Essentials of Evidence Based Practice Presentation

02/06/21 at 11 pm eastern time (USA). I am attaching the assignment requirement and a copy of a template and peer-reviewed articles previously used. Please include an introduction and conclusion in the PPP. Please use at least 4-5 resources. In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach. To Prepare: ● Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT. (PICOT question was the importance of preventive care for chronic illness such as DM) ● Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection. (Currently, work in a hospital setting, SICU unit converted into COVID unit) ● Consider the best method of disseminating the results of your presentation to an audience. (example. unit-level or organizational-level presentations or any other ) The Assignment: (Evidence-Based Project) Part 4: Recommending an Evidence-Based Practice Change Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following: ● Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.) ● Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general. ● Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered. ● Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation. Essentials of Evidence Based Practice Presentation

● Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy. ● Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change. ● Be sure to provide APA citations of the supporting evidence-based peerreviewed articles you selected to support your thinking. ● Add a lessons learned section that includes the following: ○ A summary of the critical appraisal of the peer-reviewed articles you previously submitted ○ An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides) ○ I work in a Hospital, my unit a the SICU(Now a COVID unit) Best Practice for Preventive Care Master of Science in Nursing Walden University NURS 6052N: Essentials of Evidence-Based Practice Instructor Name: Professor Janet Eckhart January 18th, 2021 © 2018 Laureate Education Inc. 1 Introduction When conducting research, it is essential to evaluate the information provided in each study. Studies should be comprehensive and clear about what they are testing, how they are testing it, and the expected outcomes. The failure to meet these standards allows ambiguity within the field that cannot be tolerated, especially when dealing with life and death as occurs in the medical field. In approaching each article objectively, one can define that aspect that makes it either a strong or weak article, determining its value and application to his practice. Essentials of Evidence Based Practice Presentation

The following table breaks down the evaluation of 4 studies, all of which deal with preventive care and its importance. Essentials of Evidence Based Practice Presentation

Evaluation Table Full APA formatted citation of selected article. Article #1 Bailey, J. M., Bartlem, K. M., Wiggers, J. H., Wye, P. M., Stockings, E., Hodder, R. K., Metse, A. P., Regan, T. W., Clancy, R., Dray, J. A., Tremain, D. L., Bradley, T., & Bowman, J. A. (2019). Systematic Article #2 Musich, S., Wang, S., Hawkins, K., & Klemes, A. (2016). The Impact of Personalized Preventive Care on Health Care Quality, Utilization, and Expenditures. Population health Article #3 Morefield, B., Tomai, L., Slanchev, V., Klemes, A. (2020). Payer Effects of Personalized Preventive Care for Patients With Diabetes. The American Journal of Article #4 Sá, L., Ribeiro, O., Azevedo, L., Couto, L., Costa-Pereira, A., Hespanhol, A., Santos, P., Martins, C. (2016). Patients’ estimations of the importance of © 2018 Laureate Education Inc. 2 review and metaanalysis of the provision of preventive care for modifiable chronic disease risk behaviors by mental health services. Preventive medicine reports, 16, 100969. Essentials of Evidence Based Practice Presentation

https://doi.org/10.1016/j. pmedr.2019.100969 management, 19(6), 389– 397. Evidence Level * (I, II, or III) Level III Level II Conceptual Framework A conceptual framework A conceptual framework is not mentioned in the is not mentioned in the article. article. A conceptual framework A conceptual is not mentioned in the framework is not article. mentioned in the article. The researchers aimed to conduct “a systematic review and metaanalysis of the prevalence of preventative care provision for four The researchers utilized the Virtual Research Data Center to gather data regarding participating physician and beneficiary enrollment lists from Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).** Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). https://doi.org/10.1089/po p.2015.0171 The researchers use MDVIP’s model of comprehensive management to study the Impact of Personalized Preventive Care on Healthcare Quality, Managed Care, 26(3):e70-e75. https://doi.org/10.37765/ ajmc.2020.42638 Level II preventive health services: a nationwide, population-based cross-sectional study in Portugal BMJ Open 6:e011755. https:// doi: 10.1136/bmjopen2016-011755 Level II This study is a crosssection study that was conducted to determine how important preventive care is to Portuguese patients. The study © 2018 Laureate Education Inc. 3 Sample/Setting The number and characteristics of modificable chronic disease risk behaviours” (Bailey et al., 2019). They intended to quantify pooled prevalence estimates regarding each behavior and its correlated preventive care utilizing its element and type as well as a narrative synthesis in the cases where meta-analysis was impossible. The researchers referred to The Preferred Reporting Items for Systematic Review and MetaAnalysis (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) for the creation of their review strategy. Utilization, and Expenditures. This model limits the number of patients to 600 per physician and operates with 60-90 minute appointments that include a variety of services along with online nutritional tools. Patients are cared for both inside and out of the office with smaller offices available for 24hour consultation. Essentials of Evidence Based Practice Presentation

Over 700 physicians are documented to be working with the model. The study analyses these members by their demographics, socioeconomics, the supply of services, and clinical characteristics. These findings are then compared to physicians who have not adopted the model. MDVIP and Medicare FFS claims. The purpose was to compare and contrast members with non-members. The researchers utilized propensity score matching to uncover comparison beneficiaries to what was documented in preenrollment trends. Time-consistent differences were controlled with individual fixed effects. In this study, only patients with diabetes were considered was conducted across the country to gather a representational sample of Portuguese patients. Essentials of Evidence Based Practice Presentation

Households with landline telephone numbers were used to select participants at random with a single person selected from each household randomly as well. Interviews were conducted. These interviews were computer-assisted and performed over the telephone. People with mental disabilities were excluded from the study. Four databases were used along with Google Scholar and the Using UnitedHealthcare employer-sponsored health plan databases, The researchers identified “Medicare FFS beneficiaries 1000 Portugues adults were interviewed © 2018 Laureate Education Inc. 4 patients, attrition rate, etc. Preventative Medicine and Psychiatric Services to find descriptive studies that were focussed on delivering mental health care to people 18 years of age and older, and who were delivered routine care. Inpatient, outpatient, and non-clinical mental health services were included in addition to dual diagnosis services. 17 studies were reviewed. Major Variables Studied Independent variables include the elements for care provisions and the risk behaviours. These behaviors include smoking tobacco, drinking too much alcohol, intaking an inadequate amount of nutrition, and not participating in enough physical activity. The dependent variables include the frequency at List and define dependent and independent variables researchers identified MDVIP members between 35 and 85 years of age. Essentials of Evidence Based Practice Presentation

Chosen members had a continuous healthcare plan membership before MDVIP. Non Members were selected at random and had the same history of a continuous healthcare plan as members. The sample size included 10,186 (one year), 5908 (two years), and 3915 (three years) members of MDVIP (Musich et al., 2016). Independent variables studied include “member demographics (eg, age, sex, plan type, the region of the United States, metropolitan location), socioeconomics (eg, income), the supply of health services (eg, number of acute care hospital beds, specialists, PCPs), and health status (eg, Charlson Comorbidity Index [CCI], receiving at least 1 Part B service from an MDVIP-affiliated physician in a 15-month period” for the use of their study (Morefield, 2020). Unaffiliated primary care physicians from the same area as well as the patients receiving care that is not guided by MDVIP. following a pilot study of 100 interviews and a second pilot study of 50 interviews. Independent variables included the changes in outcome before and after the enrollments. Dependent variables include treatment and comparison populations. Independent variables include the demographics of the participants. Dependent variables include the success rate of the interviews, some of which failed to occur. © 2018 Laureate Education Inc. 5 which the care was provided. Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done). A narrative synthesis was used to assess the studies which gave data as mean scores and proportions. Other tests include a prespecified subgroup analysis, heterogeneity, post-hoc subgroup analysis, sensitivity analyses, and post-hoc sensitivity analysis. Psychiatric Diagnostic Group [PDG] score, number of inpatient admissions) in the preperiod” (Musich, 2016). Insurance plans and locations were also studied Dependent variables include the health status of clients, which included CCI. The researchers conduct three sets of analysis. They first described member characteristics. Second, they used a propensity score match to identify nonmembers. Third, the employed multivariate regression models “to estimate health care utilization and expenditures trends” (Musich et al., 2016). The researchers utilized propensity score matching and difference-in-differences (DID) structure for statistical analyses. Questionnaires were used to collect information, from which data was extracted by means of the Statistical Package for the Social Sciences, V.19.0 for Windows (SPSS and the Complex Samples module of SPSS V.19.0. Parametric tests were also used. To deal with imbalances, the researcher applied two kinds of weights, including weights adapted to the © 2018 Laureate Education Inc. 6 sampling design and post-stratification weights. © 2018 Laureate Education Inc. 7 Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). Outcome & %(95% CI) Overall clinician reported data- highest estimates of care provision Ask/ assess Smoking: 78 (59%– 96%) Advice Smoking: 46 (31%– 61%) Nutrition: 54 (48%– 59%) Physical Activity: 72 (49%–95%) Assist Smoking: 52 (31%– 73%) Arrange Smoking: 30 (1%–59%) Overall clinician reported data- lowest estimates of care provision Ask/ assess Smoking: 78 (59%– 96%) Advice Smoking: 43 (32%– 54%) Regression-Adjusted Health Care Utilization Years 1, 2, and 3 for Members (%) compared to Non Members (%) Year One Any IP Admission: 5.9/5.8 Readmission Within 30 Days: 10.9/12.5 Any ER visit: 10.8/ 10.2 Any urgent care facility use: 2.7/5.5 Year Two Any IP Admission: 5.5/5.3 Readmission Within 30 Days: 9.0/11.2 Any ER visit: 10.0/ 12.7 Any urgent care facility use: 3.2/6.7 Year Three Any IP Admission: 7.1/ 7.6 Readmission Within 30 Days: 9.0/10.1 Any ER visit: 14.6/ 17.3 Any urgent care facility use: 4.5/ 10.1 The researchers found that over a three year period, “the differences in average Medicare expenditures between the 2 populations are $610, $773, and $737” (Morefield et al., 2020). For admissions, beneficiaries documented 0.29 fewer per year. There was a 10% decline in unplanned admissions. ED visits fell by 1.3 percentage points while E&M visits increased, coming to 0.245 visits annually. From the interviews, 58.9% of the particents thought of themselves as in good health while 25% had hypertension, 24.3% had hypercholesterolaemi a, 6.6% had diabetes, 10.4% had heart problems, 9.6% had asthma or COPD, 13.6% had depression, and 3% had cancer. Female specific interventions had a relatively high level of importance, ranging from 8.45 to 8.56. Male specific interventions were considered less important, ranging from 7.72 to 7.73. Cardiovascular screenings received a high score above 8 while lifestyle measures were seen as far less important, © 2018 Laureate Education Inc. 8 Nutrition: 54 (48%– 59%) Physical Activity: 72 (49%–95%) Assist Smoking: 39 (12%– 67%) Arrange Smoking: 7 (0%–20%) Overall client and audit reported data- highest estimates of care provision Ask/ assess Smoking: 54 (38%– 71%) Alcohol: 62 (42%–81%) Nutrition: 17 (0%–35%) Physical activity: 35 (0%–72%) Advice Smoking: 28 (14%– 42%) Alcohol: 42 (0%–100%) Nutrition: 47 (5%–90%) Physical activity: 46 (0%–100%) Assist Smoking: 37 (13%– 61%) Year three Characteristics Associated with Achieving $150 Per Member Per Month (PMPM) in Savings (Characteristic/ odds ratio) ranging from 5.99 to 7.91. Low Income Zip Code Area/ 1.59 Northeast/ 1.34 West/ 1.32 EPO/ 1.31 Female/ 1.16 Pre Number of Therapeutic Drug Classes 1–3/ 0.85 Pre CCI = 1/ 0.77 Pre Number of Therapeutic Drug Classes 4+/ 0.28 © 2018 Laureate Education Inc. 9 Arrange Smoking: 21 (0%–49%) Physical activity: 35 (10%–59%) Overall client and audit reported data- lowest estimates of care provision Ask/ assess Smoking:41 (22%–61%) Alcohol: 62 (42%–81%) Nutrition: 17 (0%–35%) Physical activity: 35 (0%–72%) Advice Smoking: 25 (10%– 40%) Alcohol: 42 (0%–100%) Nutrition: 47 (5%–90%) Physical activity: 46 (0%–100%) Assist Smoking: 31 (7%–56%) Arrange Smoking: 3 (0%–7%) Physical activity: 10 (0%–29%). © 2018 Laureate Education Inc. 10 Findings and Recommendations Researchers determined the preventative care for General findings and smoking tobacco, recommendations of the research consuming too much alcohol, obtaining inadequate nutrition, and getting inadequate physical activity to be “suboptimal” (Bailey et al., 2019). The researchers recommend improving prevention across all risk behaviors as well to conduct further studies on how to increase the delivery of such services by clinicians. The researchers found consistent results with studies previously conducted about MDVIP. Quality of care was improved by those who use MDVIP and result in fewer hospitalizations across five years. The researchers found costsaving trends to be equivalent to employerbased health management programs’ economic evaluations in the sense that it took 3 years for such cost-savings to be realized. Overall, the researchers recommend MDVIp as a model for preventive care with a particular emphasis on preventive care and aiding patients in achieving health-based goals. Transaction costs were found to decrease with the use of MDVIP while patient care increased. Changes in common outpatient services played a role in reducing ED visits and subsequent outpatient expenditures. The use of MDVIP with patients with diabetes does not exactly match the research previously made on MDVIP in a border context. Researchers call for more research on the effect of MDVIP for a period of time longer than five years. © 2018 Laureate Education Inc.

The Portuguese population finds different preventive measures to be important. Those with a disease were more likely to rank preventive care higher than those who didn’t. Blood and urine tests were deemed as the most valuable test to receive routinely. Evidence-based recommended tests were viewed as equally important. Females attribute more importance to preventive measures than males. Overall, the public’s opinion does not reflect scientific recommendations where testing is seen as more important than preventive care. The researchers recommend that FPs 11 Appraisal and Study Quality Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice? This article is valuable because it sheds light on the reality of preventive care and who is responsible for the lack of it. However, 17 studies is a relatively small sample size and more information on the subject would be a valuable asset. This is the first review of its kind and it reflects what is currently occurring by taking an observational approach. The risks associated with implementing the researcher’s recommendations include disruptions to current services. Due to a lack of a framework being defined, the outcomes recognize this tendency and expect Portuguese people to overestimate the value of preventive testing. The quality of this study is This study was This study is of high high, especially so if conducted specifically quality, but its based on the sheer number focused on the effect of application is limited of participants. These MDVIP on patients with to that of Portugal. It participants were diabetes and is thus may suggest that thoroughly surveyed as extremely limited other populations well as different aspects outside of its use as a think similarly, but it regarding their care. resource for dealing is limited in the sense Sufficient evidence was with people with that it is a also given for the claims diabetes. It lacks a broad representative study regarding cost-savings. overview of what of Portuguese beliefs. MDVIP provides, but it The study itself is Limitations of the study does offer sufficient strong with include a lack of a single evidence to suggest that appropriate insurer providing the MDVIP is useful to the questionnaire health plans in which diabetes patient. questions, a large members were enrolled. sample size, and Furthermore, the control Seeing that most of the various pilot studies. population was randomly money spent on diabetes chosen for the study. is allocated to those who There are no are 65 years old or foreseeable risks Risks associated with older, this study gives associated with adopting MDVIP include important insight into keeping i … Essentials of Evidence Based Practice Presentation