Evidence Based Practice Proposal Dissemination

Sample Answer

Introduction

Chronic diseases have profound impacts on health outcomes. They are typical in the emergency department (ED) since they are associated with high hospitalization and admission rates, extended hospital stay, high health care costs, and patients’ death. As a result, healthcare professionals should intervene appropriately through evidence-based solutions that match patient needs. The proposed project explores how implementing case management (CM) in the ED can enhance outcomes. CM involves establishing a provider-customer relationship between the case manager and the patient to provide value-based care (Marcotte & Liao, 2020). Other defining elements central to its effectiveness include engaging family members, following patients after discharge, and collaborating with the patient when developing the treatment plan.

Introduction-PICOT Statement

The PICOT approach helps nurses to develop a PICOT statement that specifies the population or the practice problem, proposed intervention, comparison, outcome, and timeframe. The population of interest includes adults with chronic diseases frequently using the ED or having frequent inpatient admissions. The intervention is case management expected to have better outcomes than traditional discharge from hospital. Positive outcomes due to case management implementation include reduced length of stay and a significant decline in emergency visits and hospital admissions. Like other EBP projects, the current project should have a timeline. The targeted outcomes are expected to be achieved within 6-12 months.

Organizational Culture and Readiness

Healthcare organizations cannot embrace and sustain change without the right culture. The organization is primarily hierarchical, implying that the management is responsible for the final decisions. However, elements of clan and adhocracy cultures dominate the structure and leadership. Such elements include people-centered decisions, engaging staff, supporting innovation, and a collaborative work environment. Organizational change is likely to thrive in such environments.

The Organizational Readiness to Change Assessment (ORCA) tool was used to measure the organization’s readiness for change. The tool assesses organizational readiness by examining the strength of evidence, context of the environment, and facilitation through staff, stakeholders, and resources (Kononowech et al., 2021). Overall, the proposed change is backed by strong evidence, stakeholder support is high, and the timing for the change is appropriate.

Successful change also requires organizations to be continuously committed to improving care quality, safety, and cost-effectiveness. The organization can use both organization-wide and employee-centered strategies to achieve this goal. Effective strategies include adopting appropriate strategies for care improvement, conducting performance appraisals, employee motivation, and employee engagement in decision-making.

Strategies to better facilitate readiness include frequent change assessment exercises, active communication, and employee training and development. Stakeholders and team members required for the project include leaders for support, the nursing staff as project implementers, and patients as the focus population. Suitable technologies for a successful project include patients’ screening gadgets, risk assessment tools, and electronic communication devices/technologies.

Problem Statement and Literature Review

Chronic illnesses make up 7 of the 10 causes of diseases worldwide (Joo & Huber, 2019). They have devastating effects on health care since they increase the rate of unplanned admissions and hospital utilization. The increased number of patient visits for non-emergent care in the ED overcrowds the critical care departments causing delays and other adverse outcomes. Implementing case management would lead to better outcomes including reducing hospital stay, emergency visits and readmissions.

Nursing literature has explored whether case management can achieve the targeted outcomes and provide different findings. According to Kim and Lee (2020) CM improves self-care ability, health care utilization, and costs. In a different study, McCants et al. (2019) found that CM can reduce readmissions with over 80% rate, underscoring its effectiveness in improving health outcomes in the ED.

Literature Review

In a retrospective chart review of the ED and inpatient visits, Grover et al. (2018) found that CM reduced ED visits by 49%, inpatient visits by 39%, and length of stay by 178 days. As a result, it is more effective than traditional discharge system in reducing health care spending, length of stay, and ED visits. Perera and Dabnry (2020) found CM effective in improving overall care quality and patient satisfaction while Hudon et al. (2018) found it effective in improving patients’ sense of security and self-management. Mattei da Silva et al. (2020) found CM effective in reducing blood pressure among chronic patients. It also improved medical adherence.

As one of the project’s expected outcomes, CM can reduce ED visits by effectively guiding patients through the treatment process (Moschetti et al., 2018). In a different study, Wong et al. (2021) found CM a suitable approach for improving medication adherence, quality of life, and self-efficacy. According to La Regina et al. (2020), CM improves adherence to individual care and reduces waiting time. In the last study, Uittenbroek et al. (2018) found that CM allows health care professionals to focus more on the patient’s health (patient-centeredness) as they communicate with colleagues. This is critical in effective disease management among patients with chronic diseases.

Change Model/Framework

The Iowa model of change was selected to implement the proposed project. The model promotes evidence-based practice in health care by ensuring that change is based on scientific evidence. Its central components include improving patient care through evidence, enhancing nursing practice, and monitoring healthcare costs (Duff et al., 2020).

The first step of the Iowa model is identifying the trigger prompting change. Next, the problem is prioritized based on its effects on health outcomes. The third step involves selecting the implement team followed by gathering appropriate evidence. The fifth step is critiquing and synthesizing research to ensure change is based on solid evidence. If there is adequate evidence (step 6) the proposed change is piloted (step 7) and outcomes evaluated (step 8).

Implementation Plan

The setting for the project is the ED where adults with chronic diseases visit frequently. Research subjects are primarily nurses, physicians, and patients who can be accessed after obtaining informed consent from them. The proposed timeline is between 6 and 12 months to ensure that it is flexible enough and allows smooth implementation. Financial resources are required to purchase any material, devices, or technologies required and facilitate the training. Human resources include the nursing staff to implement case management and community-based volunteers.

The project will use a non-experimental mixed method approach and data will be collected via baseline interviews and surveys. Questionnaires/surveys will be used to evaluate the effectiveness of case management. The intervention is expected to succeed through increased emphasis on case management in the facility and developing effective community alliances with stakeholders to achieve the desired results. Health education and training of staff in the facility will also help to improve preparedness and awareness.

Stakeholders include administrators, healthcare staff, patients and families, community health volunteers who will play different roles as dispensed and as their skills and experience obligate. Possible barriers include limited resources and time, inadequate knowledge and skills, negative attitude. To counter them, training, communication and feedback, engaging all stakeholders will be prioritized. Besides addressing a critical patient problem, the project is feasible since the organization is a Magnet facility that emphasizes a change culture. Thus, the project will get huge support.

Evaluation Plan

The expected outcomes of the project include reduced length of stay, emergency visits, and readmissions (clinically and statistically significant difference). Data will be collected via both quantitative and qualitative methods using surveys and interviews from the providers. The most appropriate statistical test for the project is a regression test since it demonstrates the situation before and after implementing the EBP intervention. A significant reduction in length of stay, emergency visits, and readmissions will indicate positive outcomes as anticipated.

The project will be maintained if it achieves positive outcomes. Extension implies positive results and allowing the project to be implemented in other units. A revision will be needed where the project needs to be customized if some components do not align with the organizational goals and objectives. It will be discontinued if it is not sustainable based on cost-benefit analysis.

Conclusion

The proposed intervention is implementing case management in the ED to achieve better health outcomes than the traditional discharge plan. Expected outcomes include reduced length of stay, emergency visits, and readmissions. Achieving these outcomes implies reducing healthcare costs and improving overall health outcomes in the ED and entire organization. The implementation period is expected to consume 6-12 months and the Iowa model will guide the implementation process. The main stakeholders include nurse administrators, nursing staff, patients and families. They should collaborate in every phase and each stakeholder should understand CM in detail to embrace and support it to avoid delays or possible project collapse.

References

•  Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment An interpretive description. Implementation Science Communications, 1(1), 1-9. https //doi.org/10.1186/s43058-020-00070-0
• Grover, C. A., Sughair, J., Stoopes, S., Guillen, F., Tellez, L., Wilson, T. M., Gaccione, C., & Close, R. (2018). Case management reduces length of stay, charges, and testing in emergency department frequent users. The Western Journal of Emergency Medicine, 19(2), 238–244. https //doi.org/10.5811/westjem.2017.9.34710
• Hudon, C., Chouinard, M. C., Dubois, M. F., Roberge, P., Loignon, C., Tchouaket, É., … & Bouliane, D. (2018). Case management in primary care for frequent users of health care services A mixed methods study. The Annals of Family Medicine, 16(3), 232-239. https //doi.org/10.1370/afm.2233
• Joo, J. Y., & Huber, D. L. (2019). Case management effectiveness on health care utilization outcomes A systematic review of reviews. Western journal of nursing research, 41(1), 111–133. https //doi.org/10.1177/0193945918762135
• Kim, M. J., & Lee, E. (2020). How to reduce excessive use of the health care service in Medical Aid beneficiaries Effectiveness of community-based case management. International Journal of Environmental Research and Public Health, 17(7), 2503. http //dx.doi.org/10.3390/ijerph17072503
• Kononowech, J., Hagedorn, H., Hall, C., Helfrich, C. D., Lambert-Kerzner, A. C., Miller, S. C., … & Damschroder, L. (2021). Mapping the organizational readiness to change assessment to the Consolidated Framework for Implementation Research. Implementation Science Communications, 2(1), 1-6. https //doi.org/10.1186/s43058-021-00121-0
• La Regina, R., Pandolfi, D., Stabile, N., Beloni, L., Glisenti, F., Griggio, P., … & La Regina, G. (2020). A new case manager for diabetic patients A pilot observational study of the role of community pharmacists and pharmacy services in the case management of diabetic patients. Pharmacy, 8(4), 193. https //doi.org/10.3390/pharmacy8040193
• Marcotte, L. M., & Liao, J. M. (2020). What we talk about when we talk about care management. The American Journal of Managed Care, 26(6), 245–247. https //doi.org/10.37765/ajmc.2020.43486
• Mattei da Silva, A. T., de Fátima Mantovani, M., Castanho Moreira, R., Perez Arthur, J., & Molina de Souza, R. (2020). Nursing case management for people with hypertension in primary health care A randomized controlled trial. Research in Nursing & Health, 43(1), 68-78. https //doi.org/10.1002/nur.21994
• McCants, K. M., Reid, K. B., Williams, I., Miller, D. E., Rubin, R., & Dutton, S. (2019). The impact of case management on reducing readmission for patients diagnosed with heart failure and diabetes. Professional Case Management, 24(4), 177-193. doi 10.1097/NCM.0000000000000359
• Moschetti, K., Iglesias, K., Baggio, S., Velonaki, V., Hugli, O., Burnand, B., … & Bodenmann, P. (2018). Health care costs of case management for frequent users of the emergency department Hospital and insurance perspectives. PloS One, 13(9), e0199691. https //doi.org/10.1371/journal.pone.0199691
• Perera, S., & Dabney, B. W. (2020). Case management service quality and patient-centered care. Journal of Health Organization and Management, 34(5), 551-568. https //doi.org/10.1108/JHOM-12-2019-0347
• Uittenbroek, R. J., van der Mei, S. F., Slotman, K., Reijneveld, S. A., & Wynia, K. (2018). Experiences of case managers in providing person-centered and integrated care based on the Chronic Care Model A qualitative study on embrace. PloS One, 13(11), e0207109. https //doi.org/10.1371/journal.pone.0207109
• Wong, A. K. C., Wong, F. K. Y., Chow, K. K. S., Wong, S. M., & Lee, P. H. (2021). Effect of a telecare case management program for older adults who are homebound during the COVID-19 pandemic A pilot randomized clinical trial. JAMA Network Open, 4(9), e2123453-e2123453. doi 10.1001/jamanetworkopen.2021.23453