Naylor, PhD,, Dorothy A. Brooten, PhD, Roberta

Naylor, PhD,, Dorothy A. Brooten, PhD, Roberta L. Campbell, PhD, Greg Maislin, MS, MA, Kathleen M. McCauley, PhD, and J. Sanford Schwartz, MD. All of the authors have graduate or post graduate degrees in the fields of health or medicine. This therefore makes them all qualified to write on the proposed study, and to carry out the research. They are, therefore, reliable and credible researchers in this field.

The title of the article itself; is appropriate to the title of the article; "Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial." Since the study focuses on the transition of older adults with heart failure, and the title of the article is represented, the title of the article is appropriate to the title of the study.

The abstract discusses how recent research suggests older adults with heart conditions, facing therapeutic regimes, are often stressed out and vulnerable when they are being moved from the hospital back into their homes to recover. The transition is obviously something to fear, since their ability to take care of themselves and follow their regimes, while trusting their own bodies to continue to function, can be an overwhelming feeling. The biggest problem is that quality of care provided in the home, in comparison to in the hospital, is generally more slack and not as helpful to the patient. This quickly creates a feeling of dissatisfaction in the older adult, and if the older adult is feeling stress like this while trying to recover, the recovery process can take much longer. Psychological happiness is considered essential for proper physical recovery in most health care situations.

Introduction

The authors define their problem statement and justification as follows: "Although reports of randomized, controlled trials (RCTs) have yielded important information regarding the management of adults hospitalized for heart failure, little is known about the effectiveness of care management strategies for elders experiencing an acute episode of heart failure complicated by multiple other chronic health conditions." The focus of care management, and how the older adults are reacting within it, therefore needs to be analyzed.

Literature Review

The literature review in this article is quite short, but still relevant to the research. This is most likely because only two similar studies have ever been performed. The authors state:

Only two single-site RCTs have tested multidisciplinary, nurse-directed, home-based interventions specifically targeting hospitalized older adults (aged 65) and including patients with both diastolic failure (approximately 50% of elders) and coexisting chronic conditions (which account for approximately 40% of rehospitalizations of older patients). Both studies demonstrated only short-term reductions in heart-failure rehospitalizations and no effect on readmissions due to comorbid conditions (Naylor et. Al, 2004, p. 675).

The discussion of these studies is demonstrated in the literature review, so the need for increased evidence regarding this information is present from the outset of the study. The theory, framework, hypothesis, and research questions are all focused on the same thing; finding more information about this concept by actually doing another study, since so little evidence exists on the topic at hand.

Methods

The researchers describe their methods as follows:

The objective of this RCTwas to examine the sustained effect of a 3-month comprehensive transitional care (discharge planning and home follow-up) intervention directed by advanced practice nurses (APNs) for elders hospitalized with heart failure on time to first readmission or death, total rehospitalizations, readmissions due to heart failure and comorbid conditions… (Naylor et. Al, 2004, p. 675).

Furthermore, the way the study was conducted is outlined as follows:

The study was conducted at six Philadelphia academic and community hospitals. All patients aged 65 and older admitted to study hospitals from their homes between February 2004 and January 2001 with a diagnosis of heart failure (diagnosis-related group 127 validated at discharge) were screened for participation (Naylor et. Al, 2004, p. 676).