SOLUTION: MGT 6502 WU Week 4 Texas Educator Sexual Misconduct Worksheet

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30 Days Hospital Readmission: Annotated Bibliography
[Author Name(s), First M. Last, Omit Titles and Degrees]
Wilmington University
MGT 6502, Academic Research Writing
[Professor(s)]
[Month DD, YYYY]
2
APA REFERENCE
CITATION
Singh, M., Guth, J. C., Liotta, E., Kosteva, A. R.,
Bauer, R. M., Prabhakaran, S., … & Naidech, A. M.
(2013). Predictors of 30-day readmission after
subarachnoid hemorrhage. Neurocritical Care, 19(3),
306-310. https://doi.org/10.1007/s12028-013-9908-0
PROBLEM/ISSUE
ADDRESSED IN THE
STUDY
The researchers identified a lack of data for rates of
readmission for patients who suffered from subarachnoid
hemorrhage. Since 30 day readmission is used more
frequently to measure the quality of care, the study aimed to
identify predictors of readmission in patients who suffered
from subarachnoid hemorrhage.
PURPOSE OF STUDY
The researchers aim to identify if there are any predictors of
30 day readmission among patients who suffered from
subarachnoid hemorrhage and in turn reduce cost of care by
proactive identification.
STUDY METHODOLOGY
The study was performed by first defining the 30 day
readmission for patients with subarachnoid hemorrhage.
Next, with the definition and parameter set, an automated
query was formulated to identify readmissions within 30
days for patients who suffered from the conditions and
sought medical help between 2006 and 2012. The result was
then cross referenced with electronic medical records that
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were available by a formal search. The study was approved
by the Institutional Review Board, and written consents were
obtained from each patient identified for the study.
PARTICIPANTS/SAMPLING The study identified 283 patients who suffered from
PROCEDURE USED
subarachnoid hemorrhage between 2006 and 2012 using
automated query and confirm data validation by cross
referencing with electronic medical records. For the purpose
of the study any individual who was discharged within 30
days of being admitted for subarachnoid hemorrhage, who
were otherwise readmitted for any reason within the 30 days
were included. The exception included individuals who made
a trip back due to scheduled readmission, and evaluation in
the emergency department
without hospital readmissions.
VARIABLES AND
RELIABILITY AND
VALIDITY OF MEASURES
The variables identified from examining the patient
population includes: demographic characteristics, the types
of subcategories of conditions such as cerebral infarction and
severity of neurological injury. Characteristics of patients
admitted to the hospital with patients who were not
readmitted within 30 days were compared. The validity of
the study was measured by using statistical calculation using
Chi squared tests, Mann-Whitney U test.
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FINDINGS/RESULTS
283 patients were identified for the purpose of the study, and
of them 255 individuals survived to be discharged. From
them, 21 patients were readmitted within 30 days of
discharge. No correlations were identified with the variables
tested in the study. The most common reasons for
readmission included infection among 8 individuals,
followed by headache among 5. The initial length of stay,
and external ventricular drain placement were seen to be
associated with readmission; however, they were nonspecific
and did not show a clear prediction of 30 day
readmissions. The study concluded that predicting or
preventing readmission is difficult among patients suffering
from SAH.
CONCLUSIONS BY
RESEARCHER
The researchers concluded difficulty in identifying predictors
for 30 day readmission amongst patients suffering from
SAH. They stated that incidents that occur after discharge
which are out of the hospital’s control being the cause of 30
days readmissions. There were no
correlations found between the variables identified above and
30 day readmission; however, the most common reason for
readmission identified was due to infection after discharge.
STRENGTHS AND
WEAKNESSES
Strengths: No conflicts of interests were identified. The
condition SAH used for the purpose of the study was valid
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because of the cost and expense associated in treating the
acute conditions
Weakness: Sample size of the population was quite small and
data was limited because the result only included patients
from one hospital, Northwestern University Feinberg School
of Medicine. Despite declaration of no conflict of interest all
are employed at the place of study.
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APA REFERENCE
CITATION
Stefan, M. S., Pekow, P. S., Nsa, W., Priya, A., Miller, L.
E., Bratzler, D. W., … & Lindenauer, P. K., (2012).
Hospital performance measures and 30-day
readmission rates. Journal of General Internal
Medicine, 28(3), 377-385.
https://doi.org/10.1007/s11606-012-2229-8
PROBLEM/ISSUE
ADDRESSED IN THE
STUDY
The study states the problem of readmission which can be
quite costly to the US health care system. They state
associations between hospital care and outcomes are
inconsistent from prior literature. Therefore, they aimed to
explore the quality measure of 30 day readmission rates for
patients aged 66 or older who were discharged upon
diagnosis and treatment for acute myocardial infarction, heart
failure, pneumonia or undergoing major surgery related to
abdomen, cardiology, vascular or orthopedics.
PURPOSE OF STUDY
The purpose of this study was to examine any associations
between hospital performance on Medicare’s Hospital
Compare Quality Measure and 30 day readmission rate for
patients suffering from heart failure, acute myocardial
infarction, pneumonia and patients undergoing a major
surgery.
STUDY METHODOLOGY
The cross-sectional analysis of hospital data from 2007 who
participated in the Hospital Inpatient Quality Reporting
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Program were used to measure the conditions mentioned in
two categories: the overall measures and appropriate care
measure scores. Medicare claims were used to measure the
rate of readmissions.
PARTICIPANTS/SAMPLING The study sampled patients aged 66 years and older who
PROCEDURE USED
were Medicare recipient. The study chose patients who were
discharged upon receiving treatment for illness including
acute myocardial infarction, heart failure, pneumonia,
undergoing major surgery related to abdomen, cardiology,
vascular and orthopedics. Any patients who did not survive
the set time period or index were excluded from the study.
International Classification of Diseases, Ninth Revision,
Clinical Modification (ICD-9-CM) codes was used in
accordance with the Specifications Manual for National
Hospital Quality Measures for 2007 hospital discharges.
VARIABLES AND
RELIABILITY AND
VALIDITY OF MEASURES
Two elements of hospital performance were measured for
each of the conditions. “Overall Measure” and “Appropriate
Care Measure”, were used to evaluate the quality of care
across the different treatments mentioned. Then the data was
compared and analyzed using the standardized readmission
rate for the hospitals which yielded no
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meaningful data. Validity in the data lies on the use of
patient level or patient specific data for quality of care scores
evaluated.
FINDINGS/RESULTS
Study conducted with data from 2700 hospitals yielded result
which showed little to no associate between hospital
performance on the quality of care and its measurements and
30 day readmission rate across the various treatments for
illnesses mentioned. The data was so insignificant that less
than 1% of the variations observed were accounted for by the
readmission rates across the hospitals examined. The
study also cited previous studies which found similar result
of hospital discharge instruction disassociation with 30 day
readmission results.
CONCLUSIONS BY
RESEARCHER
Hospitals that followed the quality care process specified by
Medicare, did not show evidence of decreased numbers of
hospital readmission for patients within 30 days of discharge
when compared to hospitals that ranked lower in the quality
care process on the same measure.
Study conducted with data from 2700 hospitals yielded result
which showed little to no associate between hospital
performance on the quality of care and its measurements and
30 day readmission rate across the various treatments for
illnesses mentioned. The data was so insignificant that less
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than 1% of the variations observed were accounted for by the
readmission rates across the hospitals examined. The
study also cited previous studies which found similar result
of hospital discharge instruction disassociation with 30 day
readmission results.
STRENGTHS AND
WEAKNESSES
Strength of the study lies in supporting multiple previous
studies which came to the same conclusion using different
types of study and data. Additionally, this study focused
primarily of first-hand patient level data and evaluated
hospital readmission using a standardized performance
score.
Weaknesses include: use of fee for service Medicare patients
and the approach of using risk adjustment data based on
administrative claims. Additionally, discharge instructions
evaluated in the data doesn’t guarantee the patient adhered to
them upon discharge. Lastly, a large
population was excluded from the study because the
boundaries set by the study focused on specific
demographics.

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APA REFERENCE
CITATION
Joynt, K. E., & Jha, A. K. (2012). Thirty-day readmissions –
Truth and consequences. New England Journal of
Medicine, 366(15), 1366-1369.
https://doi.org/10.1056/nejmp1201598
PROBLEM/ISSUE
ADDRESSED IN THE
STUDY
This study challenges the policymakers and the Affordable
Care Act for enacting its provision of penalizing hospitals for
increased number of 30 day readmission rates in a year. The
authors states that 30 day readmission is a faulty measure
because: only a small portion of readmissions are
preventable, there are other targeted policies that can be
enacted rather than improving discharge planning and
hospitals have stopped caring for quality improvement effort
by expending more energy in reducing readmissions.
PURPOSE OF STUDY
The purpose is to analyze whether hospitals diverting their
resources to only focus on the 30 day readmission based on
limited illnesses used by the Centers for Medicare and
Medicaid Services.
STUDY METHODOLOGY
The authors used data from past studies and data from
Medicare available to public for the purpose of the study.
PARTICIPANTS/SAMPLING Only data from public records of Medicare for years 2002 to
PROCEDURE USED
2009 were used.
VARIABLES AND
RELIABILITY AND
VALIDITY OF MEASURES
Variables measured were time and Risk adjusted 30 day
readmissions.
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FINDINGS/RESULTS
At the time the ACA only measured for 3 conditions: acute
myocardial infarction, congestive heart failure and
pneumonia. The authors mentions 30 day readmission rate
over time have remained the same both in the US and when
compared to data available from Canada.
CONCLUSIONS BY
RESEARCHER
The authors concluded that there are other modes of
readmission that are more likely to be controlled by hospitals
such as a measure of 3 days or 7 days rather than 30 days.
The authors’ states hospitals should be focusing on actual
quality improvement efforts and prevention policies
rather than 3 conditions which are often outside of hospital’s
control.
STRENGTHS AND
WEAKNESSES
Strengths lies in the comparison of different areas where the
policymaker can focus on more.
Weaknesses lie in the use of limited sources. In this case the
primary statistical data used for the purpose of the study was
mostly ones from a study of readmissions in Canadian
hospitals. The study doesn’t account for the different types of
healthcare systems that each of the countries operate.
There are limited studies used to make the qualitative
arguments in the research.
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APA REFERENCE
CITATION
Bradley, E. H., Curry, L., Horwitz, L. I., Sipsma, H., Wang,
Y., Walsh, M. N., & Krumholz, H. M. (2013). Hospital
strategies associated with 30-day readmission rates for
patients with heart failure. Circulation: Cardiovascular
Quality and Outcome, 6(4), 444-450.
https://doi.org/10.1161/circoutcomes.111.000101
PROBLEM/ISSUE
ADDRESSED IN THE
STUDY
There is limited evidence or data available for hospital
PURPOSE OF STUDY
The purpose of the study is to identify the various policies
strategies utilized in an effort to lower readmission rates.
and strategies employed by hospitals in order to lower
hospital readmission for patients suffering from heart failure.
STUDY METHODOLOGY
The study used a cross sectional web-based survey of 658
hospitals which participated in national quality initiatives in
order to reduce readmission for the years 2010 and 2011.
PARTICIPANTS/SAMPLING The study obtained Internal Review Board exemption for the
PROCEDURE USED
study because the participants were not required to be
identified or provide personal information for the study. The
researchers contacted all hospitals participating in the two
national quality initiatives to reduce readmission programs in
order to obtain data. 91% or 599 of 658 hospitals used in the
study consistently reported their results from the survey for
the purpose of the study. Hospital respondent collected
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their respective data from relevant staff. Responds included
were from quality management departments, clinical
departments, cardiology departments, case managements and
non-clinical roles.
VARIABLES AND
RELIABILITY AND
VALIDITY OF MEASURES
The focus of the study was heart failures due to higher than
average readmission observed from patients of other diseases
groups. The study used multiple variables which included use
of linear regression model weighted by hospital volume,
independent strategies used in risk
standardized 30 day readmission (RSRR), geographic
location, number of staffed bed and hospital teaching status.
The study was valid in its use of statistical analyst of multiple
variables in order to assess and obtain evidence for RSRR for
hospitals which implemented different strategies.
FINDINGS/RESULTS
The authors cited previously conducted study which provided
limited scope into observable links between different hospital
strategies to reduction of 30 day readmission. Upon
conducting the study, various analyses led to exclusion of
hospitals with missing data, and for the
purpose of the study 571 hospital data were deemed to be
useable. The study identified 6 strategies utilized by hospitals
to have lower RSRR: partnering with community physicians
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or groups, partnering with local hospitals, hold nurses
accountable for medication reconciliation, arrange
follow up appointment prior discharge, sending discharge
paper and summaries to primary care physicians, and
assigning staff to follow up on test results after discharge.
They also identified 4 strategies to have higher RSRR which
include: frequent linking of outpatient and inpatient
prescription records electronically, providing patients written
emergency plan upon discharge, keeping a reliable process to
ensure outpatient physicians are alerted about discharge
within 48 hours, and regularly calling patients
after discharge to follow up and provide educational
materials.
CONCLUSIONS BY
RESEARCHER
The study found 6 strategies utilized by hospitals to be linked
with lower risk standardized 30 day readmissions in their
analysis. They identified a significant association in
community driven strategies to be most effective in lowering
readmission rates. The researchers were stunned
by the 4 strategies utilized to have higher risks because the
strategies themselves seem to be derived from quality
prevention policies. The authors conclude this could be due
to information overload where the hospitals have to keep data
communication between outpatient, inpatient doctors and the
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patients in their discharge strategies. The authors blame
unintended consequences of intervention for the
higher RSSR.
STRENGTHS AND
WEAKNESSES
The researchers state their limitation in the study by
mentioning the study being cross-sectional which can
sideline causality and unmeasured variables. They also cite
having limited information about methods of
implementation from the sample size. They also did not take
account of demographic information for each of the hospitals
where socioeconomic information could be factors. Lastly,
not all hospitals around the country
participated and data was available from those who chose to
participate. Their strengths lie in plausible association
identified by
randomized controlled trials using national data, use of
similar methodology as the Centers for Medicare & Medicaid
Services , statistical analysis used in identification of
strategies used in finding a link with lowering or higher risks
of readmissions from the hospitals.
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APA REFERENCE
CITATION
Larker, C. (2011). Decreasing 30- day readmission rates.
American Journal of Nursing 111 (11), 65-69.
https://doi.org/10.1097/01.naj.0000407308.53587.02
PROBLEM/ISSUE
ADDRESSED IN THE
STUDY
As many as 20% of hospitalization for Medicare recipient are
cited to be readmitted which contributes to the 1/3 cost of the
$2 trillion annual cost of the health care in the US.
The purpose of this piece is to help provide nurses with better
strategies in order to contribute to reduction in hospital
readmissions within 30 days.
PURPOSE OF STUDY
The purpose is to address and discuss various ineffective and
effective strategies involved in reducing hospital
readmission.
STUDY METHODOLOGY
The author utilized the Pennsylvania Patient Safety
Reporting System which is a statewide reporting system all
Pennsylvania healthcare facilities utilizes to file information.
In addition, the author utilizes past research which addresses
and provides trends of 30 day readmission
data.
PARTICIPANTS/SAMPLING Case studies used for patients who were readmitted due to
PROCEDURE USED
the following of ineffective strategies. Individual or patients
are not named and no personal information divulged.
VARIABLES AND
RELIABILITY AND
VALIDITY OF MEASURES
Additional studies are cited where one study looked at
utilization of nurses to educate and advocate in effort to
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reducing 30 day readmission, and another collaborative effort
where the aim was to reduce 30% of 30 day readmission.
Variables which were discussed include:
performing admission assessments, providing effecting
teaching and enhanced learning, real time patient family
communication, and post-hospital follow-up.
FINDINGS/RESULTS
The author cited the STAAR initiative study for identifying 5
strategies showing evidence of reduction in readmissions.
The strategies are comprehensive discharge planning with
timely communication, post discharge support,
multidisciplinary team-based management, patient
education and remote monitoring services.
CONCLUSIONS BY
RESEARCHER
The author urges nurses to utilization various strategies in
their effort to reduce 30 day readmission for healthcare
facilities and in effort reduce the overall health care cost.
The author asks nurses to practice data collection and
admission assessments to understand the patient and their
needs, be actively involved in teaching and communicating
effectively with the patients and their families, and urges
nurses to have a system of post-hospital care follow up via
phone call in order to ensure the patients are following their
regiments and to ensure effective care is provided.
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STRENGTHS AND
WEAKNESSES
The strengths of the periodical involves in providing
anecdotal and real life perspective from nurses who reported
ineffective methods and strategies involved which led to
multiple hospital readmission for discharged patients. The
weakness of the periodic lied in the lack of stating how
effective the best practices discussed were in comparison to
ineffective strategies. In this case the author cites a previous
study mentioning the effective strategies but does not provide
data to support the claims.
The periodic serves as a reminder and advisory piece to
nurses, in an ef…
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