Quantitative Research

Quantitative Research

Hospital acquired infections (HAI) are infections acquired in hospitals or healthcare facilities. An infection can be classified as hospital-acquired if the infection is not present in the patient or in the incubation stage at the time of admission to a hospital or healthcare facility. Hospital-acquired infections are a major problem that many healthcare facilities and hospitals face.  HAIs are usually overlooked and underappreciated as a cause of morbidity and mortality. This paper aims to generate evidence through quantitative analysis of a research paper on non-ventilator hospital-acquired pneumonia. Need help with your assignment ? Reach out to us. We offer excellent services.

Quantitative Research

Quantitative research report study type

The quantitative research conducted was a prospective cohort study of hospitalized patients with the main objective being to determine the epidemiology of non-ventilator hospital-acquired pneumonia (NV-HAP) and the influence of NV-HAP on the total hospital charges incurred, length of stay (LOS) in hospitals, and mortality in the United States (Giuliano et al., 2018).

Hierarchy of evidence

The study falls much lower on the hierarchy of evidence. It is a nonrandomized longitudinal study, and therefore, the quality of evidence is much lower. Cohort studies are associated with a higher risk of bias. They are, however, subject to a low recall bias, and therefore multiple outcomes can be studied at the same time (Ranganathan & Aggarwal, 2018). They can be generalized and thus increase reliability.

Reason for study

There was a knowledge gap in how NV-HAP influences total hospital charges, the likelihood of death, and the length of stay in hospitals. The main objective of the study was to determine the incidence of NV-HAP as well as its influence on total hospital charges, the likelihood of death and mortality, and the length of stay (LOS) in hospitals (Giuliano et al., 2018). The findings would then be compared with 4 other group cohorts without NV-HAP. These groups include Patients with Ventilator acquired pneumonia, patients with pneumonia as a primary diagnosis,  the general population of acute care patients, and patients with a high mortality risk and illness acuity. NV-HAP is a hospital-acquired infection (HAI) that is a serious patient issue. Its ability to significantly increase cost, LOS, and mortality is often underappreciated (Giuliano et al, 2018).

Steps of the study

The study clearly identifies the steps used. Proper protocols were followed before the reception of datasets from the AHRQ (Agency for Healthcare Research and Quality). The source of data was the NIS (National Inpatient Sample) dataset and HCUP (Healthcare Cost and Utilization Project) from the AHRQ (Giuliano et al., 2018).

The selection criteria of the participants are also clearly shown. The data collected was analyzed, and conclusions were drawn. The way the report is presented is clear, as all the steps are properly arranged for easy understanding and comprehension.

Sample size

A total of 46 states, more than 95% American population, participate in HCUP. The NIS contains anonymized data about each patient admitted to the hospital (Giuliano et al., 2018).

NV-HAP cases were identified using ICD-9-CM codes. These were then used to calculate the incidence with the resultant sample of NV-HAP patients being (N = 133,595). Patients who had a LOS in a hospital of less than 48 hours were excluded. The final sample size was, therefore, 119,075 (Giuliano et al, 2018).

Reliability and validity of measurements

The measurements are reliable and valid. This is because the data was collected from state inpatient databases. This includes all data reported to the HCUP. The data analyzed is not doctored as it is stored as received from the source. The measurements are valid as data collection can be narrowed down to only the patients with NV-HAP. Also, listwise deletion was used on any dataset that was missing data on any variable. (Melnyk & Fineout-Overholt, 2019)

Data analysis

The analysis of data was done using the IBM-SPSS software version 23. For the descriptive variables and the continuous outcome, a t-test was used to analyze the mean differences between the NV-HAP group and each of the comparison groups. For the non-continuous variables, significance testing was done using the χ2 test (Giuliano et al., 2018).

LOS, mortality, and total charges were used as dependent variables. The patient group was used as a dependent variable. Multivariate regressions were run for the dependent and independent variables. Both clinical and demographic variables were taken into consideration when running the analyses. Analysis of patient death was done using logistic regression. Analysis of total cost and LOS was done using ordinary least squares regression. For missing data, listwise deletion was used.

Untoward events

The sampling strategy included the use of ICD-9 codes. This strategy has been used before in previous research.  This qualifies this research as a secondary analysis, and therefore, measurements of positive predictive value, sensitivity, and specificity cannot be performed. Also, because the data is from the 2012 HCUP-NIS dataset, analysis of HV-HAP data due to all-cause readmission is not possible because it is not part of this dataset (Giuliano et al., 2018).

Correlation with previous research

The findings obtained from this research show that the overall incidence of 1.6% is similar to reports from other researchers. This is equivalent to 3.63 per 1000 patient days. Generally, the reported incidence ranges from 1.25-5.9 per 1000 patient- days. NV-HAP has a higher incidence compared to VAP and is therefore associated with a much higher overall cost. This finding was also consistent with what other researchers found. The NV-HAP mortality rate findings were 13.1 %. These findings were also consistent with the ranges of 13.9%-30% reported by other researchers (Giuliano et al., 2018).

Significance of research on clinical practice

NV-HAP is a significant patient safety issue, especially in acute care patients. It is, however, usually overlooked as a threat and is not monitored as a preventable hospital-acquired infection. It is a condition that has a significant influence on patient morbidity mortality, and healthcare costs. This research should encourage the further collection of epidemiologic data to further help define the influence of NV-HAP (Giuliano et al., 2018). It can also help to come up with pragmatic methods that are safe and effective in NV-HAP prevention (Houghton et al, 2020).

Rapid Appraisal Questions for Cohort Studies

Did the analysis adjust for important prognostic risk factors and confounding variables?

Yes, the analysis adjusted for important prognostic variables and risk factors. The data showed that risk factors for NV-HAP do exist. These risk factors have the potential to influence the outcome of the patient. Some of the risk factors include immunocompromised status, illness severity, intensive care unit admission, age, prolonged hospital stays, underlying chronic lung diseases, and other commodities. These risk factors were factored in during the analysis of data so as to help paint a clearer picture of the epidemiology of NV-HAP. After adjusting to the risk factors, hospital charges, LOS, and mortality were significantly higher in comparison to other groups (Giuliano et al., 2018).

 What was the magnitude of the relationship between treatment/exposure and targeted outcome?

The research was conducted based on secondary data from 46 states nationwide. There is empirical data that details the risk, outcome, and incidence of NV-HAP. However, the number of NV-HAP patients with few to no risk factors is very few. After adjusting to the risk factors, hospital charges, LOS, and mortality were significantly higher in comparison to other groups (Giuliano et al., 2018).

Would the results be used to counsel patients?

The results would be more useful if used to counsel healthcare providers on the importance of infection prevention and control (Houghton et al., 2020). It can also help to come up with pragmatic methods that are safe and effective in NV-HAP prevention.

 References

Giuliano, K. K., Baker, D., & Quinn, B. (2018). The epidemiology of nonventilator hospital-acquired pneumonia in the United States. American journal of infection control, 46(3), 322-327. doi.org/10.1016/j.ajic.2017.09.005Get

Houghton, C., Meskell, P., Delaney, H., Smalle, M., Glenton, C., Booth, A., Chan, X. H., Devane, D., & Biesty, L. M. (2020). Barriers and facilitators to healthcare workers’ adherence with Infection Prevention and Control (IPC) guidelines for respiratory infectious diseases: A rapid qualitative evidence synthesis. Cochrane Database of Systematic Reviews, 2020(8). https://doi.org/10.1002/14651858.cd013582

Melnyk, B. M., & Fineout-Overholt, E. (2019). Chapter 5. In Evidence-based Practice in Nursing & Healthcare: ǂa guide to best practice. essay, Wolters Kluwer.

Ranganathan, P., & Aggarwal, R. (2018). Study designs Part 1 – An overview and classification. Perspectives in clinical research, 9(4), 184–186. https://doi.org/10.4103/picr.PICR_124_18

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Write a fully developed and detailed APA essay addressing each of the following points/questions. There is no required word count; be sure to completely answer all the questions for each question in detail. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least one (1) source using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page are required. Review the rubric criteria for this assignment.

Conduct a literature search to select a quantitative research study related to the problem identified in Module 1 and conduct an initial critical appraisal. Respond to the overview questions for the critical appraisal of quantitative studies, including:

Is this quantitative research report a case study, case-control study, cohort study, randomized control trial, or systematic review?
Where does the study fall in the hierarchy of evidence in terms of reliability and risk of bias?
Why was the study done? (Define the problem and purpose.)
Were the steps of the study clearly identified?
What was the sample size?
Are the measurements of major variables reliable and valid? Explain.
How were the data analyzed?
Were there any untoward events during the conduct of the study?
How do the results fit with previous research in the area? (This may be reflected in the literature review.)
What does this research mean to clinical practice?
Additionally, be sure to include the rapid appraisal questions for the specific research design of the quantitative study that you have chosen. These can be found in Chapter 5 of the textbook (Melnyk and Fineout-Overholt, 2015).

This critical appraisal should be written in complete sentences (not just a numbered list) using APA format.

Provide a reference for the article according to APA format and a copy of the article.