Expert answer:Capstone Project Milestone 1: Practice Issue and E
Expert answer:Please finish the worksheet according to the guidelines .Choose the ONE systematic review topic that is of most interest to you, or most relevant to your practice situation from these 3 articles. Please type your answers directly into the worksheet. see all attachments
guidelines.docx
guidelines.docx
w3_milestone1_evidence_worksheet.docx
article_1.pdf
article_2.pdf
article_3.pdf
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Practice Issue Worksheet Directions
1.Choose the ONE systematic review topic that is of most interest to you, or most relevant to your
practice situation.
2.Follow the grading criteria below to formulate your practice issue, which must be based on the topic
of the systematic review you have selected.
3.Your practice issue will be the same for all three Milestone assignments in this course.
4.Please type your answers directly into the worksheet.
Evidence Summary Worksheet Directions
1.Develop an evidence summary by following the grading criteria below.
2.Document this on the evidence summary portion of the worksheet.
3.You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2
assignment.
4.Please type your answers directly into the worksheet.
Practice Issue Worksheet Directions
1.Choose the ONE systematic review topic that is of most interest to you, or most relevant to your
practice situation from these 3 articles.
2.Follow the grading criteria below to formulate your practice issue, which must be based on the topic
of the systematic review you have selected.
3.Your practice issue will be the same for all three Milestone assignments in this course.
4.Please type your answers directly into the worksheet.
Evidence Summary Worksheet Directions
1.Develop an evidence summary by following the grading criteria below.
2.Document this on the evidence summary portion of the worksheet.
3.You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2
assignment.
4.Please type your answers directly into the worksheet.
Capstone Project Milestone 1:
Practice Issue and Evidence Summary Worksheets
Student Name:
Date:
Directions
•
Refer to the guidelines for specific details on how to complete this assignment.
•
Type your answers directly into the worksheets below.
Practice Issue Worksheet
List the topic and include the citation for the systematic review you have selected:
What is the practice issue you have identified related to the topic you have chosen?
Define the scope of the practice issue:
What is the practice area?
___ Clinical
___ Education
___ Administration
___ Other (List):
How was the practice issue identified?
(check all that apply)
___ Difference between hospital and community practice
___ Safety/risk management concerns
___ Clinical practice issue is a concern
___ Unsatisfactory patient outcomes
___ Procedure or process is a time waster
___ Wide variations in practice
___ Clinical practice issue has no scientific base
___ Significant financial concerns
__ Other:
Describe the rationale for your checked selections:
What evidence must be gathered? (check all that apply)
___ Literature search
___ Clinical Expertise
___ Guidelines
___ Financial Analysis
___ Expert Opinion
___ Standards (Regulatory, professional, community)
___ Patient Preferences
___ Other
Describe the rationale for your checked selections:
Evidence Summary Worksheet
Directions: Please type your answers directly into the worksheet.
Describe the practice problem in your own words with reference to the identified population, setting and
magnitude of the problem in measurable terms:
Type the complete APA reference for the systematic review article you chose from the list provided, It
must be relevant to the practice issue you described above.
Identify the objectives of the article.
Provide a statement of the questions being addressed in the work and how they relate to your practice
issue:
Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.
Summarize the main findings by the authors of your systematic review including the strength of
evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2
project paper.
Outline evidence-based solutions that you will consider for your project.
Discuss any limitations to the studies performed that you believe impacts your ability to utilize the
research in your project.
Cochrane Database of Systematic Reviews
Discharge plans to prevent hospital readmission for acute
exacerbations in children with chronic respiratory illness
(Protocol)
Hall KK, Chang AB, O’Grady KF
Hall KK, Chang AB, O’Grady KF.
Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness.
Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD012315.
DOI: 10.1002/14651858.CD012315.
www.cochranelibrary.com
Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness (Protocol)
Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . .
ABSTRACT . . . . . . . . .
BACKGROUND . . . . . . .
OBJECTIVES . . . . . . . .
METHODS . . . . . . . . .
ACKNOWLEDGEMENTS
. . .
REFERENCES . . . . . . . .
APPENDICES . . . . . . . .
CONTRIBUTIONS OF AUTHORS
DECLARATIONS OF INTEREST .
SOURCES OF SUPPORT . . . .
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Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness (Protocol)
Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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[Intervention Protocol]
Discharge plans to prevent hospital readmission for acute
exacerbations in children with chronic respiratory illness
Kerry K Hall1 , Anne B Chang1,2 , KerryAnn F O’Grady1
1 Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. 2 Child Health Division,
Menzies School of Health Research, Charles Darwin University, Darwin, Australia
Contact address: Kerry K Hall, Institute of Health and Biomedical Innovation, Queensland University of Technology, 62 Graham
Street, South Brisbane, Brisbane, Queensland, 4101, Australia. kerry.hall@hdr.qut.edu.au. kkmjhall@bigpond.com.
Editorial group: Cochrane Airways Group.
Publication status and date: Edited (no change to conclusions), published in Issue 8, 2016.
Citation: Hall KK, Chang AB, O’Grady KF. Discharge plans to prevent hospital readmission for acute exacerbations in
children with chronic respiratory illness. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD012315. DOI:
10.1002/14651858.CD012315.
Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ABSTRACT
This is the protocol for a review and there is no abstract. The objectives are as follows:
To evaluate the efficacy of individual caseworker-assigned discharge plans, compared to non-caseworker-assigned plans, in preventing
hospitalisation for acute respiratory exacerbations in children with chronic lung diseases such as asthma and bronchiectasis.
BACKGROUND
Description of the condition
Chronic respiratory conditions are major causes of mortality and
morbidity in developed and developing countries. Children with
chronic health conditions have increased morbidity associated
with their physical, emotional and general well-being. Their illness
and these stressors can have a great impact on parents and caregivers
and their ability to cope with ongoing care, especially when recurrent hospitalisations are required (Peterson-Carmichael 2012;
Plant 2013). Disability from chronic diseases is increasing as the
burden from acute infectious diseases is being controlled through
treatment and prevention (Ait-Khaled 2001; Asher 2014; Beran
2015; Chang 2013). Chronic respiratory diseases that are important in childhood include recurrent protracted bacterial bronchitis
(PBB), asthma, chronic suppurative lung disease, and bronchiec-
tasis (Chang 2014). These diseases present challenges to public
health in both developed and developing countries alike because
of their high prevalence, the burden they place on the individual
and the high economic cost to health systems globally (Abramson
2015; Asher 2014; Chang 2013; Kapur 2010; Zar 2014). Furthermore, repeated exacerbations of chronic lung diseases in childhood (e.g. bronchiectasis) are known precursors to further lung
function decline (Kapur 2010).
Acute respiratory exacerbations (AREs) are common in children
with chronic respiratory disease, often requiring admission to hospital (Redding 2014). A retrospective study in Brisbane, Australia,
of children with non-cystic fibrosis bronchiectasis reported that
35% of AREs required hospitalisation (Kapur 2009). A multicentre RCT of Indigenous children in Australia and Alaska found
that 15% of children were hospitalised for an ARE during the
study period, and that 52% of children at enrolment to the RCT
had been hospitalised for an ARE in the previous 12 months be-
Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness (Protocol)
Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
1
fore enrolment (Redding 2014). A retrospective, cross-sectional
study from the United States of America (USA) reported hospital admission rates of 18% in children with asthma exacerbations
(Sanders 2007). Reducing the frequency of AREs and recurrent
hospitalisations is therefore an important goal in the individual
and public health management of chronic respiratory illnesses in
children. Discharge planning is a process used to decide what a
person needs for transition from one level of care to another and is
usually considered in the context of discharge from hospital to the
home. Historically discharge planning from hospital for ongoing
management of an illness has been referral to a GP or allied health
professional or self-management by the individual and their family with limited communication between the hospital and patient
once discharged. Effective discharge planning can decrease the risk
of recurrent acute exacerbations of chronic disease with or without
readmission to hospital (Lorig 2003).
In this review we will focus on children who have been hospitalised with AREs with or without deterioration of the following
chronic respiratory conditions: asthma; recurrent protracted bacterial bronchitis; chronic suppurative lung disease; and bronchiectasis. The aim of the review is to determine the effectiveness of individual, caseworker-assigned discharge planning and follow-up,
during and after hospitalisation, in reducing subsequent hospital
admissions in children with chronic respiratory diseases compared
to traditional discharge-planning approaches (including self-management).
Description of the intervention
Traditional hospital-discharge plans tend to focus on disease-specific information and skills required to manage the disease, for example blood glucose testing in diabetes. The information can be
written, verbal or both and is usually delivered to the patient by a
ward nurse. A discharge summary of the hospital stay is usually sent
to the patient’s general practitioner (GP) and can include diagnostic findings and post-discharge follow-up requirements (Kripalani
2007). Discharge plans can vary in health facilities and across cultures (Holland 2007). Traditional discharge plans are often based
on the medical management of the condition and may not consider other aspects of living that are impacted by chronic illness
such as the emotional well-being of the individual, their support
network and the general tasks of daily living (Lorig 2003).
Self-management plans are formalised care plans developed while
the person is in hospital that aims to teach them and their family/
carer the required skills to manage and control their health condition. Self-management plans teach strategies to control disease,
promote health and how to live with a chronic health condition.
This generally includes monitoring and managing symptoms and
signs of illness, managing the impacts of illness and adhering to
treatment regimens which allow the person to identify changes in
their condition and to implement appropriate changes as their condition or disease changes (Audulv 2013; Lorig 2003; Regan-Smith
2006). Self-management discharge plans don’t generally incorporate follow-up post hospital discharge by the discharge planner to
determine plan outcomes. Self management can be effective if the
patient and his/her family have the motivation and confidence to
self manage their illness. Self management plans can fail if considerations have not been given to the patient’s perception of health
care practices and cultural considerations. For self-management
plans to be effective the individual, carer and primary health care
provider need to continually engage and be proactive in the health
care plan, which can be difficult for parents of chronically ill children (Lorig 2003).
Individual caseworker-assigned plans involve the patient being assigned a specific caseworker on admission, or shortly after, and aim
to address the gaps in simple or self-management discharge plans
described above. The caseworker’s role is to liaise with hospital
staff during the person’s stay in hospital and develop a plan for
discharge which provides individual, ongoing support to patients
and their families to improve health outcomes.This may be done
by support and motivation to attend appointments and behaviour
risk modification through education programmes (Plant 2013). A
Cochrane review that included generic discharge planning from
hospital found that tailored discharge planning led to a “small reduction in hospital length of stay and reduced the risk of readmission to hospital at three months follow-up for older people with a
medical condition” but did not reduce costs to the health service
(Gonçalves-Bradley 2016). This review did not specifically examine individualised caseworker-assigned plans that incorporate oneon-one care post discharge until resolution of symptoms or care
is no longer required (Gonçalves-Bradley 2016). Individualised
caseworker plans are likely to be particularly important in settings
where a person with low health literacy or from a different culture requires assistance to navigate the health system. A Cochrane
review on Indigenous health worker involvement (compared to
routine care) for Indigenous people with asthma described improvements in knowledge scores but no significant difference in
exacerbation rates (Chang 2010).
How the intervention might work
Caseworkers may reduce re-hospitalisation of people with chronic
conditions through a variety of ways. These can include: (a) improving communication between service providers and patients
hence leading to better self-management plans; (b) understanding
the types of available inpatient and outpatient hospital services so
as to maximise outpatient care; (c) coordinating care from hospital to home and beyond; and (d) improved health education and
promotion such as reducing tobacco smoking exposure which will
reduce acute exacerbations of chronic diseases (Jordan 2007; Plant
2013). A holistic approach to chronic disease management may
provide opportunities to identify early barriers to full recovery and
early symptom management could prevent deterioration in the
Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness (Protocol)
Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
2
person’s condition that, if not addressed, would be likely to result
in readmission to hospital.
Why it is important to do this review
The morbidity (including hospitalisations) related to chronic respiratory disease is an important issue for patients and health systems globally. Preventing possible triggers (e.g. infections, poor
adherence to medications, etc) that could cause exacerbations leading to hospitalisation have important individual and public health
impacts (Ait-Khaled 2001; Chang 2013; Plant 2013). The appropriate management and follow-up of children post-discharge
through individualised case management is one possible strategy
that may reduce the overall burden of disease and long-term sequelae of chronic respiratory disease such as bronchiectasis. However, this strategy would likely add a cost to the health system. A
systematic review of individual caseworker-assigned discharge care
plans (versus standard care) to determine the effectiveness of this
strategy in reducing the hospitalisations and the burden of disease
in children would inform clinical care and health policy.
Types of interventions
We will describe individual caseworker-assigned plans as those involving the caseworker facilitating communication on admission
to the hospital setting between the child, family and attending
physician as well as the caseworker involving the child and family in developing and implementing the plan of care during and
following hospitalisation. Caseworker activities could include, but
not be limited to: a) facilitating the discharge plan and obtaining
needed consultations from other allied health services as required;
b) collaborating with home health agencies; and c) providing educational information and emotional support to the child and family.
We will include studies comparing caseworker-assigned discharge
plans versus discharge plans that do not involve caseworker support.
Types of outcome measures
Primary outcomes
1. Rate and frequency of exacerbations requiring emergency
department visit or hospitalisation
2. Adverse events (all causes)
OBJECTIVES
To evaluate the efficacy of individual caseworker-assigned discharge plans, compared to non-caseworker-assigned plans, in preventing hospitalisation for acute respiratory exacerbations in children with chronic lung diseases such as asthma and bronchiectasis.
METHODS
Secondary outcomes
1. Rate of unscheduled healthcare visits to a GP
2. Quality of life (measured on a validated scale) at months
one and six post-discharge
3. Cost-effectiveness
4. Duration of stay at subsequent hospitalisations
5. Adherance to discharge medications
6. Mortality rate post-discharge for respiratory related illness
Criteria for considering studies for this review
Search methods for identification of studies
Types of studies
Electronic searches
We will include randomised controlled trials (RCTs) (including
cluster randomised trials). We will include studies reported as full
text, those published as abstract only and unpublished data. Crossover trials will not be included.
We will identify studies from searches of the following databases:
• The Cochrane Airways Group Register of Trials – all years
• Cochrane Central Register of Controlled Trials
(CENTRAL), latest issue (The Cochrane Library)
• MEDLINE (Ovid) 1950 to date
• EMBASE (Ovid) 1974 to date
• Trials registries (ClinicalTrials.gov and the World Health
Organization (WHO) trials portal (apps.who.int/trialsearch/))
Types of participants
We will include children aged less than 18 years admitted to hospital with an acute respiratory exacerbation or deterioration of an
underlying chronic respiratory illness.
Exclusion criteria: diagnosis of cystic fibrosis.
The proposed MEDLINE strategy is listed in Appendix 1. This
will be adapted for use in the other databases. All databases will
be searched from their inception to the present, and there will
Discharge plans to prevent hospital readmission …
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