Posted: April 30th, 2023

Criteria for Acceptable Research to Support the Doctor of Nursing Practice

Criteria for Acceptable Research to Support the Doctor of Nursing Practice Project (Direct Practice Improvement-DPI)
• As a reminder the Doctor of Nursing Practice (DNP) project ( help with nursing paper writing from experts with MSN & DNP degrees) is a direct practice improvement (DPI) and is grounded in quality improvement.
o The practice problem must originate from the project ( help with nursing paper writing from experts with MSN & DNP degrees) site and be supported with current data (from the project ( help with nursing paper writing from experts with MSN & DNP degrees) site) that confirms the need for the evidence-based solution to improve the specific, measurable patient outcome.

• The manuscript will require a total of at least 15 (no more than 7 years from your anticipated graduation date) primary quantitative research studies.
• The learner may use a meta-analysis of quantitative research (not a systematic review alone) within 7 years of your anticipated graduation date.
• One mixed-methods study may be accepted as a primary research article AND one mixed-methods study may be accepted as a secondary article.
• One pilot/quality improvement project ( help with nursing paper writing from experts with MSN & DNP degrees)s may be accepted if it meets the following criteria:
o the project ( help with nursing paper writing from experts with MSN & DNP degrees) has original research in support of the pilot
o methodology and design are present
o p-value is present
o should have clinical significance to the population impacted
o sample size of at least 40!!
• Do not include summary articles.

Your intervention is coming from the scientific evidence rather than someone else’s opinion of the evidence.
**No case studies, reports, expert opinions, editorials, animal, or lab studies permitted. No Master’s Thesis and/or Doctoral Dissertations**

If you are translating “empirical research” into an evidence-based practice (EBP) to improve a measurable patient outcome use these guidelines to support your EBP intervention.
MUST have 1 original research articles from the USA and/or Canada (depending on residency) to support the intervention within seven years of your graduation date. The other research articles may be added from the US, Canada, UK, Denmark, India, New Zealand, Germany, Australia (preferred) or from the International Compilation of Human Research Standards 2020 Edition, by DNP-815A:
https://www.hhs.gov/ohrp/international/compilation-human-research-standards/index.html
1. Look for primary research studies that are quantitative and conducted within seven years of your graduation date (you need a minimum of five articles by 815A on the intervention itself).
a. Randomized controlled trials
b. Cohort studies, and
c. Case control studies
d. One mixed-methods study
e. The learner may use a meta-analysis of quantitative research (not a systematic review alone) within 7 years of your anticipated graduation date.
f. Pilot project ( help with nursing paper writing from experts with MSN & DNP degrees)s may be accepted if they meet the following criteria:
i. methodology and design is present
ii. p-value is present
iii. should have clinical significance to the population impacted
g. Sample size of at least 40!!
h. No retrospective studies can be included in the 5 primary research articles.

2. Then you can use secondary research (studies) that are quantitative and conducted within 7 years of your graduation date which include:
a. Systematic reviews – NOT allowed to be in the original 3 for PICOT approval
b. Clinical practice guidelines that support the translation of the research into practice.
c. Retrospective studies can be included, but they must account for less than half of the total number of secondary research studies.

*You will be required to have a minimum of 15 synthesized articles for the manuscript on the intervention. Five from primary research and the rest can come from primary and/or secondary research.

If you are implementing a Clinical Practice Guideline (CPG) you still need to obtain the “empirical research” it was built from and additional primary, secondary research, quantitative meta-analysis, and/or pilot project ( help with nursing paper writing from experts with MSN & DNP degrees)s to reinforce that the CPG is current and relevant to the evidence-based practice (EBP) chosen to improve a measurable patient outcome. Use these guidelines to support your EBP intervention.
1. Locate the CPG and pull it from the organization which developed it. You may need to write to the organization if you are not a member to obtain a copy of the guidelines. NOTE: This cannot be a “pilot” project ( help with nursing paper writing from experts with MSN & DNP degrees) at a healthcare organization, meaning you cannot take someone else’s “project ( help with nursing paper writing from experts with MSN & DNP degrees)” and use it as a CPG. The CPG must have the original research in the references from which the CPG was developed.
a. You will need to find all the current research that is with 7 years that built the CPG and list them.
b. You will need two to three pilot studies (max of three) using the pilot project ( help with nursing paper writing from experts with MSN & DNP degrees) criteria on the first page (within 7-years of the graduation date)
c. You may include mixed-method study with your secondary research
2. If the clinical practice guideline is older than 7 years from your graduation date, you will be required to contact the organization and obtain a statement that the CPG is most current.

PICOT Approval requires three (3) original quantitative primary research articles.

___________________
Literature Assessment Table – DPI Intervention
Learner Name: Michelle Angus
Instructions: Use this table to evaluate and record the literature gathered for your DPI Project. Refer to the assignment instructions for guidance on completing the various sections. Empirical research articles must be published within 5 years of your anticipated graduation date. Add or delete rows as needed.
PICOT-D Question: In adult patients with Heart Failure in the skilled nursing setting does the Agency for Healthcare Research and Quality’s (AHRQ) Re-Engineered Discharge (RED) toolkit, follow up phone call Tool#5 compared to current practices impact 30 days readmission rates over a period of 8 weeks?

Table 1: Primary Quantitative Research – Intervention (5 Articles)
APA Reference
(Include the GCU permalink or working link used to access the article.) Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary Research Design Research Methodology
• Setting/Sample (Type, country, number of participants in study)
• Methods (instruments used; state if instruments can be used in the DPI project ( help with nursing paper writing from experts with MSN & DNP degrees))
• How was the data collected? Interpretation of Data
(State p-value: acceptable range is p= 0.000 – p= 0.05) Outcomes/
Key Findings
(Succinctly states all study results applicable to the DPI Project.) Limitations of Study and Biases Recommendations for Future Research
Explanation of How the Article Supports Your Proposed Intervention

Yiadom, M. Y. A. B., Domenico, H., Byrne, D., Hasselblad, M. M., Gatto, C. L., Kripalani, S., Choma, N., Tucker, S., Wang, L., Bhatia, M. C., Morrison, J., Harrell, F. E., Hartert, T., & Bernard, G. (2018). Randomized controlled pragmatic clinical trial evaluating the effectiveness of a discharge follow-up phone call on 30-day hospital readmissions: balancing pragmatic and explanatory design considerations. BMJ open, 8(2), e019600. https://doi.org/10.1136/bmjopen-2017-019600

Readmissions within 30 days are a challenge for the quality of healthcare, since they lead to higher costs and subpar health results. This scientific experiment will look at how well a phone call after discharge can cut down on 30-day inpatient readmissions (Yiadom et al., 2018). Randomized Controlled Study • 3045 participants
• The 30-day mortality rate, time to readmission, all-cause emergency department revisits within 30 days, patient satisfaction (measured as the mean Hospital Consumer Assessment of Healthcare Providers and Systems scores).
• The Vanderbilt Institute for Clinical and Translational Research Institute (VICTR) data management team collects patient visit data from the hospital’s clinical data archive, the Research Derivative (Yiadom et al., 2018). All 3054 patients discharged home were enrolled and randomized to the telephone call program (n=1534) or usual care discharge (n=1520). Using a prespecified intention-to-treat analysis, we found no evidence supporting differences in 30-day inpatient readmissions [14.9% vs. 15.3%; difference -0.4 (95% confidence interval, 95% CI), -2.9 to 2.1; P=0.76], observation readmissions [3.8% vs. 3.6%; difference 0.2 (95% CI, -1.1 to 1.6); P=0.74], emergency department revisits [6.1% vs. 5.4%; difference 0.7 (95% CI, -1.0 to 2.3); P=0.43], or mortality [4.4% vs. 4.9%; difference -0.5 (95% CI, -2.0 to 1.0); P=0.51] between telephone call and usual care groups (Yiadom et al., 2018). Inpatient readmission within 30 days after hospital release, censored for death, is our main goal. We took into account the 30-day inpatient readmission or death composite outcome. On the other hand, we discovered that the 30-day death rates in our general medicine population were 2.6% the year before. This shows that the risk of mortality is not a large competing concern and that there would be little trouble with informative censoring22. All-cause emergency department (ED) revisits within 30 days, observation status readmission within 30 days, time to readmission, patient satisfaction (measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems ratings), and 30-day mortality are examples of secondary endpoints. Exploratory outcomes include the number of call attempts necessary for successful intervention delivery and the requirement for Helpance with discharge plan execution among participants who were randomly assigned to the intervention arm and contacted by the research nurse. To increase generalizability, a single-center trial was carried out in a tertiary care referral facility with only the general medicine population included.
designed to show effectiveness while making practical compromises (such as an expected 30% intervention delivery rate) that restrict our ability to assess efficacy.
The right choice of more pragmatist and less explanatory design components was made in response to the requirement to support a time-sensitive clinical practice decision in the context of clinical equipoise.
Study feasibility was made possible by the waiver of permission and the utilization of clinical informatics tools (Yiadom et al., 2018). The structure, goal, and purpose of a subsequent iteration of the discharge follow-up phone call program will be informed by study findings, which will also be submitted for publication in future literature (Yiadom et al., 2018). The Phone Call RN verifies the disposition of the discharge and then examines the medical file to ascertain what was anticipated to happen following hospital discharge, such as medication adjustments, follow-up appointments, education for new diagnoses, and symptoms for which urgent care should be sought. This article will support the DPI project ( help with nursing paper writing from experts with MSN & DNP degrees) intervention.
Biese, K. J., Busby-Whitehead, J., Cai, J., Stearns, S. C., Roberts, E., Mihas, P., Emmett, D., Zhou, Q., Farmer, F., & Kizer, J. S. (2018). Telephone Follow-Up for Older Adults Discharged to Home from the Emergency Department: A Pragmatic Randomized Controlled Trial. Journal of the American Geriatrics Society, 66(3), 452–458. https://doi.org/10.1111/jgs.15142

To identify barriers to accessing medication, receiving post-discharge instructions, and obtaining physician follow-up, an intervention that comprised a telephone call from a nurse utilizing a scripted questionnaire was included. Only a satisfaction survey was administered to the control group (Biese et al., 2018 Pragmatic Randomized Controlled Trial • A total of 120 patients completed the study. located in Southeastern United States.
• A trained nurse called intervention group patients 1 to 3 days after each patient’s index ED visit to review discharge instructions and help with discharge plan compliance. Patients in the placebo call group received a patient satisfaction survey call, while patients in the control group were not called.
• For all three groups, data collection calls took place five to eight days and thirty to thirty-five days after the index ED visits. For categorical data, chi-square or Fisher’s exact tests were run, and the Kruskal-Wallis test looked at group differences in follow-up times (Biese et al., 2018 p= 0.04 120 patients in all finished the research. Patients had a mean age of 75 years (SD = 7.58 years), were 60% female, and were 72% white. Patients in the intervention group were more likely than those in the control or placebo groups to follow up with doctors within five days of their ED visits (54, 20, and 37%, respectively; p = 0.04). The acquisition of medications and the understanding of dosage and indications were strong points for all groups. When compared to patients in the placebo or control groups (22, 33, and 27%, respectively; p = 0.41), there were no differences in the number of return visits to the emergency department or hospital within 35 days of the index ED visit for intervention patients. According to an economic analysis, there is a 70% possibility that this action will lower overall expenses (Biese, et al., 2018) The study was carried out at a single facility that is a part of a major healthcare network that has a wide range of providers. In comparison to more isolated EDs, this system may be better equipped to schedule prompt follow-up appointments.
Second, certain possible sources of bias were offered by the requirement to randomize and consent patients after they left the ED. Patients in the control group got their first calls from the research Helpant 5 to 8 days after their initial ED visits, whereas participants in the intervention and placebo groups got their calls 1 to 3 days after discharge (Biese et al., 2018).
Further research is required to ascertain whether this intervention can lessen repeat visits to the ED and/or hospitalizations, show cost savings, and apply these findings to new sites and patient populations (Biese et al., 2018 An older adult receiving a pre-recorded phone call from a qualified nurse after being released from the ED did not result in a decrease in 30-day mortality rates or ED or hospital re-admission rates. The goal of this intervention is to reduce 30-day readmission using a telephone call; therefore, this article can support the project ( help with nursing paper writing from experts with MSN & DNP degrees) intervention (Biese et al., 2018
Hwang, B., Huh, I., Jeong, Y., Cho, H.-J., & Lee, H.-Y. (2022). Effects of educational intervention on mortality and patient-reported outcomes in individuals with heart failure: A randomized controlled trial. Patient Education & Counseling, 105(8), 2740–2746. https://doi-org.lopes.idm.oclc.org/10.1016/j.pec.2022.03.022
To investigate the impact of an educational intervention on heart failure (HF) patients’ patient-reported outcomes with telephone follow-up (Hwang et al., 2022) Randomized Controlled Study • 122 hospitalized patients with HF. The intervention group (n = 60) received an individual nurse-led education session on HF self-management during hospitalization and three telephone calls after discharge, with HF were recruited from inpatient units at a university-affiliated hospital located in Seoul, South Korea.
• To determine the degree of health literacy, we employed the Short Form Korean Health Literacy Scale. This questionnaire consists of 12 items that assess older persons’ reading and comprehension skills when it comes to medical information. The total scores may be between 0 and 12.
• Research staff conducted structured interviews to collect sociodemographic and clinical data from patients, using questionnaires and medical records (Hwang et al., 2022). p=.004 7 fatalities (12%) occurred in the intervention group throughout the follow-up (median: 568 days); 15 deaths (24%) happened in the control group (adjusted hazard ratio, 0.40; 95% confidence range, 0.16-0.98; p =.046). From baseline to 3 and 6 months, the intervention group showed greater improvements in HF knowledge (difference=6.14, p = .03; difference=5.76, p = .02, respectively), self-care (difference=-6.08, p < .001; difference=-6.16, p< .001, respectively), and health-related quality of life (difference=-11.90, p = .01; difference=-14.57, p = .004, respectively) than the control group (Hwang et al., 2022). This research has several restrictions. The findings can only be applied to environments that are similar because the study was conducted at a single center. In addition, despite our efforts to meet the enrollment target, we were unable to reach the desired sample size (Hwang et al., 2022). Although it did not obfuscate the intervention’s impact on patient outcomes, our findings should be regarded cautiously and require future research validation (Hwang et al., 2022). According to Hwang et al. (2022), telephone follow-up and educational intervention decreased all-cause mortality and enhanced patient-reported outcomes. Therefore, this study will help support the DPI project ( help with nursing paper writing from experts with MSN & DNP degrees).
van Loon-van Gaalen, M., van der Linden, M. C., Gussekloo, J., & van der Mast, R. C. (2021). Telephone follow-up to reduce unplanned hospital returns for older emergency department patients: A randomized trial. Journal of the American Geriatrics Society, 69(11), 3157–3166. https://doi.org/10.1111/jgs.17336

Since unplanned hospital admissions and/or ED return visits within 30 days were a concern, the aim of this study was to investigate the impact of a telephone follow-up call for community-dwelling patients aged 70 and older after discharge from the ED (van Loon-van et al., 2021). Randomized Controlled Trial • The trial was conducted in two emergency departments at HMC, an inner-city, non-academic teaching hospital in The Hague, The Netherlands. In 2018, the Westeinde site saw 53,000 patients, 18% of whom were 70 years of age or older, while the Bronovo location had 28,000 patients, 25% of whom were under the age of 70.
• Telephone follow-up questionnaire for patients over the age of 70.
• An information technology specialist who was not involved in the study abstracted demographic information, ED visit data, ED return visit data, and hospitalization data from the EHS. The data was then organized by a researcher who was blind to the study groups. We followed Worster’s recommended approaches for data abstraction (van Loon-van et al., 2021). p = 0.42 During the study period, 9836 community-dwelling patients aged 70 years and older were discharged home from the ED, 4732 in odd months, and 5104 in even months. Due to shortage of staff, trained ED nurses were not able to call 40% of eligible patients in the intervention group and 36% of patients in the control group (p < 0.001). In the intervention group, 32% could not be reached, compared with 31% in the control group (p = 0.42) (van Loon-van et al., 2021). Patients with cognitive impairment or mental illnesses were not allowed to participate in Biese’s trial, despite the fact that they have a high chance of returning to the hospital. Moreover, the impact of phone follow-up on unforeseen hospital hospitalizations and repeat ED visits was not studied. 4 Even though these restrictions were removed for our most recent trial, the outcomes were consistent. The Biese experiment had a flaw that we were unable to fix—patients’ limited telephone accessibility. Our patient recruitment success rates were comparable to those of other research (van Loon-van et al., 2021). Data indicate that telephone follow-up increases patient satisfaction, feelings of loneliness, and depressive symptoms in older patients at risk who were discharged from the ED, even if a positive effect on hospital returns was not discovered. This might be looked at in a later study (van Loon-van et al., 2021). Telephone follow-up and sharing discharge information are two examples of socially complicated interventions that may be impacted by patient and environmental factors as well as healthcare provider-level confounders. A possible benefit of telephone follow-up could be increased by educating doctors and nurses in geriatric competencies, such as communication and shared decision-making (van Loon-van et al., 2021). This information can be supporting to the DPI project ( help with nursing paper writing from experts with MSN & DNP degrees).
Patel, P. H., & Dickerson, K. W. (2018). Impact of the Implementation of Project Re-Engineered Discharge for Heart Failure patients at a Veterans Affairs Hospital at the Central Arkansas Veterans Healthcare System. Hospital pharmacy, 53(4), 266–271. https://doi.org/10.1177/0018578717749925
This study aims to evaluate Project Re-Engineered Discharge (RED) implementation’s effects on the frequency of hospital readmissions, all-cause mortality, primary care physician follow-up rate, and cost savings for HF patients (Patel & Dickerson, 2018). Single-center, retrospective, cohort study • Patients admitted with HF exacerbation at the Central Arkansas Veterans Healthcare System (CAVHS), The study included a random sample of 50 patients treated after Project RED intervention and 100 patients admitted before Project RED was implemented.
• Pearson’s chi-square test was used to compare baseline variables, primary outcome, and secondary outcomes, with P values under 5. Principal author responsible for data analysis.
• All data outcomes collection and analysis were performed by primary author (Patel & Dickerson, 2018). p = .04 To enhance patient outcomes and safety while lowering total health care costs, institutions should implement care coordination utilizing a discharge tool like Project RED (Patel & Dickerson, 2018). It is important to be aware of the limitations of this study. The fact that this review was retroactive lends itself to various biases. Male patients made up the bulk of the study’s patients, which lessens the study’s external validity (Patel & Dickerson, 2018).

According to the findings of this study, it would be advised for future interventions to schedule PCP appointments at the time of discharge (Patel & Dickerson, 2018). This study was to enhance patient outcomes and safety while lowering total health care costs, institutions using implement care coordination utilizing a discharge tool like Project RED. This study support the DPI project ( help with nursing paper writing from experts with MSN & DNP degrees) by using Project RED to enhance follow up discharge instructions.

Table 2: Additional Primary and Secondary Quantitative Research (10 Articles)
APA Reference
(Include the GCU permalink or working link used to access the article.) Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary or Secondary Research Design Research Methodology
• Setting/Sample (Type, country, number of participants in study)
• Methods (instruments used; state if instruments can be used in the DPI project ( help with nursing paper writing from experts with MSN & DNP degrees))
• How was the data collected? Interpretation of Data
(State p-value: acceptable range is p= 0.000 – p= 0.05) Outcomes/
Key Findings
(Succinctly states all study results applicable to the DPI Project.) Limitations of Study and Biases Recommendations for Future Research
Explanation of How the Article Supports Your Proposed DPI Project
Mwachiro, D. M., Baron-Lee, J., & Kates, F. R. (2019). Impact of post-discharge follow-
up calls on 30-day hospital readmissions in neurosurgery. Global Journal on
Quality and Safety in Healthcare, 2(2), 46–52. https://doi.org/10.4103/jqsh.jqsh_29_18
Impact of Post-Discharge Follow-Up Calls on 30-Day Hospital Readmissions (Mwachiro et al., 2019).

A Plan–Do–Study–Act methodology • In total, 83 patients were included in the analysis. Of these, 45% (n = 37) received a follow-up call after they were discharged from initial admission.
• Follow up Phone call
• Medical insurance claims data, also known as claims-based data in the American health care system, were reviewed and analyzed to assess whether there was any difference in number of days from initial discharge to readmission between patients who received a follow-up call and those who did not (Mwachiro et al., 2019).

p = 0.005 Readmitted patients who received post-discharge follow-up calls had significant improvements in the length of time out of the hospital. Future development could include developing additional call strategies (Mwachiro et al., 2019).
The problem with utilizing clinical staff to initiate follow-up calls post-discharge is that it adds to their list of responsibilities and many dislike making post-discharge calls with over 20% affirming that they would rather do any other task (Mwachiro et al., 2019).
Future development could include developing additional call strategies and identifying patients at higher risk of readmission. Further studies need to be completed because the results from this single-center cannot necessarily be generalized to other institutions (Mwachiro et al., 2019). The study findings suggest that readmitted patients who received follow-up calls post-discharge had significant improvements in the length of time out of hospital compared to those that did not receive a follow-up call post-discharge (Mwachiro et al., 2019).

Vernon, D., Brown, J. E., Griffiths, E., Nevill, A. M., & Pinkney, M. (2019). Reducing readmission rates through a discharge follow-up service. Future healthcare journal, 6(2), 114–117. https://doi.org/10.7861/futurehosp.6-2-114

Cohort study • 756 patients were located throughout seven hospital wards; 303 were chosen for the intervention and 453 were placed in a comparison group. The intervention was chosen for patients who were over 65 and registered at a general practitioner (GP) that was a part of the Solihull Clinical Commissioning Group (CCG).
• Data on hospital admissions and readmissions for patients who received the intervention and the comparison group were taken between January 1, 2016, and June 30, 2016, one month after the trial’s six-month end, from the HEFT computer system (icare) (Vernon et al., 2019).
•
p=0.033 Patients who may have gotten the intervention but were not contacted are included in the exposure group, which raises the possibility of misclassification bias. This provides an effect size that may be a more accurate representation of the intervention’s potential impact in the real world, where some patients may not be able to use the service. The risk of loss to follow-up in the cohort is decreased by the short duration of the study and the removal of patients who passed away (Vernon et al., 2019). The results also imply that additional research will need to examine the wider consequences and expenses of providing this service. In addition to increasing community and primary care service activity, these effects include the sustainability of interventions outside of the secondary care context. Future research will need to take into account additional patient health and wellbeing outcome metrics (Vernon et al., 2019).

Du, R. Y., Shelton, G., Ledet, C. R., Mills, W. L., Neal-Herman, L., Horstman, M.,
Trautner, B., Awad, S., Berger, D., & Naik, A. D. (2020). Implementation and
feasibility of the re-engineered discharge for surgery (RED-S) intervention: A
pilot study. Journal for Healthcare Quality: Official Publication of the National
Association for Healthcare Quality, 00, 1-9.
https://doi.org/10.1097/JHQ.0000000000000266
Implementation and
feasibility of the re-engineered discharge for surgery (RED-S) intervention (Du et al., 2020). Pilot Study • Participants 100, implementation of RED-S occurred on surgical services
at our hospital, a large tertiary care medical center consisting of three acute surgical
care units, one step down surgical unit, and one surgical intensive care unit for general
surgery.
• RED-S bundle component.
• For RED-S participants, we surveyed via telephone all
participants approximately 30 days following discharge to administer each of these four
composite measures (Du et al., 2020). P=0 .5 Patients received postoperative education on wound care because this component integrated easily with existing processes. Among the nine ostomy patients, seven (77%) received a documented enter ostomy therapy nursing consultation with education on management of ostomies (du et al., 2020).
This is a pilot study intended to establish proof of concept. It was conducted at a single tertiary referral center and enrolled primarily older men, which may limit the generalizability. Adherence rates for some intervention components were lower than desired, but this finding may represent underreporting and poor documentation by chart review because omissions of details in EMR are common (Du et al., 2020). Opportunities for further investigation in the implementation and impact of the RED-S intervention include its potential relationship with reducing postsurgical hospital readmissions (Du et al., 2020). The RED-S intervention standardizes the hospital discharge process with the goal of improving care transitions and readmission rates for colorectal surgery patients. This pilot study shows promise for the feasibility of implementation of RED-S and provides proof of concept of the positive impact of the RED-S intervention on patient-reported experiences (Du et al., 2020).

Mitchell, S. E., Reichert, M., Howard, J. M., Krizman, K., Bragg, A., Huffaker, M., Parker, K., Cawley, M., Roberts, H. W., Sung, Y., Brown, J., Culpepper, L., Cabral, H. J., & Jack, B. W. (2022). Reducing Readmission of Hospitalized Patients With Depressive Symptoms: A Randomized Trial. Annals of family medicine, 20(3), 246–254. https://doi.org/10.1370/afm.2801
To determine if hospitalized patients with depressive symptoms will benefit from
post-discharge depression treatment with care transition support (Mitchell et al., 2022). Randomized Control Study • 709 participants in Boston Massachusetts
• Baseline sociodemographic data, Rapid Estimate of Adult
Literacy in Medicine, 20 Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), 2
• During recruitment, study staff reviewed a daily list of hospitalized patients admitted within 24 hours and assessed eligibility using medical records (Mitchell et al., 2022). p = .003 Care transition support and post discharge depression treatment can reduce unplanned hospital use with sufficient uptake of RED-D intervention (Mitchell et al., 2022). This study also has several limitations. Because we observed an effect of the RED-D intervention in the as-treated analysis but not the intention-to-treat analysis, we strongly suspect that low study adherence was responsible for the null (Mitchell et al., 2022). Assignment to the RED-D intervention by itself does not
produce a detectable effect. Therefore, future studies is recommended (Mitchell et al., 2022). This research showed that a
systematic approach to hospital discharge can reduce 30-day readmissions and
emergency department visits (Mitchell et al., 2022).
Cui, X., Zhou, X., Ma, L. L., Sun, T. W., Bishop, L., Gardiner, F. W., & Wang, L. (2019). A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: a randomized and controlled trial in China. Rural and remote health, 19(2), 5270. https://doi.org/10.22605/RRH5270
Nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure (Cu et al., 2019). Randomized Controlled Trial

• Ninety-six patients in the eastern Chinese province of Shandong with CHF were randomly divided into intervention and control groups
• Statistical analysis was completed using the Statistical Package for the Social Sciences v16.0 (IBM; http://www.spss.com).
• A Fisher’s exact t-test was used to analyze categorical data, and an independent t-test was used for numerical data. A p-value ≤0.05 was considered statistically significant (Cu et al., 2019). p=0.036 The primary endpoint of the study was all-cause mortality and hospital admission due to cardiac problems, such as shortness of breath, chest pain, arrhythmia, and syncope. Information on hospital readmission was obtained from the patients and confirmed by reviewing the medical charts at the cardiology or emergency department (Cu et al., 2019). This study was limited by the small study population in only one region in rural China. Although the patients were representative of the demographics of heart failure patients in this region, the applicability of findings to other patient populations is yet to be evaluated (Cu et al., 2019). In addition, cognitive function and other comorbidities, which were not analyzed in this study, may also impact on the outcomes of CHF. Therefore, future studies are recommended (Cu et al., 2019). This study has demonstrated that a structured education program was associated with a significant improvement in medication adherence, dietary modifications, social support, and symptom control in rural CHF patients. Furthermore, this program was associated with a significant reduction in hospital readmission and would be beneficial to the DPI (Cu et al., 2019).
Popejoy, L. L., Vogelsmeier, A. A., Wang, Y., Wakefield, B. J., Galambos, C. M., & Mehr, D. R. (2021). Testing Re-Engineered Discharge Program Implementation Strategies in SNFs. Clinical nursing research, 30(5), 644–653. https://doi.org/10.1177/1054773820982612
Quantitative results of a multimethod study testing two different RED program implementation strategies in SNFs (Popejoy et al., 2021). Multimethod study

• 450 participants in Boston, MA
• Data sources included Master Beneficiary Enrollment for Medicare A/B (MBSF), Beneficiary Chronic Conditions, Inpatient Services, Non-institutional Provider, SNF Provider, Home Health Agency (HHA) Provider, and Minimum Data Set (3.0) (MDS) files.
• Pretest-posttest design (Popejoy et al., 2021). p = .01 They also had statistically significantly less functional impairment as measured by ADL self-performance (11.6, SD 5.3) compared to 2015 (12.5, SD 5.3, p < .05) and had a higher Charlson Comorbidity Index score (4.65, SD 3.3 vs. 3.97, SD 3, p < .001). There were fewer occupational and physical therapy minutes in 2013, but this difference was not statistically significant. (Popejoy et al., 2021). This study took place in four SNFs located in a Midwestern midsize city in rural part of the state, thus findings cannot be generalized to large urban areas. During the course of the study, facilities experienced leadership changes, staffing shortages, and building repair issues which may have impacted the results of the study (Popejoy et al., 2021). Other outcome measures introduced in this study such as SNF readmission may be useful to consider in future studies (Popejoy et al., 2021). Implementation of a SNF RED program to prepare patients for discharge to the community showed promise in some of the facilities in our study. Combined with findings of others, the RED program holds promise as an approach to avoiding hospital readmissions following SNF discharge. In our study, a slower implementation strategy worked best to allow SNFs to consider how to most effectively implement new discharge processes. However, context rather than the specific intervention may have been the critical component (Popejoy et al., 2021).

Popejoy, L. L., Wakefield, B. J., Vogelsmeier, A. A., Galambos, C. M., Lewis, A. M., Huneke, D., Petroski, G., & Mehr, D. R. (2020). Reengineering Skilled Nursing Facility Discharge: Analysis of Reengineered Discharge Implementation. Journal of nursing care quality, 35(2), 158–164. https://doi.org/10.1097
To describe implementation of Re-engineered Discharge (RED) Process in SNFs and
makes recommendations for its future implementation (Popejoy et al., 2021). Mixed methods study • 120–132 bed participants
• Detailed field notes were recorded for every encounter between SNF staff and study staff. At baseline, SNFs described their existing discharge processes including stakeholders affected by the discharge process (e.g., provider, families, and community agencies). These data were then mapped and presented to the SNF staff to verify that the discharge process as described
was accurate.
• Detailed field notes were recorded for every encounter between SNF staff and study staff (Popejoy et al., 2021). p = .001 There were 58 staff who completed the Staff Satisfaction with RED survey; the majority
were nurses (RN/LPN, n = 31, 53%), followed by leadership, physicians, therapists (n= 12,
21%), licensed social workers/social work designees (n= 11, 19%), and 4 (7%) did not give
a role designation. Staff satisfaction with discharge process results can be found in
Supplemental Digital Content (Popejoy et al., 2021). There were study limitations. This was a small-scale implementation study that took place in
a specific region. This was a nonprobability sample. There was turnover in SNF leadership
and staff over the course of the study, particularly in 1 Enhanced SNF (Popejoy et al., 2021). Future approaches might include identification of an internal facilitator or change agent, i.e.,
someone employed within the SNF, who could work with an external facilitator. Staff may
feel uncomfortable with new roles, e.g., patient education or coordination of care with
primary care offices, thus some staff education may be required to facilitate change (Popejoy et al., 2021). This study proved that SNFs can use RED to enhance the discharge procedures. SNFs require a means to prioritize their efforts to enhance the discharge process because it is difficult to incorporate all RED components at once. Implementation frameworks like CFIR may be helpful to utilize when companies are considering significant changes to their discharge programs as a method to comprehend present discharge procedures, external factors, SNF resources, and the organization’s capacity for change (Popejoy et al., 2021).
Roberts, S., Moore, L. C., & Jack, B. (2019). Improving discharge planning using the re-
engineered discharge programme. Journal of Nursing Management, 27(3), 609-
615. https://doi.org/10.1111/jonm.12719
a) Assess nurses’ readiness to learn (RTL) before receiving education on the re-engineered discharge (RED) programme and (b) measure utilization of the RED discharge process from patient chart reviews following an educational intervention (Roberts, Moore, & Jack, 2019).
Systemic Review • Sixty-nine participants (69) Rural U.S.A
• Chart reviews found usage of the RED 12 actionable item pre-intervention.
• Measure utilization of the RED discharge process from patient chart reviews following an educational intervention (Roberts, Moore, & Jack, 2019). p = 0.000 Participants scored high M = 219.8 (SD 23.7) on the SDLR, indicating nurses’ high RTL prior to educational intervention. Chart reviews found usage of the RED 12 actionable item pre-intervention, (n = 60) M = 6.55 (SD 1.478) compared to post-intervention (n = 60) M = 10.08 (SD 1.544) indicated statistically significant improvement in pre-discharge patient education and planning (t = 17.730, p = 0.000 [CI 3.13–3.93]) (Roberts, Moore, & Jack, 2019). Rural areas are at a disadvantage, due to decreased access to health care and other disparities (Roberts, Moore, & Jack, 2019). Future Studies is recommended in assessing nursing readiness to learn RTL. Current study found that nurses with higher levels of RTL who underwent RED educational sessions significantly improved delivery of the RED process documented in the medical record (Roberts, Moore, & Jack, 2019).
Weerahandi, H., Li, L., Bao, H., Herrin, J., Dharmarajan, K., Ross, J. S., Kim, K. L., Jones, S., & Horwitz, L. I. (2019). Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study. Journal of the American Medical Directors Association, 20(4), 432–437. https://doi.org/10.1016/j.jamda.2019.01.135
Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization (Weerahandi et al., 2019). Retrospective cohort study • All Medicare fee-for-service beneficiaries 65 and older admitted during 2012-2015 with a HF diagnosis discharged to SNF then subsequently discharged home.
• Study population characteristics were summarized with descriptive analyses.
• They utilized piecewise exponential Bayesian
models to partition the time scale in order to estimate baseline hazard of readmission (Weerahandi et al., 2019). P=0.05 In order to examine readmission patterns among homogenous sets
of patients to inform our final model, 30 cohorts were created for patients with SNF stays of
1 to 30 days, respectively. We then plotted the percentage of readmissions that occurred on
each day (0-30) after discharge from SNF for each of these cohorts (Weerahandi et al., 2019). This analysis differs from prior work in that it focuses on readmission and mortality after
SNF discharge, not during SNF stay.1, 36, 37 The few studies that have examined outcomes
from SNF to home did not use national data (Weerahandi et al., 2019). Further work should
examine if formal discharge practices currently used in hospitals could be applied to the transition from SNF to home (Weerahandi et al., 2019).

Discharge from hospital to skilled nursing facility (SNF) is common in heart failure patients. The 30-day readmission risk during the transition from SNF to home is almost 25%. Readmission risk decreases as SNF length of stay increases (Weerahandi et al., 2019).
Zingmond, D. S., Liang, L. J., Parikh, P., & Escarce, J. J. (2018). The Impact of the Hospital Readmissions Reduction Program across Insurance Types in California. Health services research, 53(6), 4403–4415. https://doi.org/10.1111/1475-6773.12869

Examine 30-day readmission rates for indicator conditions before and
after adoption of the Hospital Readmissions Reduction Program (HRRP). Cohort Study • Sample consisted of 333,640 heart attack in California hospital
• The pre-HRRP
period included data from 2005 through the third quarter of calendar year
2012 (31 quarters), while the post-HRRP period included the fourth quarter of
calendar year 2012 through 2014 (nine quarters).
• Using the CMS definitions, were
measured 30-day unplanned readmission for each of these cohorts (Yale New
Haven Health Services Corporation 2016) p=0.01 Post-HRRP, reductions occurred for the three conditions among
Fee-for-Service (FFS) Medicare. Readmissions decreased for heart attack and heart failure in Medicare Managed Care (MC). No reductions were observed in the younger
commercially insured (Zingmond et al., 2018). This is a retrospective study of hospital readmissions using data from a single,
albeit large, state. Findings may not generalize outside of California. These retrospective data cannot assign causality to the observed trend changes. Future work should focus on the underlying mechanisms mediating these changes. In the period after the introduction of the HRRP, greater than expected reductions have occurred in unplanned rehospitalizations both for patients with Medicare FFS and for those in Medicare MC.

Table 3: Theoretical Framework Aligning to DPI Project
Nursing Theory Selected APA Reference – Seminal Research References
(Include the GCU permalink or working link used to access each article.) Explanation for the Nursing Theory Guides the Practice Aspect of the DPI Project
Orem’s Theory on Self-Care Deficit Orem, D. E. (1971). Nursing: Concepts of practice. New York: McGraw-Hill.
Orem’s theory offers a sufficient theoretical basis for nursing practice in basic healthcare settings. Primary care nurses can offer care for a person as an important part of a wider family and society by putting this theory principles into reality. This theory can help in the DPI project ( help with nursing paper writing from experts with MSN & DNP degrees) by DNP learner viewing their patient as someone who can establish and adopt a self-care routine. One useful outcome of using the theory is that Nurses can analyze their clinical practice using nurse-sensitive metrics. Orem’s theory offers a helpful framework for considering patient care, which helps us better understand the ongoing fluidity and adaptation of advanced nursing practice and fundamental healthcare.

Change Theory Selected APA Reference – Seminal Research References
(Include the GCU permalink or working link used to access each article.) Explanation for How the Change Theory Outlines the Strategies for Implementing the Proposed Intervention
Rogers’ Diffusion of Innovations Theory Rogers, E. M. (1962). Diffusion of innovations. New York, Free Press of Glencoe.

According to the Diffusion of Innovation (DOI) theory developed by Rogers in 1962, “knowledge is produced when an individual is exposed to an existing innovation and acquires some understanding about the mechanism and functions” (Rogers, 1962).
Rogers’ diffusion of innovations theory (Rogers, 1962) demonstrates how ideas become ingrained within a context by utilizing the social system, time, communication channels, and the suggested new idea as a key component of the theory to accomplish change.

Table 4: Clinical Practice Guidelines (If applicable to your project ( help with nursing paper writing from experts with MSN & DNP degrees)/practice)
APA Reference –
Clinical Guideline
(Include the GCU permalink or working link used to access the article.) APA Reference –
Original Research (All)
(Include the GCU permalink or working link used to access the article.) Explanation for How Clinical Practice Guidelines Align to DPI Project
Agency for Healthcare Research (2020). Re-Engineered Discharge (RED) Toolkit. Content last reviewed February 2020. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/index.html
Agency for Healthcare Research and Quality (2013). Re-engineered Discharge (RED) Toolkit. Content last reviewed March 2013. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/redtool1.html
The goal of this DPI project ( help with nursing paper writing from experts with MSN & DNP degrees) is to reduce 30-day readmissions using a follow up phone after patients are discharged from the SNF. According to the guidelines this tool outlines the numerous procedures discharge educators carry out to execute the RED components, ranging from coordinating medication lists to going over the patient’s After Hospital Care Plan (AHCP). The tool comes with instructions on how to make an AHCP, a patient-friendly pamphlet that explains how to take care of themselves after leaving the hospital. Therefore, this guidelines can also be used in the SNF setting.

References
Agency for Healthcare Research (2020). Re-Engineered Discharge (RED) Toolkit. Content last reviewed February 2020. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/index.htm
Biese, K. J., Busby-Whitehead, J., Cai, J., Stearns, S. C., Roberts, E., Mihas, P., Emmett, D., Zhou, Q., Farmer, F., & Kizer, J. S. (2018). Telephone Follow-Up for Older Adults Discharged to Home from the Emergency Department: A Pragmatic Randomized
Controlled Trial. Journal of the American Geriatrics Society, 66(3), 452-458.https://doi.org/10.1111/jgs.15142
Boxer, R. S., Dolansky, M. A., Chaussee, E. L., Campbell, J. D., Daddato, A. E., Page, R. L., 2nd. Fairclough. D. L., & Gravenstein, S. (2022). A Randomized Controlled Trial ofHeart Failure Disease Management in Skilled Nursing Facilities. Journal of the American
Medical Directors Association, 23(3), 359-366. https://doli.org/10.1016/j.jamda2021.05.023
Deek, H., Chang, S., Newton, P. J., Noureddine, S., Inglis, S. C., Arab, G. A., Kabbani, S., Chalak, W., Timani, N., Macdonald, P. S., & Davidson, P. M. (2017). An Assessment of involving family caregivers in the in the self-care of heart failure patients on hospital
readmission: Randomised controlled trial (the FAMILY study). International Journal of Nursing Studies, 75, 101–111. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2017.07.015
Du, R. Y., Shelton, G., Ledet, C. R., Mills, W. L., Neal-Herman, L., Horstman, M., Trautner, B., Awad, S., Berger, D., & Naik, A. D. (2020). Implementation and feasibility of the re-engineered discharge for surgery (RED-S) intervention: A pilot study.
Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality, 00, 1-9.https://doi.org/10.1097/JHQ.0000000000000266
Friesen, M. A., Brady, J. M., Milligan, R., & Christensen, P. (2017). Findings from a Pilot Study. Bringing Evidence-Based Practice to the Bedside. Worldviews on evidence-based nursing, 14(1), 22-34. https://doi.org/10.1111/wvn.12195
Gardner, R. L., Pelland, K., Youssef, R., Morphis, B., Calandra, K., Hollands, L., & Gravenstein, S. (2020). Reducing Hospital Readmissions Through a Skilled Nursing Facility Discharge Intervention: A Pragmatic Trial. Journal of the American Medical Directors
Association, 21(4), 508–512. https://doi-org.lopes.idm.oclc.org/10.1016/j.jamda.2019.10.001
Lyngggard, V., Zwisler, A. D., Taylor, R. S., May, O., & Nielsen, C. V. (2020). Effects of thepatient education strategy “Learning and Coping” in cardiac rehabilitation on readmissions and mortality: a randomized controlled trial (LC-REHAB). Health
Education Research, 35(1), 74-85. https://doi-org.lopes.idm.oclc.org/10.1093/her/cyz034
Mitchell, S. E., Reichert, M., Howard, J. M., Krizman, K., Bragg, A., Huffaker, M., Parker, K., Cawley, M., Roberts, H. W., Sung, Y., Brown, J., Culpepper, L., Cabral, H. J., & Jack, B. W. (2022). Reducing Readmission of Hospitalized Patients With Depressive
Symptoms. A Randomized Trial. Annals of family medicine, 20(3), 246–254. https://doi.org/10.1370/afm.2801
Mwachiro, D. M., Baron-Lee, J., & Kates, F. R. (2019). Impact of post-discharge follow-up calls on 30-day hospital readmissions in neurosurgery. Global Journal on Quality and Safety in Healthcare, 2(2), 46–52. https://doi.org/10.4103/jqsh.jqsh_29_18
Pereira Sousa, J., Neves, H., & Pais-Vieira, M. (2021). Does Symptom Recognition Improve Self-Care in Patients with Heart Failure? A Pilot Study Randomised Controlled Trial. Nursing reports (Pavia, Italy), 11(2), 418–429. https://doi.org/10.3390/nursrep11020040
Popejoy, L. L., Vogelsmeier, A. A., Wang, Y., Wakefield, B. J., Galambos, C. M., & Mehr, D. R. (2021). Testing Re-Engineered Discharge Program Implementation Strategies in SNFs. Clinical nursing research, 30(5), 644–653. https://doi.org/10.1177/1054773820982612
Popejoy, L. L., Wakefield, B. J., Vogelsmeier, A. A., Galambos, C. M., Lewis, A. M., Huneke, D., Petroski, G., & Mehr, D. R. (2020). Reengineering Skilled Nursing Facility Discharge: Analysis of Reengineered Discharge Implementation. Journal of nursing care quality,
35(2), 158–164. https://doi.org/10.1097
Puwanant, S., Sinphurmsukskul, S., Krailak, L., Nakaviroj, P., Boonbumrong, N., Siwamogsatham, S., Chettakulanurak, K., Ariyachaipanich, A., & Boonyaratavej, S. (2021). The impact of the coronavirus disease and Tele-Heart Failure Clinic on cardiovascular
mortality and heart failure hospitalization in ambulatory patients with heart failure. PloS one, 16(3), e0249043. https://doi.org/10.1371/journal.pone.0249043
Roberts, S., Moore, L. C., & Jack, B. (2019). Improving discharge planning using the re-engineered discharge programme. Journal of Nursing Management, 27(3), 609-615. https://doi.org/10.1111/jonm.12719
Weerahandi, H., Li, L., Bao, H., Herrin, J., Dharmarajan, K., Ross, J. S., Kim, K. L., Jones, S., & Horwitz, L. I. (2019). Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study.
Journal of the American Medical Directors Association, 20(4), 432–437. https://doi.org/10.1016/j.jamda.2019.01.135
Yip, J. Y. C. (2021). Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem’s Self-Care Deficit Nursing Theory. SAGE Open Nursing. https://doi.org/10.1177/23779608211011993
Zingmond, D. S., Liang, L. J., Parikh, P., & Escarce, J. J. (2018). The
___________________Impact of the Hospital Readmissions Reduction Program across Insurance Types in California. Health services research, 53(6), 4403–4415. https://doi.org/10.1111/1475-6773.12869
____________________________

Example: 10 Strategic Points Document for a Quality Improvement Project
Ten Strategic Points
The 10 Strategic Points
Title of Project 1) Title of Project

Implementation of a Follow-Up Discharge Phone Call to Impact 30 days Readmission Rates

Background
Theoretical Foundation
Literature Synthesis
Practice Change Recommendation
2) Background to Chosen Evidence-Based Intervention:

i) Background of the Practice/gap at the project ( help with nursing paper writing from experts with MSN & DNP degrees) site

• Heart failure impact approximately 6.2 million adults in the United States and has an estimated cost of $30.7 billion ever year in care nationally (Rizzuto et al., 2022).
• Self-care deficit and non-compliance with treatment are the most common reasons for patient readmission to SNF.
• SNF in rural NJ has seen approximately 120 readmissions over the period of 6 months with adult patients with Heart Failure.
• Weekly approximately 10 patients are discharging home from SNF and returned within a 30-day period.
• Educating nurses in the sub-acute setting on how to conduct a follow-up phone call using AHRQ (2020), Re-Engineer Discharge follow-up phone call to ensure compliance with treatment can potentially reduce 30-days readmission.
• AHRQ Re-Engineered Discharge Follow-up phone call increases patient education and compliance with care, early symptom recognition, lifestyle medication, adhere to medication and follow-up appointments can result in a reduction in readmission rates (Du et al., 2020).
• Therefore, using tools like the AHRQ Re-Engineered Discharge (RED) toolkit, follow-up phone call Step #5 is one way to improve compliance with care in patients with heart failure to reduce readmission rates (AHRQ, 2020).

ii) Significance of the practice problem/gap at the project ( help with nursing paper writing from experts with MSN & DNP degrees) site
At this time, the AHRQ, RED toolkit follow-up phone call step #5 is not being used at the DPI project ( help with nursing paper writing from experts with MSN & DNP degrees) site. Currently, a care conference is planned involving the family caregiver who will Help the patient at home, but there is no focus on follow-up phone call. This has led to the same patients being admitted within a 30-day period. According to Deek et al. (2017), involving family caregivers in the self-care of heart failure patients is helpful to maintain compliance in care. On discharge patients and family are given verbal and written discharge instructions on how to reduce exacerbation of Heart Failure symptoms.
iii) Theoretical Foundations
• Orem’s Theory on Self-Care Deficit will guide the implementation of the AHRQ Re-engineer Discharge Follow-up Phone Call Toolkit # 5 to address the self-care deficit in improving the patient’s health outcomes with and advanced nurses’ help (Yip, 2021).
• This theory focuses on Self-care deficit to improve patients’ health outcomes Parker & Hill, 2017).
• This theory involves improving patient’s health outcomes with the nurses’ help. Therefore, the nurse makes the necessary interventions to help the patient achieve their self-care needs (Yip, 2021).
• So, Orem’s theory of self-care deficit evidence-based interventions is a good way to decrease patients non-compliance with care and increase patient’s self-management confidence and emotional well-being and increases the nurse’s job satisfaction and engagement(Yip, 2021).
• Implementation of the Re-Engineered Discharge follow-up phone call will help patients maintain compliance. It will also determine patient understanding of Heart Failure care and symptoms to achieve optimal health outcomes to reduce readmission.
• Rogers’ Diffusion of Innovation (DOI) theory states “knowledge is produced when an individual is exposed to an existing innovation and acquires some understanding about the mechanism and functions” (Mohammed et al., 2018, p.26).
• Rogers’ diffusion of innovations theory shows how ideas become embedded within a setting by using social system, time, means of communication and the proposed new idea as an important component of the theory to implement change (Friesen et al., 2017).
• Innovation diffusion is conceived as occurring over a number of stages, including knowledge, persuasion, decision-making, execution, and confirmation.
• According to this idea, there are five groups of change-adopters: innovators, early adopters, early majority, late majority, and lastly the laggards, who are dispersed along a bell-curve (Rizan et al., 2017).
• The use of bedside nurses in the sub-acute setting to help in data collection will promote knowledge of the need to help reduce readmissions rates in heart failure patients by using the AHRQ Re-Engineered follow up phone call toolkit #5 to reduce re-admission rates.
• This DPI project ( help with nursing paper writing from experts with MSN & DNP degrees) will translate the evidence into practice for this particular site.
iv) Annotated Bibliography
Lynggaard, V., Zwisler, A. D., Taylor, R. S., May, O., & Nielsen, C. V. (2020). Effects of the patient education strategy “Learning and Coping” in cardiac rehabilitation on readmissions and mortality: a randomized controlled trial (LC-REHAB). Health Education Research, 35(1), 74–85. https://doi-org.lopes.idm.oclc.org/10.1093/her/cyz034
• This randomized trial is about the effects of the patient education strategy “Learning and Coping” in cardiac rehabilitation on readmission and mortality. In all, 825 patients with ischemic heart disease or heart failure were randomized to the
intervention arm (LC-CR) or the control arm (standard CR) at three hospitals in Denmark. The patient characteristics in the two arms at baseline were compared descriptively using chi-squared tests for the binary and categorical variables and an unpaired Student’s t test for the continuous variables. The randomization procedure was applied independently of the research team using a web-based system and stratified for gender, diagnosis (IHD or HF) and hospital unit. In this article it shows how patient education aims to encourage patients to take active part and responsibility in managing risk and lifestyle factors and improving coping strategies. Use of the Re-Engineered Discharge follow-up phone call will help persons in the teaching in either joint education with health professionals or sole lay-led education to promote self-managing process in patients after discharge from SNF.
Deek, H., Chang, S., Newton, P. J. Noureddine, S., Inglis, S. C., Arab, G. A., Kabbani, S., Chalak, W., Timani, N., MacDonald, P. S., & Davidson, P. M. (2017). An Assessment of involving family caregivers in the self-care of heart failure patients on hospital readmission: Randomised controlled trial (the Family study). International Journal of Nursing Studies, 75, 101-11. https://doi.org.lopes.idm.oclc.org/10.1016/j.jnurstu.2017.07.015
This randomized trial is an Assessment of involving family caregivers in the self-care of heart failure patients on hospital readmission. The study was conducted over a 13-month period in three tertiary medical centers in Beirut and Mount Lebanon, Lebanon. 256 patients. The study was conducted over a 13-month period in three tertiary medical centers in Beirut and Mount Lebanon, Lebanon.
Follow-up phone calls were conducted 30 days following discharge. Method can be used in the DPI project ( help with nursing paper writing from experts with MSN & DNP degrees). Data were analyzed using version 22 of the Statistical Product and Service Solutions (SPSS)
Follow-up phone calls were conducted 30 days following discharge Data were analyzed using version 22 of the Statistical Product and Service Solutions (SPSS). It was show that readmission at 30 days was significantly lower in the intervention group compared to the control group (n = 10, 9% vs. n = 20, 19% respectively, OR = 0.40, 95% CI = 0.02, 0.10, p = 0.02). In terms of the primary outcome, this novel self-care promotion intervention resulted in a significant reduction in the 30-day readmission incidence among these seriously affected patients.
Boxer, R. S., Dolansky, M. A., Chaussee, E. L., Campbell, J. D., Daddato, A. E., Page, R. L., 2nd, Fairclough, D. L., & Gravenstein, S. (2022). A Randomized Controlled Trial of Heart Failure Disease Management in Skilled Nursing Facilities. Journal of the American Medical Directors Association, 23(3), 359–366. https://doi.org/10.1016/j.jamda.2021.05.023
The objective of this study is to determine if an HF-DMP in SNF improves outcomes for patients with HF. The trial was conducted in 47 SNFs, and 671 patients were enrolled (329 HF-DMP; 342 to usual care) in the INTERACT quality improvement program. This program included tools designed to improve the identification, Assessment, management, communication, and documentation of acute changes in condition in SNFs. The HF-DMP included documentation of ejection fraction, symptoms, weights, diet, medication optimization, education, and 7-day visit post SNF discharge. The composite outcome was all-cause hospitalization, emergency department visits, or mortality at 60 days. Secondary outcomes included the composite endpoint at 30 days, change in the Kansas City Cardiomyopathy Questionnaire and the Self-care of HF Index at 60 days. Rehospitalization and mortality rates were calculated as an exploratory outcome.
Weerahandi, H., Chaussee, E. L., Dodson, J. A., Dolansky, M., & Boxer, R. S. (2022). Disease Management in Skilled Nursing Facilities Improves Outcomes for Patients with a Primary Diagnosis of Heart Failure. Journal of the American Medical Directors Association, 23(3), 367–372. https://doi.org/10.1016/j.jamda.2021.08.002
This randomized control study aim to determine if patients in SNFs with a primary hospital discharge diagnosis of HF benefit from an HF disease management program (HF-DMP). 671 individuals enrolled in the main study, 125 had a primary hospital discharge. The HF-DMP standardized SNF HF care along HF practice guidelines and performance measures and was delivered by a registered nurse called the HF nurse advocate. To accomplish this multipronged intervention, the HF nurse advocate visited enrolled patients randomized to the HF-DMP group three times over seven days and scheduled HF nurse advocate follow up in person or by phone 7-days post SNF discharge. Patients with a primary hospital discharge diagnosis of HF were included in the analysis. Baseline characteristics were compared between those who received HF-DMP versus usual care. Chi-square tests were used for categorical variables, t-tests for normally distributed continuous variables and the Wilcoxon signed-rank test for non-normally disturbed continuous variables. Descriptive statistics described adherence to quantifiable intervention components in the HF-DMP group. Composite event outcomes at 60 days and 30 days post SNF admission were compared with chi-square tests. Linear mixed models were also used to compare outcome rates to account for patient clustering at the physician level using a random effect and correlation within participant via an unstructured covariance matrix.
Pereira Sousa, J., Neves, H., & Pais-Vieira, M. (2021). Does Symptom Recognition Improve Self-Care in Patients with Heart Failure? A Pilot Study Randomised Controlled Trial. Nursing reports (Pavia, Italy), 11(2), 418–429. https://doi.org/10.3390/nursrep11020040
In this Randomised controlled trial Pilot study does Symptom Recognition improve self-care in patients with Heart Failure. sixty-three patients in New York Self-care behaviors were measured using the 12-item European Heart Failure Self-care Behavior Scale (EHFScBS). The IG patients demonstrated a positive, progressive evolution of knowledge and understanding of HF, displaying an improvement of disease understanding in all follow-up moments (p < 0.05; Φ > 0.5). In other words, when questioned were posed about which signs and symptoms were relevant or when asked to describe which actions to take in a given circumstance related to HF.
v) Practice Change Recommendation: Validation of the Chosen Evidence-Based Intervention
The Agency for Healthcare Research and Quality (2020), validates the use of the Re-Engineered Discharge (RED)Toolkit to conduct a post discharge follow-up telephone call to impact 30 days readmission rates. According to AHRQ (2020), these results have important implications for quality of care and costs for the more than 38 million patient discharges each year in the United States. Patients who received the RED experienced a 30 percent lower rate of readmission within 30 days of discharge compared to patients receiving usual care. Readmitted patients who received post-discharge follow-up calls had significant improvements in the length of time after discharge. Future development could include developing additional call strategies (Mwachiro, Baron & Kates, 2019). The education materials and toolkit from the AHRQ will teach nurses how to conduct the follow phone to provide quality care to heart failure patients.
vi) Summary of the Findings written in this section
This annotated biography includes research that proves the Re-Engineered Discharge (RED) follow-up phone call Toolkit #5 is reliable and can be used for Direct Project Improvement at the chosen site. Over a 30-day period, RED has been shown to lower the number of times people with heart failure have to be readmitted. The goal with implementing the Re-Engineered Discharge (RED) toolkit is to better prepare patients and their families for leaving the SNF and lower the number of times people must go back to be readmitted (AHRQ, 2020). The post-discharge follow-up phone call, RED, is an important way to help the patient from the time they are sent home until their first appointment for follow-up care (AHRQ, 2020).

Problem Statement 3) Problem Statement:

It is not known if the implementation of Agency for Healthcare Research & Quality (AHRQ) guidelines, Re-Engineered discharge follow up phone call toolkit #5 would impact 30-day readmission rates, when compared to current practices, among adult heart failure patients.

PICOT to Evidence-Based Question 4) PICOT Question Converts to Evidence-Based Question:
In adult patients with Heart Failure in the skilled nursing setting does the Agency for Healthcare Research and Quality’s (AHRQ) Re-Engineered Discharge (RED) toolkit, follow up phone call step #5 compared to current practices impact 30 days readmission rates over a period of 8 weeks?

Evidence-Based Question
In adult patients with heart failure in the skilled nursing setting does the Agency for Healthcare Research and Quality’s (AHRQ) Re-Engineered Discharge (RED) toolkit, follow up phone call step #5 compared to current practices impact 30 days readmission rates over a period of 8 weeks?

Sample
Setting
Location
Inclusion and Exclusion Criteria 5) Sample, Setting, Location
i) Sample and Sample Size: To determine the sample size, the UCSF clinical & Translational Science Institute’s sample size calculator was used to find out the amount of patient to use in this DPI project ( help with nursing paper writing from experts with MSN & DNP degrees). This Skilled Nursing Facility sees approximately 50 patients on a weekly basis with diagnosis of heart failure. With a confidence level of 95% and a confidence interval of 10, a sample size of 37 will be needed for this project ( help with nursing paper writing from experts with MSN & DNP degrees). There should be no bias and all participants will be included in the study and the sample size. This unit has 100 beds and has approximately 6-10 admissions weekly. All adult patients will be qualified as a candidate for this project ( help with nursing paper writing from experts with MSN & DNP degrees).
ii) Setting: Skilled Nursing Facility

iii) Location: Rural New Jersey

iv) Inclusion Criteria
Who can participate?
• All adults with Heart Failure
• Patients awake, alert, oriented x4
• Who speaks English
• Patients admitted for Short Term Stay
• Patients who are willing to participate
v) Exclusion Criteria
Who cannot Participate
• All adults without Heart Failure
• Patients not awake, alert, oriented x4
• Patients who do not speak English
• Patients not admitted for Short Term Stay
• Patients who are not willing to participate
Define Variables 6) Define Variables:
i) Independent Variable (Intervention): Agency for Healthcare Research and Quality (AHRQ) using the RE-Engineered Discharge (RED) Toolkit #5 follow-up phone call.
ii) Dependent Variable (Measurable patient outcome): Readmission rates pre and post intervention.

Project Design 7) Project Design:
i) This quality improvement project ( help with nursing paper writing from experts with MSN & DNP degrees) will use a quantitative methodology with a quasi-experimental design, as the effectiveness of AHRQ Re-Engineer Discharge follow-up Phone call to reduce 30-days readmission rates in adult Heart Failure patients.
ii) For this DPI project ( help with nursing paper writing from experts with MSN & DNP degrees), we will use information from past research on the Re-Engineered Discharge (RED) follow-up Phone Call Toolkit #5 to show the impact of readmission rates in patients with Heart Failure. This project ( help with nursing paper writing from experts with MSN & DNP degrees) will use a quantitative design. The quality improvement (QI) will focus on system issue of patient comprehension how to take care of themselves after discharge with methods that are clear and easily understood. Along with this, nurses will place follow-up phone calls to reinforce, remind patients and clarify misunderstanding on how to maintain compliance with treatment. Data will be collected on current follow up phone call practices, implementation of new methods, and monitor data on the new method to ensure patients understands, and a quality outcome should be reduction in readmission rates.
Purpose Statement 8) Purpose Statement:

The purpose of this quality improvement project ( help with nursing paper writing from experts with MSN & DNP degrees) is to determine if the implementation of AHRQ guidelines, re-engineered discharge follow up phone call toolkit#5 would impact 30-day readmission rates when compared to current practices among adult heart failure patients. This project ( help with nursing paper writing from experts with MSN & DNP degrees) was piloted over an eight-week period in a rural New Jersey skilled nursing facility.

Data Collection Approach 9) Data Collection Approach:
i) We will use an excel spreadsheet to gather data on demographics which includes, age, race, ethnicity, diagnosis and readmission rates from electronic health record (EHR). Using the patient health care information from the EHR to access data with permission from the project ( help with nursing paper writing from experts with MSN & DNP degrees) site. The data included will be comparative and implementation data on patients, comparative and implementation data on the number of patients that needs a follow-up call after discharge.
ii) There will be a standard discharge instruction and also patient specific instructions on self-care and compliance. It is necessary to document how many follow-ups phone calls each patient will receive and how much info each nurse has completed for each patient. The facility’s electronic health record (EHR) will be used when necessary to gather data related to heart failure patients, their care plans, goals, and intervention implemented by the team during the duration of the project ( help with nursing paper writing from experts with MSN & DNP degrees). More data collection will be completed to verify the number of patients with heart failure who were compliant after receiving follow-up phone calls and the impact it had on the readmission rates compared to current practices.
iii) The tools have been tested many times among various agencies and even translated into diverse languages.
iv) Describe the step-by-step process you will use to collect the data, explain where the data will come from, and how you will protect the data and participants.
(1) The method of quality improvement will mimic quality improvement frameworks Six Sigma, Lean, as the Model for Improvement. Six Sigma seeks to improve the quality of process outputs by identifying and removing the causes of defects (errors) and minimizing variability in processes. A key focus of Six Sigma is the use of statistical tools and analysis to identify and correct the root causes of variation. As roadmap for problem solving and process improvement, Six Sigma uses Define, Measure, Analyze, Improve, Control (DMAIC) methodology (AHRQ, 2020).
(2) For this project ( help with nursing paper writing from experts with MSN & DNP degrees), the IRB process will begin with Grand Canyon University (GCU) as the clinical agency as the project ( help with nursing paper writing from experts with MSN & DNP degrees) site does not have an IRB. After approval from the IRB is received, there will be a teaching session to educate the nurses and other staff wo are included in the project ( help with nursing paper writing from experts with MSN & DNP degrees). Then participants who met the criteria will be given the implementation plan.
(3) For the sample size that is available at the time of the project ( help with nursing paper writing from experts with MSN & DNP degrees), will, they will be given the opportunity to change their minds and opt out if necessary. There will be no direct contact between the participants and the project ( help with nursing paper writing from experts with MSN & DNP degrees) leader.
(4) Patient teaching will be reinforced focusing on understanding treatment goals. This will be done on each follow-up phone call.
(5) On completion of the project ( help with nursing paper writing from experts with MSN & DNP degrees) with the 8-week period, nurses will re-educate the patients and allow them to acknowledge understanding.
(6) The appropriate personnel will be given a report with referral for further recommendations.
v) In quality improvement project ( help with nursing paper writing from experts with MSN & DNP degrees)s, the upholding of ethical concepts such as autonomy, beneficence, non-maleficence, and fairness ought to be held to the same exacting standards as those required in clinical research (Hall, Lee & Haase, 2020). Participants in QI project ( help with nursing paper writing from experts with MSN & DNP degrees)s may be exposed to risk or burden, computer screens, or conversations that take place in hallways or elevators, regardless of whether this was done intentionally or not. Generally speaking, quality improvement programs are subjected to some level of internal assessment in order to reduce the risk to participants and ensure participant confidentiality. During this DPI project ( help with nursing paper writing from experts with MSN & DNP degrees) respect of the decisions made by participants will be maintained to ensure participants are not harmed in way or form. All participants will be treated fairly.
Data Analysis Approach 10) Data Analysis Approach:
• A priori analysis will be used to justify the sample. Participants demographic data will be analyzed using descriptive statistics. A paired t- test will be utilized to measure readmission rates. A statistician may be used.

References
Agency for Healthcare Research and Quality (AHRQ). (2020). Re-Engineered Discharge (RED)
Toolkit. https://www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/redtool1.htm
Agency for Healthcare Research and Quality (AHRQ). (2020). Ways To Approach the Quality
Improvement Process. Rockville, MD.
https://www.ahrq.gov/cahps/quality-improvement-guide/4-approach-qi-process/sect4part
2.html
Biese, K. J., Busby-Whitehead, J., Cai, J., Stearns, S. C., Roberts, E., Mihas, P., Emmett, D.,
Zhou, Q., Farmer, F., & Kizer, J. S. (2018). Telephone Follow-Up for Older Adults
Discharged to Home from the Emergency Department: A Pragmatic Randomized
Controlled Trial. Journal of the American Geriatrics Society, 66(3), 452-458.
https://doi.org/10.1111/jgs.15142
Boxer, R. S., Dolansky, M. A., Chaussee, E. L., Campbell, J. D., Daddato, A. E., Page, R. L.,
2nd. Fairclough. D. L., & Gravenstein, S. (2022). A Randomized Controlled Trial of
Heart Failure Disease Management in Skilled Nursing Facilities. Journal of the American
Medical Directors Association, 23(3), 359-366.
https://doli.org/10.1016/j.jamda2021.05.023
Deek, H., Chang, S., Newton, P. J., Noureddine, S., Inglis, S. C., Arab, G. A., Kabbani, S.,
Chalak, W., Timani, N., MacDonald, P. S., & Davidson, P. M. (2017). An Assessment
involving family caregivers in the self-care of heart failure patients on hospital
re-admission: Randomised Controlled trial (the Family study). International Journal of
Nursing Studies, 75, 101-111.
https://doi.org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2017.07.015
Du, R. Y., Shelton, G., Ledet, C. R., Mills, W. L., Neal-Herman, L., Horstman, M., Trautner,
B. Awad, S., Berger, D., & Naik, A. D. (2020). Implementation and feasibility of the
re-engineered discharge for surgery (RED-S) intervention. A pilot study. Journal for
Healthcare Quality: Official Publication of the National Association for Healthcare
Quality, 00, 1-9. https://doi.org/10.1097JHO.0000000000000266
Faiman, B. (2021). Quality Improvement Projects and Clinical Research Studies. Journal of the
advanced practitioner in oncology, 12(4), 360-361.
https://doi.org/10.6004/jadpro.2021.12.4.1
Gardner R. L., Pelland, K., Youssef, R., Morphis, B., Calandra, K., Hollands, L., &
Gitenstein, A. (2020). Reducing Hospital Readmissions Through a Skilled Nursing
Facility Discharge Intervention: A pragmatic Trial. Journal of the American Medical
Directors Association, 21(4), 508-512.
https://doi.org/lopes.idm.oclc.org/10.1016/jamda.2019.10.001
Hall, S., Lee, V., & Haase, K. (2020). Exploring the challenges of ethical conduct in quality
Improvement project ( help with nursing paper writing from experts with MSN & DNP degrees)s. Canadian oncology nursing journal = Revue Canadienne de
nursing oncologique, 30(1), 64-68.
Lyngggard, V., Zwisler, A. D., Taylor, R. S., May, O., & Nielsen, C. V. (2020). Effects of the
patient education strategy “Learning and Coping” in cardiac rehabilitation on
readmissions and mortality: a randomized controlled trial (LC-REHAB). Health
Education Research, 35(1), 74-85.
https://doi-org.lopes.idm.oclc.org/10.1093/her/cyz034
Mwachiro, D. M., Baron-Lee, J., & Kates, F. R. (2019). Impact of post-discharge follow-up
calls on 30-day hospital readmissions in neurosurgery. Global Journal on Quality and
Safety in Healthcare, 2(2), 46-52. https://doi.org/10.4103/jqsh.jqsh_29_18
Parker, J. M., & Hill, M. N. (2017). A review of advanced practice nursing in the United States,
Canada, Australia and Hong Kong Special Administrative Region (SAR), China,
International Journal of Nursing Sciences, 4(2), 196-204.
https://doi.org/10.1016/j.ijnss.2017.01.002
Pereira Sousa, J., Neves, H., & Pais-Vieira, M. (2021). Does Symptom Recognition Improve
Self-Care in Patients with Heart Failure? A Pilot Study Randomised Controlled Trial.
Nursing reports (Pavia, Italy), 11(2), 418-429. https://doi.org/10.3390/nursrep11020040
Rizzuto, N., Charles, G., & Knobf, M. T. (2022). Decreasing 30-Day Readmission Rates in
Patients With Heart Failure. Critical Care Nurse, 42(4), 13-19.
https://doi.org/lopes.idmoclc.org/10.4037/ccn2022417
Weerahandi, H., Li, L., Bao, H., Herrin, J., Dharmarajan, K., Ross, J. S., Kim. K. L., Jones, S. &
Horwitz, L. I. (2019). Risk for Readmission After Discharge From Skilled Nursing
Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study.
Journal of the American Medical Directors Association, 20(4), 432-437.
https://doi.org/10.1016/j.jamda.2019.01.135
Yip, J. Y. C. (2021). Theory-Based Advance Nursing Practice: A Practice Update on the
Application of Orem’s Self-Care Deficit Nursing Theory. SAGE open nursing, 7,
23779608211011993. https://doi.org/10.1177/23779608211011993

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