Designing and Implementation PHASE 2

Brief Literature review

Preventable hospitable readmission is a significant and growing concern in the United States healthcare sector. The issue of hospital readmission represents about 20% of the hospitalization, and the patient incurs about $18- $25 billion of unnecessary cost. The Medicare reimbursement financial incentives and the National quality initiatives have made significant efforts which are aimed at reducing the rate of readmission following several strategies and interventions (Al-Amin, 2016).

The rate of readmission for the Medicaid and Medicare beneficiaries has continued to increase hence impacting the United States health care provision negatively. The primary reason for the numerous readmission in the health care facilities is contributed by medical errors, failure of the treatment plan, defects in care, shortcomings in preparing the patients and their families the health care outside the health facility(Lackey, 2015). The main reason for this frequent readmission is the inability to create discharge processes which are of quality standard, minimal preparation of patients and families for the discharge, poor communication and minimum education to he patients in regards to the essentialness of the treatment approach. Several studies tend to link the increasing rate of readmission with inadequate follow up by the primary care providers and other concerned healthcare facilities

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As the cost of health care continues to increase and the health care reimbursement being dependent on the length of stay and satisfaction of the patient, the rate of hospital readmission has become a tool that used to measure the quality of patient care a health facility provides(Axon & Williams, 2011). Despite being a tool of measuring quality, the rate of hospital readmission also tends to impact the well being of the patient. The research topic tends to have a public significance due to the health disparities for those with high risks for readmission.

The knowledge of nurses plays a significant role in the development of approaches that may be used to develop a follow as well as continuous care to limit readmission, promote practical usage of resources and also be able to reduce cost. Currently, health facilitates are often engaging their patients with health training before discharging them to reduce the rate of readmission. Nurses play a significant role in ensuring that quality health care services have been administered to the patients. A health facility that tends to establish a skilled nursing unit can improve health care coordination as well as quality(Ballard-Hernandez, 2010). Following efficient communication, planning, education as well as coordination the nurses and the Nurse case Managers may be able to reduce hospital readmission effectively. Designing and Implementation PHASE 2

Also, communication may improve the collaboration between the Professional Care Providers, the home health care agencies, among other agencies that are responsible for a successful discharge of the patient. Information exchange among these agencies during transitional care may aid in the reduction of hospital readmission (Bottle, Aylin, & Bell, 2013). Through effective communication approach standard coordinating care with multiple settings and providers, involving the patient and family caregivers in the plan of care as well as conducting post-discharge follow-up phone calls may be developed hence minimizing the rate of hospital readmission which in turn improves the quality of health care and reduces the health care cost.

Methodology and design of the study

The health facility readmission has continued to increase the cost of health care in the United States. Health care readmission is often regarded to be an essential tool for measuring the quality of the health care services that particular health care services provider. It is not quite easy to measure quality based on readmission rate of the patient, but it tends to make more sense that a patient tends to be readmitted because the services he was provided with were not of high quality hence not being able to meet his or her health needs. Often readmission is caused by adverse outcomes from a previous treatment. The primary purpose of this study is to determine if the rate of hospital readmission tends to be an accurate measure of quality in the health sector.

To be able to attain effective results relating to the research question the study design that I used was the grounded theory approach. The study design was the most appropriate approach because it tends to emphasize on developing hypothesis based on the research information collected. The strategy would assist me in being able to understand the research question and situation of research to develop a theory that asserts that the frequency of hospital readmission tends to measure the quality of health services provided by the health care facility. The setting of the study design involved several patient care units at a tertiary- care and academic center hospital. The methodology that was used to attain information was interviewing the patients based on how they felt if they would be readmitted within 30 days of discharge. Also, the care providers were interviewed on what they thought was the primary cause of readmission and how it impacted the relationship they have with their patients. The interview conducted on the patients involved a questionnaire which comprised of about five items. Every item required the patient to provide a yes or no answer. Besides, there was a face to face interview, which allowed the researcher to attain the patient’s perspective on the issue of readmission. Also, the health care providers were provided with a question which had eight items all which were in relation to ways of reducing hospital readmission. Also, the researchers conducted a face to face interview, which enabled them to understand the health providers perspective on health readmission and how they measure the quality of health they provide. Generally, to be able to attain the relevant information, the researchers used the semi-structured interviews on health care providers and patients in different health care settings. A typical sampling case study of about 20 health care providers and 50 patients was conducted. The interviews focused on the issue of readmission, and also codes were developed and analyzed based on the responses using the grounded theory. Designing and Implementation PHASE 2

Sampling methodology

The research was conducted at various patient care units in a leading public health facility in the United States. The first services of the health facility were Surgical ICUs, Cardiovascular, and general medical services. The health facility often provides health care services to more than 40, 000 patients annually, and it holds an average of 700-bed capacity. The rates that were used in the study were similar to the national standards.

The participants of the study were recruited using public advertisements, as well as referrals. The recruitment process avoided the exclusion and inclusion criteria because the survey was a typical case sampling. Therefore the individuals who were selected to participate in the study were conventional health care providers who were the representative to the health care process while the patients typically represented the community population and how they felt in regards to hospitalization.

The Institutional Review Board and the Nursing Research Review Committee approved the study. Also, every individual participating was provided with a copy of consent as a participants reference. Before commencing with the research or interview the researcher verbally reviewed the study with the participant in detail. Individuals interested in participating in the survey provided a verbal affirmation of consent. Written consent was waived to prevent linking of personal identifiers to the interview data during the consent process period.

Research tools

Researchers may use different techniques to attain information for their research. The methods may be either primary or secondary. The primary tools for achieving knowledge include the questionnaires as well as statistical data. On the other hand, secondary research tools include the internet, research journals, and interviewing people. The tools that I found to be essential and necessary in the study were the internet, talk from the research participants, and the research journals. All these tools enable me to have a more in-depth understanding of the research question in focus.

Algorithm or flowchart created

The findings of the research showed that health care readmission was majorly contributed by the inability to create discharge processes which are of quality standard, minimal preparation of patients and families for the discharge, poor communication and minimum education to he patients in regards to the essentialness of the treatment approach. Several studies tend to link the increasing rate of readmission with inadequate follow up by the primary care providers and other concerned healthcare facilities Designing and Implementation PHASE 2

Complication within 30days of discharge

Readmission

Successful Discharge

Unsuccessful discharge

Patient education

Team communication

References

Al-Amin, M. (2016). Hospital characteristics and 30-day all-cause readmission rates. Journal of Hospital Medicine, 11(10), 682-687. doi:10.1002/jhm.2606

Axon, R. N., & Williams, M. V. (2011). Hospital Readmission as an Accountability Measure. JAMA, 305(5), 504. doi:10.1001/jama.2011.72

Ballard-Hernandez, J. (2010). Nurse practitioners improving the transition from hospital to home and reducing acute care readmission rates in heart failure patients. Heart & Lung, 39(4), 365-366. doi:10.1016/j.hrtlng.2010.05.031

Bottle, A., Aylin, P., & Bell, D. (2013). Predictors of Readmission in Heart Failure Patients Vary by Cause of Readmission: Hospital-Level Cause-Specific Readmission Rates Show No Correlation. 2013 IEEE International Conference on Healthcare Informatics. doi:10.1109/ichi.2013.88