Heart failure is the number one cause of hospitalization among adults over the age of 65 in the United States. More than one million people are hospitalized every year with a primary diagnosis of heart failure. This accounts for more than $17 billion in Medicare expenditures. Even though there have been significant improvements in medical therapy that lead to improved outcomes with medical treatment, hospital admission rates after hospitalization for heart failure continue to remain high. More than half of congestive heart failure patients must be readmitted to the hospital within six months of their initial discharge (Desai & Stevenson, 2012).
A reduction in readmission rates could lead to improved quality of care as well as reduced costs which have led both public and private payers to target pay-for-performance incentives on reducing readmission rates. Desai and Stevenson noted “In 2009, the US Center for Medicare & Medicaid Services began public reporting of all-cause readmission rates after heart failure hospitalization, and, in the following year, the Patient Protection and Affordable Care Act established financial penalties for hospitals with the highest readmission rates during the first 30 days after discharge.” As concern regarding the necessity of reducing readmission rates has increased, a national research and hospital-driven efforts has been focused on developing predictions of which patients with congestive heart failure are more likely to be admitted to the hospital again and what interventions could be used to reduce the need for readmission (Desai & Stevenson, 2012).
A variety of different applications could be considered when attempting to reduce the readmission rates of congestive heart failure patients. The P or patient population will remain the same in all questions and can be identified as congestive heart failure patients. O or outcome will be not readmitted to the hospital. T or time can also be the same as a timeframe of 30 days. It is the I or intervention, and C or comparison intervention that would be different in five different PICOT questions (Polit & Beck, 2017).
A comparison of transitional care (I) versus usual care (C) could be considered (Fu, Lee, Stewart, & Yu, 2015). This question would be difficult for one person to study as it would require outside facilities and would be outside the capacity of one individual. Another PICOT question could consider the use of mobile technology (I) compared to traditional one-on-one education (C) (Inglis, Du, Dennison Himmelfarb, & Davidson, 2015). Again, this would require the creation of mobile apps and other technology that would be outside of the scope of possibility for this research. One-hour education sessions (I) could be tested against standard discharge instructions (C). While this PICOT question was a viable option and could produce data that could lead to improvement in nursing interventions, it is not strong enough, and there were better options for improving the quality of care for congestive heart failure patients.
Continuous education while hospitalized (I) versus peri discharge and post-discharge education (C) is another PICOT option. Working with the PICOT question “In Congestive Heart Failure (CHF) Patients (P) what is the effect of providing daily education on CHF (I) compared to traditional education (C) on the rates of readmission (O) within a 30-day study (T)” is the best choice. Daily education has the potential for developing significant data and improved readmission rates for people with congestive heart failure while at the same time is an easy enough task for one person to carry out a study. Data can be collected and can prove or disprove this as an appropriate nursing intervention.
The P is patients that have been admitted to the hospital for the first time with a primary diagnosis of congestive heart failure. The I is daily education about congestive heart failure and how to develop a healthy lifestyle and diet starting from the day the patient is diagnosed to the hospital, through 30 days after discharge. Most patients with congestive heart failure need repeated education sessions as there is a significant amount of data and information to be understood and condition and treatment that the patient is going to undergo may change over time (Stromberg, 2005). The C intervention is traditional education. In the typical setting, education does not begin upon diagnosis as the patient is not normally receptive to training and stress can trigger a cardiovascular crisis. Stromberg describes “The most appropriate time for extensive education is when the patient is in a stable condition and has started to adapt to living with heart failure” (Stromberg, 2005). The goal outcome of the research is to prevent readmission as there is such a high incidence of this occurring in the patient population. Finally, the T frame that is being studied is 30 days. While it is common for readmissions to occur within six months, researching a smaller window of time will show the acute effects of the educational interventions.
To search for previous studies that would fit with the PICOT question, a thorough search must be completed. Using specific search terms will return the most relevant journal articles. Terms that should be included are congestive heart failure, CHF, daily education, traditional education, nursing education interventions, patient education, teaching methods, teaching implications, reducing readmissions, learning theory. Working with these search terms should provide accurate information and data to answer the question “In Congestive Heart Failure (CHF) Patients (P) what is the effect of providing daily education on CHF (I) compared to traditional education (C) on the rates of readmission (O) within a 30-day study (T)?”
- Desai, A., & Stevenson, L. (2012). Rehospitalization for Heart Failure. Circulation, 501-515.
- Fu, D., Lee, D., Stewart, S., & Yu, C.-M. (2015). Effect of Nurse-Implemented Transitional Care for Chinese Individuals with Chronic Heart Failure in Hong Kong: A Randomized Controlled Trial. Journal of the American Geriatrics Society, 1583-1593.
- Inglis, S., Du, H., Dennison Himmelfarb, C., & Davidson, P. (2015). mHealth education interventions in heart failure. Cochran Library.
- Polit, D., & Beck, C. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
- Stromberg, A. (2005). The crucial role of patient education in heart failure. The European Journal of Heart Failure, 363– 369.