Posted: January 26th, 2019

Congestive Heart Failure and Hospital readmission rates

Paper details:

All references are in the literature review 13 total. see the instructions on the synthesis paper inst. See YouTube video from instructor on instruction page.

Congestive Heart failure and Rehospitalization

Matrix 1

Franks, S. (2015). Transitional Care to Reduce 30-day Heart Failure Readmissions Among the Long-Term Care Elderly Population.

Variable and key concepts List the important points of the article, variables, framework, and concepts mentioned.
The article provides some of the evidence-based and transitional care procedure that can be used by the nursing personnel in the Medicare for long-term care (LTC) of the patients while they aim to reduce the thirty-day HF hospital rehospitalization in the country.
Was hypothesis stated or implied
Yes, the hypothesis was stated. It states that Congestive Heart Failure is serious health condition that has affected more than five million people in the USA and is thus one of the most expensive diseases that the government has been fighting to eliminate.
What was the research question Was it clearly stated
The research question was, what are the methods of that can be used to improve the quality of the lives of the long-period care patients by limiting the emotional and the physical torture they undergo by the continuous hospitalizations
Yes, the research question was clearly stated.
Sampling Who were the participants
The participants were veterans and their spouses in the long-term veteran nursing home that is for all veterans who were on active duty.
How many What it enough
There was a total of 313 veterans, 260 of whom are males while 53 are females. This number was enough for the project since enough date were collected.
How were participants gathered (sampling plan)
The participants were convinced into participating in the research as it gave them hope of reducing the number of times they have to be hospitalized if the research was a success. Questionnaires and direct interviews with the veterans were the main methods used for sampling.
Did any dropout Why
No. none of the patients dropped out since the research was an assurance that there was a possibility of reducing their rate of readmissions into the hospitals.
Design and Method How was the research designed
The research was designed in an experimental mode. Several experiments were conducted and tested using the patients who were willing and the results tabulated. The patients were also engaged in nursing education to make them aware of the medical care that they needed to have. Chart reviews in the hospitals were also analyzed, and they provided objective information that was also very useful.
Quantitative Qualitative, mixed
It was both quantitative and qualitative. For the quantitative, the research only ensured that the exact number of patients and days that was required for the project was used. For the qualitative, the project formulated the best methods of reducing the thirty-day rehospitalization.
What it appropriate to answer the question
Yes, the project was necessary to respond the question. Several methods of reducing the thirty-day readmission were formulated.
Instruments/Data Collection What data was collected
The data collected was on the rate of heart failures and its prevalence on people in the long-term care and skilled nursing clinics.
Was the data sufficient
This data was sufficient enough to help in the formulation of the reduction methods.
What instrument was used Survey Interview Questionnaire
The questionnaire, surveys and direct interview with the patients were used to obtain information from the patients.
Was the instrument valid
Yes, the tools used were accurate since the intended data was obtained from the patients without any force.
Results What were the results
The result obtained was that heart failure is both common to people in the long-term care and also in the skilled nursing clinics. Its prevalence ranges between the percentages of 20 to 38. In addition to that, the rate of readmission of the patients was approximately 27 to 44%. With this result, they were able to formulate the readmission prevention methods that included
1. Patient education to transitional care
2. The Advanced Practice Nurse (APN) to act as the coordinator of the healthcare and
3. CMS to reduce payments for readmission in the hospitals among others

Is it what you expected
No, this is not what I expected. The percentages were too high that what I expected.
Does it make sense
Yeah, they make sense. It was now clear why the rate of readmission has increased significantly for the last couple of months.
Strengths Limitations Strengths:
What were the strengths of the study
1. The patients were willing to answer all the questions and to give blood samples for the experiment
2. There were previous reports that allowed for comparison of facts.
3. Reducing readmission reduces mortality and burden to the nurses and the facilities.
Did it show a statistical difference Was it supported
No there was no statistical difference, and it was not supported.
Limitations:
1. It was costly and time-consuming
2. Bias in the data collected since some of the patients were not so willing to give the information that was required

Critique Overall, what is your opinion of the study
The study was a success, and it provided several methods that when applied could reduce the rate of readmission by a good percentage, and this could benefit the health sector in a great deal.
Can you use this study for your literature review
Yes, I can use this article for my literature review since it covers various aspects like the causes of heart failures, its effects and methods of reducing rehospitalization.
Did the researchers explain their research well
Yes, the researchers explained the research well. They gave dates, references used and the research outcome and recommendations that could be utilized.
Was it easy to understand
Yes, it was easy to understand as they also used simple language.
Does the research make sense
Yes, it makes sense and could be very useful if applied in the medical field.

Matrix 2

Boutwell, A., & Hwu, S. (2009). Effective interventions to reduce rehospitalization: a survey of the published evidence. Cambridge, MA: Institute for Healthcare Improvement.

Variable and key concepts List the important points of the article, variables, framework, and concepts mentioned.
Rehospitalization is both common and costly as much it is usually necessary at times. It has been proved that most patients are re-hospitalized within the thirty days after discharge. However, many of this re-admissions can be avoided, and this suggests that there is a failure with the systems at ensuring that there are quality and care in the health care.
Was hypothesis stated or implied
The hypothesis was stated. It indicated that the reduction methods of rehospitalization could be categorized into four main groups, namely
1. Quality care and patient support during the transition procedures
2. Team management of the patients with both the patients and the nurses
3. Patient education
4. Patient-oriented care techniques to be developed.
What was the research question Was it clearly stated
The research question was, what are the effective intervention methods that can be used to reduce that rate of rehospitalization among the patients and the care settings
The question was not clearly stated can it could be implied as the one noted above.
Sampling Who were the participants
Patients, doctors and patients in some hospitals
How many What it enough
It was s independent research with no definite number of the patients, nurses, and doctors. Yes, it was enough
How were participants gathered (sampling plan)
The participants were collected by engaging them in a one-on-one interview and asking them several questions
Did any dropout Why
Yes, some of the patients, doctors and nurses found it uneasy to share information, so they dropped out during the research.
Design and Method How was the research designed
The design method was developed in a descriptive mode. It gave details of all the procedures of the investigation and the results that were obtained during their study.
Quantitative Qualitative, mixed
It was qualitative. This is because all the results were tested and verified and they were explained in detailed.
What it appropriate to answer the question
Yes, it was suitable for the solution since it gave effective intervention methods that can be used to reduce that rate of rehospitalization among the patients and the care settings.
Instruments/Data Collection What data was collected
The data collected was the patient rate of readmission and the usefulness of the intervention methods that are already being used.
Was the data sufficient
Yes, the data was adequate for the team to give its final recommendations
What instrument was used Survey Interview Questionnaire
The tools used were survey and interviews. This even included home visits of the participants to obtain information from them
Was the instrument valid
Yes, the instruments were valid as they enabled the team to have a comprehensive analysis of the procedure.
Results What were the results
The following intervention was proved to be effective
1. Improved discharge processes as supported by the project red or what is termed as Re-Engineered Discharge
2. Early and constant post-discharge check-ups of the patient by the doctors or nurses.
3. Doctor and nurses home care and visits of the patients.
Is it what you expected
Yes, it was what I expected as I believe that close link between the doctor and patient is the best method to reduce the rate of readmissions.
Does it make sense
Yes, it makes sense since most doctors do not care to check on their patients after discharge and this has high chances of the patients bring readmitted.
Strengths&Limitations Strengths:
What were the strengths of the study
The power of the survey includes
1. Gives the various interventions that can be used in the prevention methods that can be used to reduce rehospitalization
2. Involves the patients, nurses, and doctors on one-on-one talk, hence a more comprehensive report was obtained.
Did it show a statistical difference Was it supported
No, it was written from a primary source. Yes, it was supported.
Limitations:
1. Bias of information
2. Unwillingness by some participants to give information
3. It was costly since it involved a lot of traveling.
Critique Overall, what is your opinion of the study
The study was very comprehensive and descriptive. It gives all the details that are essential for every intervention approach.
Can you use this study for your literature review
Yes, I can use this research for my literature review since it covers a lot of interventions that are paramount in the medical field.
Did the researchers explain their research well
Yes, the researchers explained the research well. It is a descriptive project, and the researchers took their time to explain all the steps and findings.
Was it easy to understand
Yes, it was easy to understand. The researchers use simple illustrative language.
Does the research make sense
Yes, the research makes sense. Even the conclusion summarizes everything in the project and gives it more meaning.

Matrix 3

Zolfaghar, K., Verbiest, N., Agarwal, J., Meadem, N., Chin, S. C., Roy, S. B., … & Reed, L. (2013). Predicting risk-of-readmission for congestive heart failure patients: A multi-layer approach. arXiv preprint arXiv:1306.2094.

Variable and key concepts List the important points of the article, variables, framework, and concepts mentioned.
Since readmission of patients after discharge is not only expensive and also an indicator of poor health quality, then a proper prediction of the possible risks of readmission can be very important. The prediction can be divided into three stages, the risks in general, the risks after sixty days and the risks after thirty days. Using these classifications, then step-wise and quality predictions can be made to reduce these risks.
Was hypothesis stated or implied
Yes, the hypothesis was stated. It was to come up with risks level of the patients that were being discharged after having congestive heart diseases and after that identify any risks that may result within the thirty days of readmission.
What was the research question Was it clearly stated
The research question was; can you build a predictive risk model that can be used to enhance the health quality of the patients with a heart attack
It was clearly stated.
Sampling Who were the participants
Patients are suffering from congestive heart diseases.
How many What it enough
It was s independent research with no definite number of the patients, nurses, and doctors. Yes, it was enough
How were participants gathered (sampling plan)
The sample design used entailed right diagnosis for both right and left heart failure of the patients and taking down the outcome and checking their rates of readmission after discharge and the risks after that.
Did any dropout Why
Yes, some patients dropped out due to fear of contacting more risks.
Design and Method How was the research designed
The research was Correlational since it involved a lot of case-control analysis and also observational study
Quantitative Qualitative, mixed
Qualitative. It aims to remove all readmission risks and make healthcare risk free.
What it appropriate to answer the question
Yes, it was appropriate to respond the question since it was able to achieve all the objectives by coming up with various methods of eliminating the risks.
Instruments/Data Collection What data was collected
The risks factors for patients within a period of thirty and sixty days after readmission.
Was the data sufficient
Yes, the data was sufficient. It enabled the team to identify some of the risks and some of the methods to reduce them
What instrument was used Survey Interview Questionnaire
The instrument used was initial surveys and medical diagnosis of the patients,
Was the instrument valid
Yes, it was valid since the risks were determined.

Results What were the results
Patients admitted for sixty days had high chances of contacting the risks compared to those of thirty days. The risks were majorly opportunistic diseases that took advantage of the low immunity of the patients body.
Is it what you expected
No, I expected the thirty-day patients to be prevalent to high risks.
Does it make sense
No, It does not make sense. I expected the thirty-day patients to be prevalent to high risks since they bodys immunity should be much small from the fact that they had just completed their medication.
Strengths&Limitations Strengths:
What were the strengths of the study
1. The study designed a multi-layer grouping technique that can be used to predict the chances of readmitting the patients after thirty days of discharge
2. The project allowed the team to perform a study that involved a lot of experiments using the data in the real world that were provided by the MultiCare health facilities.
Did it show a statistical difference Was it supported
Yes, this research was unique in its way and the results obtained were new.
Limitations:
1. The was an imbalance in the classification of the risks on the patients
2. The use of traditional methods of classification tended to assign a large number of the patients to the readmission class.
Critique Overall, what is your opinion of the study
The study is well-researched and therefore contains a lot of useful information that if applied can help boost the health system and raise the mortality rate of the patients suffering from heart-related diseases.
Can you use this study for your literature review
Yes, I can use it for my literature review.
Did the researchers explain their research well
Yes, they even use tables and charts to explain their findings.
Was it easy to understand
Not entirely, somehow some concepts were new to me, and I had to check them out.
Does the research make sense
Yes, it makes sense.

Matrix 4

Feltner, C., Jones, C. D., Cen, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E. J., … & Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for people with heart failure.

Variable and key concepts List the important points of the article, variables, framework, and concepts mentioned.
Heart attack remains to be a major health problem and also the main cause of rehospitalization of patients. It very costly and therefore steps should be taken to reduce it. Heart attack incidences have also been proved to increase with age and research showed that for every 100 people aged 65 tears and above, one person is a victim of the disease.
Was hypothesis stated or implied
The hypothesis was stated. For every 100 people aged 65 tears and above, one person is a victim of the disease.
What was the research question Was it clearly stated
The research question was, conduct a clinical systematic review and the effectiveness and dangers of the transitional interventions care methods that can be used to reduce rehospitalization rates and the mortality for the patients of heart-related diseases.
The question was not clearly stated, but it could be implied to be the one above.
Sampling Who were the participants
Patients suffering from heart attack and fall in different age groups
How many What it enough
It was a blind study with no definite number of the patients. A total of forty-seven trials were conducted. Yes, it was sufficient.
How were participants gathered (sampling plan)
The researchers selected patients and conducted a series of trial tests on them. They also conducted some meta-analysis by the application of random effects models so that they could estimate the pooled effects on the patients.
Did any dropout Why
Yes, some patients dropped out due to developing more complication that made them more vulnerable.
Design and Method How was the research designed
The research was developed in an experimental mode. A series of preliminary test were conducted, and the results obtained recorded.
Quantitative Qualitative, mixed
It was a mixture of qualitative and quantitative research.
What it appropriate to answer the question
Yes, it was appropriate to answer the question. The researchers used the resulst obtained to conduct a clinical systematic review, and the effectiveness and dangers of the transitional interventions care methods that can be used to reduce rehospitalization rates and the mortality for the patients of heart-related diseases.
Instruments/Data Collection What data was collected
Sex and age of the patients and the rate of readmission.
Was the data sufficient
Yes, it was enough since the research question was answered.
What instrument was used Survey Interview Questionnaire
The instruments were mainly questionnaires and forty-seven experimental trials.
Was the instrument valid
Yes, it was valid. It gave the necessary data to answer the research question.
Results What were the results
The trials conducted showed thirty-day rehospitalization. Increasing the home-care program reduced all the possible causes of readmission almost to completion. The telephone services also showed a mortality benefit. However, both the telemonitoring and the nurse-oriented clinics did not reduce rehospitalization or mortality rates.
Is it what you expected
Yes, this is what I expected. Home- care services are the best method to reduce the rate of readmissions of the heart attack patients.
Does it make sense
Yes, it makes a lot of sense.
Strengths&Limitations Strengths:
What were the strengths of the study
1. Two intervention techniques that were analyzed reduced heart attack readmission rate by over three to six months. These techniques were home-care programs and STS
Did it show a statistical difference Was it supported
No, it did not show any statistical difference. It was however supported.
Limitations:
1. The meta-analysis used did not show any difference that could be existing in the composite outcome obtained between the patients who were receiving the MDS-HF clinic care programs and the controls
2. The relationship that existed between the rates of readmission and other useful results like mortality were not clear.
Critique Overall, what is your opinion of the study
The study is very comprehensive but not that effective since the limitations are very many compared to the benefits.
Can you use this study for your literature review
Yes, it is comprehensive enough and by trying to eliminate the limitations, it can do a real research too for my literature review.
Did the researchers explain their research well
Yes, the researches described the research well.
Was it easy to understand
Yes, it was easy to comprehend. They used a lot of illustrations and description language that made it easy to comprehend.
Does the research make sense
Yes, it makes sense since it is easy to understand and comprehend.

Matrix 5

Corral, S. (2015). Congestive Heart Failure Readmission Rates with Relation to Patient Compliance (Doctoral dissertation).

Variable and key concepts List the important points of the article, variables, framework, and concepts mentioned.
Heart failure has in the past accounted for more than one million patient hospitalization and rehospitalization after discharge for patients who aver over sixty-five years of age. It also contributes to 12.5% of the total deaths and therefore lowering the rate of readmissions is an important safety method.
Was hypothesis stated or implied
Yes, the hypothesis was implied. It stated that there is a relationship between the patient’s compliance with the medical directives for the heart diseases and the rate of admissions after discharge from the health medical center
What was the research question Was it clearly stated
The research question was, identify the relationship between the patient’s compliance with the medical directives for the heart diseases and the rate of admissions after discharge from the health medical center
It was clearly stated.

Sampling Who were the participants
Patients who had been admitted to the hospital for two or number of times due to the failure of their hearts.
How many What it enough
It was a random study with no exact number of patients, but a total of forty-three studies were conducted. Yes, it was enough.
How were participants gathered (sampling plan)
All patients who were considered to be eighteen years and above and who had been readmitted to the hospitals cardiology department and were proved to have been diagnosed with congestive heart attack were willingly enrolled in the research.
Did any dropout Why
No patient dropped out. They were included in the study in their free will.
Design and Method How was the research designed
The research was experimental and descriptive. A series of experimental tests were conducted and the results described in a report.
Quantitative Qualitative, mixed
It was qualitative. It aimed at establishing the relationship that exists readmission and mortality rate of the heart attack patients.
What it appropriate to answer the question
Yes, it was appropriate for the question. The results obtained in the research answered he research question.
Instruments/Data Collection What data was collected
The data collected included the following gender of the patient, their age and marital status, the duration of their illness and the fraction of their left ventricular ejection.
Was the data sufficient
Yes, the data was enough to analyze and answer the research question.
What instrument was used Survey Interview Questionnaire
The researchers use qualitative and quantitative surveys and interviews to obtain data from the patients
Was the instrument valid
Yes, it was valid as it gave them first-hand information.
Results What were the results
The patients were people aged between twenty-nine to eighty years old, and their average age was approximately 52.2 with the median age being 54. The males were eighty percent while the females were twenty percent. Seventy percent had marital partners while the rest were single.
The diagnosis of the CHF lasted for a period that ranged between one week and of eight years.
The fraction of the left ventricular ejection of all the patients was recorded immediately they were admitted, and it was shown that it varies within the range of twenty to fifty-five percent.
Is it what you expected
Yes, this is what I expected. It was such a comprehensive and involving research, and the medical data of the patients could verify the results.
Does it make sense
Yes, it makes sense since the medical data in the hospitals where the patients were admitted showed the same results.
Strengths Limitations Strengths:
What were the strengths of the study
1. Showed the relationship that exists between heart attack and mortality rate
2. It was easy to establish what causes high mortality rates of the patients.
Did it show a statistical difference Was it supported
Yes, it showed the statistical difference, and it was supported.
Limitations:
1. Information bias as some of the patients gave wrong information.
2. The fraction of the left ventricular ejection was not easy to determine due to the failure of some of the machines used.

Critique Overall, what is your opinion of the study
A study is a good tool that can be used to better the health care. It covers a lot of medical aspects that are useful and essential for establishing the risks associated with heart diseases.
Can you use this study for your literature review
Yes, I can use the study for my literature review. It a good medical tool
Did the researchers explain their research well
Yes, the researchers explained the research well. They have charts and diagrams to illustrate on their information.
Was it easy to understand
Yes, it was easy to comprehend. The charts even give a more picture of the information contained.
Does the research make sense
Yes, it makes sense.

References
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 Outcomes, 6(4), 444-450.
Desai, A. S., & Stevenson, L. W. (2012). Rehospitalization for heart failure predicts or prevent Circulation, 126(4), 501-506.
Feltner, C., Jones, C. D., Cen, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E. J., … & Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis. Annals of internal medicine, 160(11), 774-784.
Hall, M. J., Levant, S., & DeFrances, C. J. (2012). Hospitalisation for congestive heart failure: The United States, 20002010. Age, 65(23), 29.
Swedberg, K., Komajda, M., Bhm, M., Borer, J., Robertson, M., Tavazzi, L., & Ford, I. (2012). Effects on outcomes of heart rate reduction by ivabradine in patients with congestive heart failure: is there an influence of beta-blocker dose Findings from the SHIFT (Systolic Heart failure treatment with the If inhibitor ivabradine Trial) study. Journal of the American College of Cardiology, 59(22), 1938-1945.