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Maria Adorno

Analyzing Published Research

Chamberlain College of Nursing

NR 449

May 2020
ANALYZING PUBLISHED RESEARCH 2

Analyzing Published Research

Clinical Research

1. Problem is described: What is the focus of your group’s work? 2. Significance of the problem

is described: What health outcomes result from your problem? Or what statistics document this is

a problem? You may find support on websites for government or professional organizations. 3.

Purpose of your paper: What will your paper do or describe? “The purpose of this paper is

to . . .” **Please note that although most of these questions are the same as you addressed in

paper 1, the purpose of this paper is different. You can use your work from paper 1 for items 1

and 2 above, including any suggestions for improvement provided as feedback. Item 3 above

should be specific to this paper

The purpose of the research is to determine the impact of follow up care post-discharge.

I will be comparing two articles that I have selected and will determine if the data found will

support or answer our PICO question; “will ensuring appropriate follow-up care post-discharge

reduce the risk of hospital readmissions compared with providing discharge education alone”

specifically focusing on the elderly populations,?

Over the years, discharging patients from the hospital has been increasingly more

difficult. Not only are hospital discharges a complicated process but involve several challenges.

One of the biggest problems related to discharges is unplanned readmissions. The problem with

continued unplanned readmissions is that it costs our government roughly 15 to 20 billion dollars

annually (Hospital discharge and readmission, n.d). Why is patient readmission so significant?
PREVENTING HOSPITAL READMISSION 3

The significance of this issue is that it dramatically affects our healthcare system.

Preventing avoidable readmissions would have the potential to substantially improve not only

our patient’s quality of life but also our healthcare system's financial wellbeing. For example,

according to the Medicare Payment Advisory Commission (MedPAC), if we were able to prevent

10% of the unnecessary readmittances, Medicare could potentially save one billion dollars a year

(McIlvennan, 2015, May 19). It will be interesting to compare and contrast the impact of follow-

up care post-discharge on hospital readmission rates compared with providing discharge

education alone.

Description of Findings on the Matrix Table

The first article by Afsaneh Bjorvatn took a qualitative approach to the study of the

relationships responsible for patient readmission. The focus was to look into the occurrences and

determinants among elderly patients and the rate of hospital readmissions. The study

conducted was based on information gathered from the registered inpatient admissions data

from public hospitals from 1999 to 2006 (Bjorvatn, A, 2015). Researchers found that during

this block of time, the average stay in the hospital decreased.

Meanwhile, at the same time, the rate of hospital readmissions increased. Researchers

used instrumental variable regression models to find relationships and correlations to

determine the relationships between the frequency rate of patient stays and readmissions to the

hospital. The data found that there was a distinct relationship between the time or length of

visit a patient spent in the hospital and the probability of readmission. The article showed that

the longer a patient stayed in the hospital, the lower their likelihood of readmission. The

significant findings of the study concluded that the patient’s age, comorbidities, and complexity

of the treatment were contributing factors associated with readmissions. The conclusions of
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this article lead me to believe that because of all of the health variables that could negatively

affect patients in the elderly demographics, ensuring appropriate follow-up care post-discharge

would reduce the risk of hospital readmissions more significantly than just giving them discharge

instructions alone.

The second article by Hughes took a more detailed and specific approach to the problem

of hospital readmissions. They narrowed down their field of view and only focused on

readmissions within thirty and one hundred- and eighty-days from discharge from an elderly

rehabilitation unit. The purpose of the study was to discover the reasons for elderly readmissions

from healthcare facilities within thirty and one hundred and eighty days from being discharged.

Concepts

Both studies used the same method of research gathering and used primary data

collection to gather statistical information from a specific period. Both mostly used

the public medical records, one from 1999 to 2006, and the other over thirteen years to conduct a

quantitative study to quantify the data from a sample of the elderly population. The overall

concepts of the studies where to show the relationship between discharged patients who were

unnecessarily readmitted and its effects on both the patients and the healthcare system's financial

wellbeing.

Methods

The study conducted by Bjorvatn used roughly 270, 266 randomly selected elderly

patients to determine the frequency of hospital readmissions among the elderly population

(Bjorvatn, A, 2015). The data collected was from public hospital medical records from 1999 to

2006 (Bjorvatn, A, 2015). The researchers took the data collected and made the percentage of
PREVENTING HOSPITAL READMISSION 5

hospital readmissions and correlated the findings with the amount of money that it costs our

healthcare system each year.

The second article by Hughes looked at the problem set through a more specific lens and

focused on thirty and one hundred- and eighty-day readmissions over thirteen years. By doing

so, they were able to collect clinical data on the frequency of admissions based on demographics,

comorbid disease, and length of hospital stay, and number of medications on discharge (Hughes,

2018).

Both studies compiled the statistical data from their research and determined that hospital

readmission both are needlessly increasing the amount of money our hospitals spend each year,

and only just a slight decrease in the number of unnecessary readmissions could save our

healthcare programs a substantial amount of money.

Participants

The first article studied 270, 266 randomly selected elderly patients to determine the

frequency of hospital readmissions among the elderly population (Bjorvatn, A, 2015). The only

requirement that this study had was focused on discharges between 1999 and 2006. The second

article studied individual patients over a thirteen-year period, and its only requirement was that it

focused on hospital readmissions within thirty to one hundred and eighty days from discharge.

Instruments

Both studies reviewed the statistical data retrieved from the public hospital records

research the reasons why patients were readmitted and connected them to reasons why they

affect the patient and the healthcare industry. The first study focused on readmissions between

1999 to 2006. While the second collected and interpreted data collected over a thirteen period.

The first study conducted a survey covering all readmissions. While the second study only
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included readmissions between thirty to one hundred and eighty days from discharge. I felt that

the data collected from the first study by Bjorvatn was more of a broader view of hospital

readmission because it covered any and all readmission while the second one was more specific

information. However, I would say the second study, even though it was more specific, was not

as reliable because they were not able to get a solid pattern accurate enough to determine specific

reasons for patient readmissions.

Purpose and Conclusion

After comparing each of the articles, I believe that they both have similar findings that

can significantly benefit my group's research on hospital readmissions. Both studies compiled the

statistical data from each of their research and determined that hospital readmission both affects

the amount of money our hospitals spend each year, and that decrease or preventing unnecessary

readmissions could save our healthcare programs a substantial amount of money. The first study

found a relationship between the length of stay and the probability of readmission. The study

found that the longer a patient stays in the hospital, the lower the patient's likelihood of

readmission. The second study, while using similar methods of data collection as the first article,

found that most of the reasons for readmissions in elderly patients were different from their

original hospital admission and were unable to solidify an actual pattern as the reasons why a

patient was being readmitted.

The next step for my group will be to compare all the different studies and cross-

reference what we found from our different articles and us the data collected and conduct a more

detailed analysis to help further progress on our PICO question. We will conduct a more

thorough internal study of our collective articles and determine whether giving appropriate
PREVENTING HOSPITAL READMISSION 7

follow-up care post-discharge actually reduces the risk of hospital readmissions versus just

providing discharge education alone.

References

Bjorvatn, A. (2015). Hospital readmission among elderly patients. The European Journal of

Health Economics, 14(5), 809-820. Doi: 10.1007/s10198-012-0426-3

Houser, J. (2018). Nursing research reading, using, and creating evidence (4th ed). Boston, MA:

Jones & Bartlett Learning, LLC.

Hospital discharge and readmission. (n.d.). Retrieved from

https://www.uptodate.com/contents/hospital-discharge-and-readmission.

Hughes, L. D., & Witham, M. D. (2018). Causes and correlates of 30 days and 180-day

readmission following discharge from a Medicine for the Elderly Rehabilitation

unit. BMC Geriatrics, 18(1). DOI: 10.1186/s12877-018-0883-3

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McIlvennan, C. K., Eapen, Z. J. & Allen, L. A. (2015, May 19). Hospital readmissions reduction

program. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439931/