Grid Representation Evidence Level

This is intended to be a working tool to assist you with organization of evidence for the Capstone Narrative Paper. Do not use Systematic Reviews or Meta-analysis studies for this assignment. Only primary research should be entered on this grid. Only a typed document will be accepted.

Citation (APA)

Purpose

Sample

Design

Measurement

Results/Conclusions

Proposal Contribution

Ranking

Boden-Albala, B., Goldmann, E., Parikh, N. S., Carman, H., Roberts, E. T., Lord, A. S., Torrico, V., Appleton, N., Birkemeir, J., Parides, M., & Quarles, M. (2018). Efficacy of a discharge educational strategy versus standard discharge care on reduction of vascular risk in patients with stroke and transient ischemic attacks: The DESERVE randomized controlled trial. JAMA Neurology, 76(1), 20-27.

The study sought to assess the efficacy of a skill-based, culturally-tailored discharge education program with telephone follow-up vis-à-vis standard discharge care in reducing the risk of systolic blood pressure among patients with transient ischemic attack and stroke.

The sample comprised of 1,083 patients selected randomly, and visiting four medical centers in New York City with transient ischemic attacks or mild to moderate stroke

Randomized controlled trial (RCT) with 1 year follow-up

IV: Discharge educational strategy, Standard discharge care

DV: vascular risk

Participants in the intervention group were exposed to an interactive patient education at discharge that was facilitated by a community health nurse. Participants were given a patient video and workbook emphasizing the need for three skills: risk-reduction, medication adherence, and physician-patient communication. The intervention group also received follow-up phone calls from the community health nurse 72 hours, 1 month, and 3 months after discharge. The control group received standard discharge care that included receiving stroke pamphlets by the American Heart Association to minimize their exposure to vascular risk. Vascular risk was measured at baseline, 6months and 12 months using systolic blood pressure. Linear regression and analysis of variance (ANOVA) were used to test for relationships and associations between variables.

Results showed clinically significant differences in systolic blood pressure reduction between the intervention and control groups. The authors concluded that culturally-tailored, skill-based discharge education significantly reduced the risk of vascular disease among patients at 1-year follow-up

This study supports my proposal by lending credence to the effectiveness of enhanced discharge education programs in improving patient health outcomes, thus reducing the risk of revisits and readmissions that would increase wait times. The study also provides adequate insights on how to design a skill-based discharge education strategy for at-risk patients

VII.

deJong, N. A., Kimple, K., Morreale, M., Han, S., Davis, D., & Steiner, M. J. (2020). A quality improvement intervention bundle to reduce 30-day pediatric readmissions. Pediatr Qual Saf., 5(2), e264.

The study sought to determine the effectiveness of a quality improvement bundle aimed at reducing the readmission rates of pediatric patients through enhanced discharge education and follow-up

The sample comprised of 4,853 children discharged from the two general pediatric services at the North Carolina Children’s Hospital

A quality-improvement study comparing pre and post-intervention patient health outcomes (longitudinal design)

IV: intervention bundle (consisting of pre-discharge planning and education by a transition coordinator, physician follow-up and access to the transition clinic based at the hospital)

DV: readmission rates within 30 day of discharge

The researchers reviewed patient records to determine the rates of readmission within 30 days of discharge. Readmission rates before the adoption of the intervention bundle were compared to after its adoption

The readmission rate reduced from10.3% in the pre-implementation phase to 7.4% in post-implementation and remained stable throughout the four-month period of observation.

The authors concluded that the quality improvement bundle improved readmission rates for pediatric patients

This study supports my proposal as it points to pre-discharge health education as an effective way of reducing readmission rates among pediatric patients, who are the capstone project’s target population. Lower readmission rates would reduce the number of patients coming for revisits after discharge, thus reducing overall wait times at the facility. However, pre-discharge education in this study is conducted together with a range of other strategies. Interestingly, the capstone project will be seeking to test whether a discharge education program alone would cause variations in the results.

IV.

Fruhan, S., & Bills, C. B. (2022). Association of a call-back program with emergency department (ED) revisit rates among patients seeking emergency care. JAMA Netw Open, 5(5), e2213154.

The aim of the study is to assess the effectiveness of follow-up calls several days after a patient’s discharge in reducing the risk of revisits and readmissions

The sample comprises of 8,810 participants selected non-randomly. The sample was selected from participants visiting the emergency department of a large county hospital over a 10-week observation period from June to August 2018.

A prospective non-randomized pragmatic clinical trial

IV: call back program that involve calling patients two days after discharge from the ED

DV: ED revisit rates

2,958 patients in the intervention group received a call from the hospital two days after they were discharged. The caller followed up on the patient’s health and reminded them about their medication schedules as well as the need to follow up with a physician and ways of maintaining a healthy lifestyle. The control group did not receive the follow-up call. The researchers then compared revisit rates at 72 hours and 7 days and used t-tests and chi-square to test for differences in revisit rates between the two groups.

Patients in the intervention group were more likely to make successful follow-up plans with other healthcare providers, to be successful in getting medication, and to understand their discharge plan. The odds of revisits as shown by the odds ratio were significantly lower for those in the intervention group at both 72 hours and 7 days.

This study supports my proposal as it introduces the aspect of follow-up calls by physicians as a best practice. Follow-up calls are proposed as a best practice to reduce revisit rates among the target group. Based on its findings, this study informs the inclusion in the capstone project, of follow-up calls to enhance the effectiveness of its patient discharge program.

VIII

Hodges, R., Stepien, S., & Kim, L. Y. (2021). Quality improvement: Using the teach-back to improve patient satisfaction during discharge in the emergency department. Journal of Emergency Nursing, 1(1), 1-9.