of the hospital’s culture reveals that the organizational culture within the hospital can support diverse change processes. To begin with, the normative operationalizations within the organization skew towards the adhocratic and clan cultures. This is typified by the organizational leadership leaning towards collaborative paradigms in their hospital’s decision-making process. Likewise, the staff members are flexible to healthcare innovations and have proven, over time, to be the vessels of change for the organizations. The staff’s commitment and unwavering support for change processes within the organization have been demonstrated by their propositions on different change processes and the success of previous change processes. The organizational leadership has also been at the forefront of encouraging healthcare innovations within the hospital.

An analysis of the hospital’s readiness for change through the Organizational Readiness for Implementing Change (ORIC) tool revealed the hospital’s positivity toward change processes. ORIC is a valuable tool in assessing organizational readiness for implementing meaningful changes. The tools score the organization on the thematic areas of commitment to implementing meaningful changes within the organization, the underlying politics around change processes and change management within the organization, the staff member’s willingness to track the progress of the change process, and the staff’s ability to coordinate all processes that facilitate effective implementation of the change (Miake-Lye et al., 2020).

The organization under scrutiny had an average score of 4.0., translating to excellent readiness for change processes. An analysis of the work environment using the tool revealed favorable scores on the organizational commitment toward implementing changes. The organization also supported the change and was willing to coordinate services, such as staff education, behavior change, and transparent communications to support the change and track its progress. The organizational leadership also voiced their willingness to guide the change management process to guarantee its success. The politics around the change process related to the implementing care transition programs was, however, varied. While some noted that some aspects of the programs are tedious and time-consuming, others mentioned that they were comfortable with the existing practices surrounding care transition currently used by the hospital. This calls for actions to facilitate and streamline the organization’s readiness for change.

Several strategies can be used to enhance organizational readiness toward various change processes. Change communications is one of the best practices for enhancing change uptake within care organizations (Vax et al., 2021). Aggressive communication to all the impacted stakeholders on the significance of the change process may help enhance members’ readiness for change implementation. Through effective communication, change leaders can explain to the stakeholders the benefits of the change process and how the change is likely to impact their operationalizations (Vax et al., 2021). This may help create a buy-in into the change process thereby improving its uptake. Engaging and empowering all the stakeholders in the change process is equally important in enhancing the organization’s readiness for change. This can be attained by involving them in all the decision-making steps, including during the design phase, soliciting feedback, and integrating their opinions into the change process. This may further enhance their uptake of the change process. Expanding staff members and skills to adopt the change process is also helpful in improving staff’s readiness for change. This can be attained through structured education on the change process and workshops to demonstrate how the project will impact their operationalizations and patients’ wellness. Building staff’s skills and capabilities also creates excitement around the change and thereby improves its adoption among staff members. It is thus important that these strategies are employed to enhance the level of organizational readiness for the change process (Vax et al., 2021).

The change culture within the organization coupled with its readiness for change is expected to significantly enhance the adoption of the proposed program within the organization. To begin with, its supportive stakeholders and leadership are expected to not only steer the change process but also provide the necessary support required for the change process. Effective leadership is integral to change management. As Musaigwa (2023) reports, the success of change management and change processes within a care organization requires leadership that understands the change process and can guide the change process effectively. Even with effective leadership and positive support systems, financial limitations may still be a barrier to the effective and successful implementation of the change process. This can be addressed by mobilizing finances through external donations. Likewise, timing the project to coincide with the organization’s fiscal budgetary creation, may allow the hospital’s finance department to look into budgetary areas that can be adjusted to avail funds for the project.

Several stakeholders will be impacted by the project. These include the hospital administration, nurses, physicians, pharmacists, and patients. The hospital administration is the primary source of funds for the project. Through the finance department, they will be tasked with mobilizing the required funds to facilitate the project. The administration is also expected to guide the change processes. Through the change leaders and departmental heads, it will communicate all the aspects of the project to the members and ensure sufficient organizational readiness for the project. Nurses, pharmacists, and physicians will be involved in the actual implementation of the project. Their role will be to execute the care transition programs outlined in the project. They will also provide valuable feedback on the feasibility of the plan.

The proposed programs heavily depend on electronic health records (EHR). EHR systems facilitate information flow at diverse points of care. They also store patients’ health data, allowing them to be accessed whenever needed. EHR can also be integrated with other technologies, such as clinical decision support systems and computerized provider order entry (CPOE). Collectively, these systems enhance the efficiency of healthcare operationalizations. They will be valuable in the project as they allow caregivers to retrieve patients’ health data (Luan et al., 2023). This underlines their utility in conventional healthcare.

Literature Review

There is a consensual finding on the significance of care transition programs in improving health and healthcare outcomes for patients with chronic illnesses. Notwithstanding, poor care transition remains a potential source for safety and quality compromises during the comprehensive management of chronic illnesses. Poor care transition continues to undermine global efforts towards improving chronic care (Wachholz et al., 2021). They have been implicated in increased rates of hospital readmission, increased cost of healthcare, increased risk of functional decline associated with illness progressions, and avoidable debilitation for patients with chronic illnesses. Value-based systems, such as the Hospital Readmission Reduction Program (HRRP) under CMS, affirm the need for implementing best practices in reducing hospital readmission (Wachholz et al., 2021). Addressing gaps in care transition is thus paramount in improving healthcare quality and safety of the patients.
Several studies weigh in on the effectiveness of care transition programs in reducing hospital readmission and subsequently, the health and healthcare outcomes of patients with chronic illness. A search into various biomedical databases revealed multiple articles that detail the significance of care transition programs and their effectiveness in reducing hospital readmission. The PICOT formatted question that formed the basis for the literature search and review is: 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 six months (T)?

A search strategy was developed and utilized to locate relevant articles for the literature review process. Biomedical databases used to obtain the research articles included EMBASE, PubMed, PsychInfo, and Cochrane. These databases have a long-standing reputation for domiciling biomedical research. A research question was also developed to guide the search process. The research questions utilized in this literature review were: Does care transition improve the healthcare outcomes for adult patients under care transitions?

The second step in the literature search was to develop key terms that would aid the location of articles across the selected databases. The search terms used, in this respect, were care transition programs and hospital readmissions. The search strategy was aimed at identifying articles that detailed whether care transition programs reduced hospital readmission. Boolean operator AND was employed to refine the research and ensure the articles obtained were aligned with the research question. A total of 10 articles were obtained from the search process.

The third step was to analyze the located articles to filter those less relevant to the study. The Currency, Relevance, Authority, Accuracy, and Purposefulness (CRAAP) criteria were utilized in analyzing the articles. As per the criteria, currency details the publication age of the article, relevance details how well the article and its findings answer the researchers, and authority details whether the source of information the author uses is provided. The purposefulness criterion details whether the author provided the reason for conducting the study. Accuracy denotes whether the author outlined the methodologies used. The selected articles were current, relevant to the study, authoritative as they outlined the source of information used to inform the findings, and purposeful as the objectives were clearly outlined.

The article by Kripalani et al. (2019) is a quantitative research that explores the effectiveness of the care transition model in lowering hospital readmission and overall healthcare costs. Findings from the article revealed that the care transition model is effective in lowering 30-day and 90-day hospital readmission. Care transition interventions such as the use of telehealth technologies in monitoring patients with chronic illness post-discharge, lowered hospital readmission rates by up to 60%. This proved that care transition programs are effective in lowering 30-day and 90-day hospital readmission rates.

Further, another study conducted by Kripalani et al. (2019) was a quantitative research utilizing a quasi-experimental design to arrive at its findings. Data was primarily obtained from electronic health records systems using questionnaires and patient survey data collection tools. The obtained data was then analyzed through descriptive and inferential statistics and the data was further synthesized. The ultimate finding was that patients assigned to care, transition models, had lower hospital readmission rates than those not assigned to any care transition programs. This affirmed the use of these programs in chronic care. The article addressed the components of the stated PICOT questions. Regarding populations, the research examines care transition programs used with patients with chronic illnesses who are being released from inpatient care. Regarding interventions, the study examines the efficacy of the care coordinator model. Finally, it compares the results of patients who were assigned to the coordinator model with those who were not. On the outcome, the project interrogated whether hospital readmission rates were lowered upon the application of the care transition model. On the time aspect, the research was specific to 30-day and 90-day readmission rates.

The article by Leland et al. (2019) analyzed care transition processes that promote successful discharge after post-acute care. The article sought to identify specific care transitions that could enable the community to diminish the occurrences of various adverse events implicated in hospital readmission and smoothen the discharge process. The article was a scoping review that analyzed the results from 35 primary studies. A care transition program that integrated follow-up assistance through telehealth, scheduled clinical visitations, self-management, or medical self-management facilitated smooth discharge processes. It also lowered the chances of adverse events. The article addressed the PICOT questions aspect of intervention and outcome. It details specific activities that could be integrated into a care transition program. Likewise, it draws a nexus between the activities and outcomes.

The article by Annora (2020) analyzes the effectiveness of transitional care programs among hospitalized adults in reducing hospital readmission. Transitional care programs, such as follow-up home visitations and follow-up telehealth communications post-discharge were found to enable caregivers to identify adverse events on the patients. Likewise, pre-discharge activities on hospitalized patients, such as medication reconciliation were effective in lowering adverse events and subsequent readmission and health compromises. The article is a systematic review article. It analyzed 10 articles and elucidated the effectiveness of care transition programs integrating follow and pre-discharge medication reconciliation in minimizing 30-day hospital readmission. Effective and timely transitional care programs lowered the 30-day readmission rates. They also improved the health and clinical outcomes of patients with chronic illnesses. The article addressed all the aspects of the PICOT formatted question. The study was centered on elderly patients with chronic illnesses, as per the Population provisions. Additionally, the study drew a nexus between the intervention (implementing care transition programs) and the outcomes (reducing hospital readmission rates). The article also compared the outcomes of using care transition programs against not using care transition programs.

Hansen et al. (2011) also detail the significance of care transition programs in lowering hospital readmission. The author analyzes the specific interventions that could reduce hospital readmission rates 30 days after discharge. The article is a systematic review article that analyzes findings from 43 articles. Predischarge activities such as discharge planning, medication reconciliation, patient education, and follow-up schedule, coupled with post-discharge interventions such as routine follow-ups through telehealth, and post-discharge clinical visitation appointments are effective in reducing the 30-day hospital readmission rates. The article addresses the intervention, outcome, and time aspects of the PICOT questions. It describes care transition activities that can be employed to reduce hospital readmission rates. It also details the impact of implementing the activities on the patient’s outcomes. Likewise, the article states the time frame under consideration (30 days post-discharge).
In summation, the articles synthesized were all related to the topic under scrutiny. There was a significant resemblance in the thematic areas exploited in the articles. These were care transition programs, their effect on hospital readmission rates, and the specific activities that surmount an effective care transition program. They differed, however, in the methodology used and scope. While some were specific to care transition programs others drew a nexus between the programs and the outcomes. Regardless, a point of convergence exists on the significance of care transition programs. Notwithstanding, a gap still exists on the level of implementation of the care transition programs. Mitchell et al. (2023) note that care transition programs are scarcely used among middle and low-income countries. This warrants a system change that can promote the implementation of care transition programs in the coordination and continuum of care services.

Change Model or Framework

Implementing change processes within care organizations can sometimes be tedious. This is especially the case when the organizational readiness for change is low, and the organizational change culture is poor. Change management processes steer change processes in healthcare. Change management models such as Kurt Lewin’s model for change provide a framework for implementing meaningful changes within a care organization. The proposed model will utilize Kurt Lewin’s change model in implementing the provisions of the care transition program.

Lewin’s model of change management is best suited for the project. The model provides an elaborate plan for implementing meaningful changes within healthcare organizations. As per Lewin’s postulates in change management, the destiny of the change process in healthcare is dependent on an interplay between the driving and restraining factors for the change process. The success will be guaranteed if the driving factors prevail. Conversely, a predomination of the restraining factors will hinder the change process (Drake, 2020). It is thus imperative that healthcare leaders and change managers focus on addressing the restraining factors while encouraging the driving factors for the successful implementation of the change process.
Lewin’s change model posits that change management is a three-stepped process that includes unfreezing, freezing, and refreezing. In the unfreezing step, the organization readies itself for the change process. This includes creating excitement over the change processes and laying down the required infrastructure to facilitate the change process (Harrison et al., 2021). In the proposed project, the unfreezing process will be attained through aggressive communication with the stakeholders on the change process. This will include messaging on the benefits of care transition programs and how they will impact organizational operationalizations. These communicative processes are expected to create excitement over the program as well as enhance its uptake within the organization.

The second step in Lewin’s change model is freezing. This step involves the actual implementation of the plan. This can include establishing workshops for the staff members to allow them to integrate the provisions of the change, empowering staff members and all involved stakeholders to deal with the change process, and sustaining communication on the change (Harrison et al., 2021). In the project, the freezing step will be attained by gradually integrating care transition programs into the conventional care coordination and continuum for patients with chronic illnesses. This will be accompanied by sustained engagement and communication on the significance of the process and feedback solicitation.
The third step in Lewin’s change management process is refreezing. This step is aimed at reinforcing the change. It involved organizing on-demand training based on the feedback received and continuous solicitation of feedback (Saleem et al., 2019). In the proposed project, refreezing will be attained through establishing channels for obtaining feedback, obtaining any feedback provided, and organizing training programs to address any arising concerns around the change.

Implementation Plan

The proposed project is set to be implemented in a hospital setup. The target population is adult patients with chronic illnesses under inpatient care. These patients will be assessed upon being discharged to ascertain their health and clinical outcomes, as demonstrated by their readmission status within the first 30 days after discharge. The project will also interrogate care transition programs implemented on the pre- and post-discharge. Informed consent will be sought from all the selected participants, per the provisions of ethical human research (Pietrzykowski & Smilowska, 2021).

The project will be implemented in three phases. The first phase will be to recruit the participants. An informed consent will be obtained from all the selected participants. This will then be followed by the data collection process. This step will involve assessing patients transitioning from inpatient care to home-based care to ascertain whether or not care transition programs were applied to them and determine their outcomes. The final step will be to tabulate and analyze the results to draw meaningful findings and subsequently disseminate the findings. The project is expected to last between 8-9 months.

The project will cost upward of 100,000 dollars. These funds will cover the logistical costs of the project. Due to the human resource considerations for the project, ten personnel will be recruited to aid in data collection. They will be provided with data collection tools such as computers, questionnaires, and surveys. Quantitative research methodology, employing quasi-experimental designs, will be employed to answer the research question. This methodology and design are best suited when a causal-effect equation between multiple variables is being investigated (Miller et al., 2020). Survey forms are the primary data collection tools that will be employed. The stakeholders needed for the effective implementation of the plan include the healthcare administration for approval purposes, the university library for research assistance, and the individual patients for their participation in the research process. The proposed implementation plan is feasible as it requires a workable time frame and exploits existing resources.

Evaluation Plan

The project seeks to evaluate the effectiveness of care transition programs in reducing hospital readmission rates from patients with chronic illnesses. The project is expected to give recommendations on the effectiveness of care transition programs in lowering hospital readmission rates. It is also expected to inform specific care transition programs that can be utilized to minimize hospital readmission for patients with chronic illnesses. Data will be collected through structured surveys. Multiple regression models will be used to analyze the data obtained and draw meaningful conclusions. The project will be successful if the findings affirm the effectiveness of the care transition program integrating medication reconciliation, follow-up appointment assistance, discharge education, and care coordination.

Poor care transition programs compromise safety and quality improvement efforts in healthcare. Poor care transition programs have been implicated in increased hospital readmission, elevated costs of healthcare, and patient suffering. This warrants its address. The proposed project integrates a care transition program that will lower hospital readmission and subsequent suffering attributed to hospital readmission. Upon its completion, the project will draw meaningful conclusions that affirm the significance of care transition programs in adult patients with chronic illnesses transitioning to home-based care. Likewise, it will inform specific interventions that can be integrated into care transition programs to reduce hospital readmission.

References

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

Drake, K. (2020). Change is inevitable. Nursing Management, 51(7), 56–56. https://doi.org/10.1097/01.numa.0000669092.10582.06

Fønss Rasmussen, L., Grode, L. B., Lange, J., Barat, I., & Gregersen, M. (2021). Impact of transitional care interventions on hospital readmissions in older medical patients: A systematic review. BMJ Open, 11(1). https://doi.org/10.1136/bmjopen-2020-040057

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

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where do models for change management, improvement, and implementation meet? A systematic review of the applications of change management models in healthcare. Journal of Healthcare Leadership, Volume 13, 85–108. https://doi.org/10.2147/jhl.s289176

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

Leland, N. E., Roberts, P., De Souza, R., Hwa Chang, S., Shah, K., & Robinson, M. (2019). Care transition processes to achieve a successful community discharge after Postacute Care: A scoping review. The American Journal of Occupational Therapy, 73(1). https://doi.org/10.5014/ajot.2019.005157

Luan, Z., Zhang, Z., Gao, Y., Du, S., Wu, N., Chen, Y., & Peng, X. (2023). Electronic health records in nursing from 2000 to 2020: A Bibliometric analysis. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1049411

MacGillivray, T. E. (2020). Advancing the culture of patient safety and quality improvement. Methodist DeBakey Cardiovascular Journal, 16(3), 192. https://doi.org/10.14797/mdcj-16-3-192

Miake-Lye, I. M., Delevan, D. M., Ganz, D. A., Mittman, B. S., & Finley, E. P. (2020). Unpacking organizational readiness for change: An updated systematic review and content analysis of assessments. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-4926-z

Miller, C. J., Smith, S. N., & Pugatch, M. (2020). Experimental and quasi-experimental designs in implementation research. Psychiatry Research, 283, 112452. https://doi.org/10.1016/j.psychres.2019.06.027

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

Musaigwa, M. (2023). The role of leadership in managing change. International Review of Management and Marketing, 13(6), 1–9. https://doi.org/10.32479/irmm.13526

Pietrzykowski, T., & Smilowska, K. (2021). The reality of informed consent: Empirical studies on patient comprehension—systematic review. Trials, 22(1). https://doi.org/10.1186/s13063-020-04969-w

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/cureus.39022

Saleem, S., Sehar, S., Afzal, M., Jamil, A., & Gilani, Dr. S. (2019). Accreditation: Application of Kurt Lewin’s theory on private health care organizational change. Saudi Journal of Nursing and Health Care, 02(12), 412–415. https://doi.org/10.36348/sjnhc.2019.v02i12.003

Vax, S., Gidugu, V., Farkas, M., & Drainoni, M.-L. (2021). Ready to roll: Strategies and actions to enhance organizational readiness for implementation in community mental health. Implementation Research and Practice, 2, 263348952098825. https://doi.org/10.1177/2633489520988254

Wachholz, L. F., Knihs, N. da, Sens, S., Paim, S. M., Magalhães, A. L., & Roza, B. de. (2021). Good practices in transitional care: Continuity of care for patients undergoing liver transplantation. Revista Brasileira de Enfermagem, 74(2). https://doi.org/10.1590/0034-7167-2020-0746

Wang, Y., Eldridge, N., Metersky, M. L., Rodrick, D., Faniel, C., Eckenrode, S., Mathew, J., Galusha, D. H., Tasimi, A., Ho, S.-Y., Jaser, L., Peterson, A., Normand, S.-L. T., & Krumholz, H. M. (2022). Analysis of hospital-level readmission rates and variation in adverse events among patients with pneumonia in the United States. JAMA Network Open, 5(5). https://doi.org/10.1001/jamanetworkopen.2022.14586

Appendix 1

APA Writing Checklist

Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.
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NUR590 Benchmark Evidence-Based Practice Project Proposal Final Paper