Running Head: QUANTITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATIONS 1 CRITIQUE 2 Quantitative Research Critique and Ethical Considerations Angelique Christoffel Grand Canyon University Nurs 433V June Helbig August 30, 2020 Quantitative Research Critique and Ethical Considerations Article ‘Reducing Behavioral Inpatient Readmissions for People with Substance Use Disorders: Do Follow-up Services Matter’ is written by Reif, S., Acevedo, A., Garnick, D. W., & Fullerton, C. A. (2017) and they have evaluated the effectiveness of the follow-up which extended for the period of fourteen days among the people who had a problem of substance abuse and this follow-up took place after the discharge from the hospital. It has been found out that readmission is common among the patients having the problem of substance abuse which is major because of the lack of any kind of subsequent communication between the patients and doctors after their discharge. Background of Study The research question in the article aims at evaluating the effectiveness of the services provided in the follow-up sessions. The article ‘Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity’ is written by Wakeman, S. E., Metlay, J. P., Chang, Y., Herman, G. E., & Rigotti, N. A. (2017) in which they assessed the impact of the hospital-based intervention among people who had a problem of drug use and alcohol use during their hospital visits. People suffering from substance abuse a mostly taken care of in the general medical setting. The hospital-based intervention for such patients also included the addiction consultation in the inpatient setting and research has shown that such interventions can improve the outcomes. The interventions which include the consultation and follow-up settings are usually performed by the nurses who significantly increase the value of their profession and they are given more responsibility that becomes beneficial for them. My research question is as follows:  “In mental health patients with substance use disorders (P), does treatment, (I) as compared to non-treatment, (C), reduce readmissions, (O) within 90 days?” The effectiveness of the intervention treatment in the patients with substance abuse will be evaluated in my research study and the hypothesis states that such intervention can reduce the chances of readmission back to the hospitals among the patients with the problem of drug and alcohol abuse. Addiction is the worst thing and once people get addicted, it becomes harder for them to leave their dependence and stay clean even when they are given the medical and hospital interventions. It has been found out that lack of medical co ...

1. Running Head: QUANTITATIVE RESEARCH CRITIQUE AND
ETHICAL CONSIDERATIONS
1
CRITIQUE
2
Quantitative Research Critique and Ethical Considerations
Angelique Christoffel
Grand Canyon University
Nurs 433V
June Helbig
August 30, 2020
Quantitative Research Critique and Ethical Considerations
Article ‘Reducing Behavioral Inpatient Readmissions for People
with Substance Use Disorders: Do Follow-up Services Matter’
is written by Reif, S., Acevedo, A., Garnick, D. W., &
Fullerton, C. A. (2017) and they have evaluated the
effectiveness of the follow-up which extended for the period of
fourteen days among the people who had a problem of substance

2. abuse and this follow-up took place after the discharge from the
hospital. It has been found out that readmission is common
among the patients having the problem of substance abuse
which is major because of the lack of any kind of subsequent
communication between the patients and doctors after their
discharge.
Background of Study
The research question in the article aims at evaluating the
effectiveness of the services provided in the follow -up sessions.
The article ‘Inpatient Addiction Consultation for Hospitalized
Patients Increases Post-Discharge Abstinence and Reduces
Addiction Severity’ is written by Wakeman, S. E., Metlay, J. P.,
Chang, Y., Herman, G. E., & Rigotti, N. A. (2017) in which
they assessed the impact of the hospital-based intervention
among people who had a problem of drug use and alcohol use
during their hospital visits. People suffering from substance
abuse a mostly taken care of in the general medical setting. The
hospital-based intervention for such patients also included the
addiction consultation in the inpatient setting and research has
shown that such interventions can improve the outcomes. The
interventions which include the consultation and follow-up
settings are usually performed by the nurses who significantly
increase the value of their profession and they are given more
responsibility that becomes beneficial for them. My research
question is as follows:
“In mental health patients with substance use disorders (P),
does treatment, (I) as compared to non-treatment, (C), reduce
readmissions, (O) within 90 days?”
The effectiveness of the intervention treatment in the patients
with substance abuse will be evaluated in my research study and
the hypothesis states that such intervention can reduce the
chances of readmission back to the hospitals among the patients
with the problem of drug and alcohol abuse. Addiction is the
worst thing and once people get addicted, it becomes harder for
them to leave their dependence and stay clean even when they
are given the medical and hospital interventions. It has been

3. found out that lack of medical consultation in the follow -up
increases the risk of readmission. Therapies are also found
effective in reducing dependence among patients with substance
abuse. The selected articles for this assignment had chosen two
different interventions and their impact on the readmission
among patients. Interventions include hospital-based
intervention including therapy and consultation and fourteen
days follow-up. These studies will find out the impact of any
kind of intervention which will assist in answering the selected
research problem. The time periods in which interventions are
monitored are different from the one selected in PICOT but that
will help the question because the selected time period is more
than what is being evaluated in the assignments. The
intervention plan includes the follow-up and the consultation in
addition to providing the regular services. The comparison
groups’ selection is also on point because patients suffering
from alcohol and drug use from different age groups are
selected in these studies.
How do these two articles support the nurse practice issue
you chose?
The sample selected in the study ‘Reducing Behavioral Inpatient
Readmissions for People with Substance Use Disorders: Do
Follow-up Services Matter’ includes people from the age of 18
to 64 suffering from the problem of substance abuse and along
with that inclusion criteria included their inpatient hospital stay
and residential detoxification. The intervention plan includes
residential and outpatient treatment, medication-assisted
treatment, and intensive outpatient treatment. The intervention
was conducted and evaluated in people belonging to ten
different states and was given index admission numbers and
follow-up prevalence services. Survival analyses were

4. conducted in which time-variant independent variables were
analyzed and at the same time connection of follow-up services
with the medication-assisted treatment was assessed in relation
to the behavioral health readmissions frequency. People from
different age groups were added into this study which is a plus
point because the impact of different people will be evaluated
but it has a negative point of having a different time frame than
the research question.
Method of Study
The prospective quasi-experiment for the thirty days post-
discharge is conducted in people having additional consultation
from doctors and the ones without any kind of consultation in
the article ‘Inpatient Addiction Consultation for Hospitalized
Patients Increases Post-Discharge Abstinence and Reduces
Addiction Severity’. The people from urban academic hospitals
were evaluated and selected which were a total of 399 adults.
The intervention used for them had a multidisciplinary approach
including pharmacotherapy initiation, motivational counseling,
relation with the ongoing addiction treatment, and treatment
planning. The calculation was conducted on the basis of the
Addiction Severity Index (ASI). The inclusion of people from
different age groups was a plus point but the limitation of the
time frame poses a negative challenge to the chosen research
problem.
Results of Study
The results of ‘Reducing Behavioral Inpatient Readmissions for
People with Substance Use Disorders: Do Follow-up Services
Matter’ showed that twenty-nine percent of patients got the
follow-up checkup who had behavioral health admission before.
However, the combination of residential treatment and
medication-assisted treatment improved their overall outcomes
and decreased their chances of getting readmission again in
three months. At the same time, the ones without outpatient
follow-up became more vulnerable to the chances of
readmission. The conclusion stated that such medication-

5. assisted treatment and residential treatment after the inpatient
treatment and detoxification minimizes the risk of future
readmission and hence it is recommended to the Medicaid
programs to improve their residential treatment and medication-
assisted treatment.
The results of ‘Inpatient Addiction Consultation for
Hospitalized Patients Increases Post-Discharge Abstinence and
Reduces Addiction Severity’ showed that patients in the
intervention group getting the follow-up sessions have
decreased ASI composite score. Results remained the same in
people belonging to different genders, ages, and severity of
diseases but the people without any kind of follow -up were
found out to be vulnerable to readmission. Therefore the
addiction consultation was found to be effective in reducing the
chances of getting addicted to alcohol and substance abuse. The
chosen research studies presented that any kind of information
including the consultation and follow-up decreases the pressure
from the medical profession because fewer people are
readmitted again and hence it also helped in signifying the
importance of nurse’s intervention.
Ethical Considerations
Therefore, it is found out that there is a correlation between the
reduced readmissions and the intervention treatments in the
form of follow-ups. The anticipated outcome of the research
suggests that intervention in the form of treatment in people
suffering from substance abuse can minimize the chances of
readmission in hospitals due to the same reason in ninety days.
The selected studies have shown that intervention in form of the
addiction consultation and follow-ups decreases the readmission
risk in the people suffering from substance use disorders, which
is also the same as the anticipated outcome of my research
study.

6. References
Wakeman, S. E., Metlay, J. P., Chang, Y., Herman, G. E., &
Rigotti, N. A. (2017). Inpatient addiction consultation for
hospitalized patients increases post-discharge abstinence and
reduces addiction severity.
Journal of general internal medicine,
32(8), 909-916.
https://doi.org/10.1007/s11606-017-4077-z
· Reif, S., Acevedo, A., Garnick, D. W., & Fullerton, C. A.
(2017). Reducing behavioral health inpatient readmissions for
people with substance use disorders: do follow -up services
matter?
Psychiatric services,
68(8), 810-818.
10.1176/appi.ps.201600339
Research Critique Guidelines – Part I
Use this document to organize your essay. Successful
completion of this assignment requires that you provide a
rationale, include examples, and reference content from the

7. studies in your responses.
Qualitative Studies
Background of Study
1. Summary of studies. Include problem, significance to
nursing, purpose, objective, and research question.
How do these two articles support the nurse practice issue you
chose?
1. Discuss how these two articles will be used to answer your
PICOT question.
2. Describe how the interventions and comparison groups in the
articles compare to those identified in your PICOT question.
Method of Study:
1. State the methods of the two articles you are comparing and
describe how they are different.
2. Consider the methods you identified in your chosen articles
and state one benefit and one limitation of each method.
Results of Study
1. Summarize the key findings of each study in one or two
comprehensive paragraphs.
2. What are the implications of the two studies in nursing
practice?
Ethical Considerations
1. Discuss two ethical consideration in conducting research.
2. Describe how the researchers in the two articles you choose
took these ethical considerations into account while performing
their research.
© 2019. Grand Canyon University. All Rights Reserved.
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RUNNING HEADER: QUALITATIVE RESEARCH CRITIQUE
AND ETHICAL CONSIDERATIONS 1

8. QUALITATIVE RESEARCH CRITIQUE AND ETHICAL
CONSIDERATIONS 7
Qualitative Research Critique and Ethical Considerations
Angelique Christoffel
Grand Canyon University
Nurs 433V
June Helbig
August 23, 2020
Qualitative Research Critique and Ethical Considerations
The following critical appraisal of two studies is based on the
PICOT question; In mental health patients with substance use
disorders, does treatment, compared to non-treatment, reduce
readmissions within 90 days? The articles chosen for the
appraisal are "Qualitative study of perspectives concerning
recent rehospitalizations among a high-risk cohort of veteran
patients in Connecticut, USA" by Antony, Grau, and Brienza,
and "Contribution of Psychiatric Illness and Substance Use to
30-Day Readmission Risk" by Burke, Donzé, and Schnipper.
Background of Study

9. In the article by Antony et al., the authors note that
hospital readmissions have been a rising problem that has now
become a national issue. It is said that readmissions are related
to increased cost, and the relationship between quality of care
and readmissions has been vague. Besides, the costs that
readmissions incur, readmissions cause more complications for
patients such as chronic comorbidities and increase impaired
functional status, which makes increases their risk of death
(Antony et al., 2018). Moreover, there have been system-level
factors that have been associated with increased negative
patient outcomes of death and rehospitalization. The study
focuses on veteran affairs. These patients are at a higher risk of
rehospitalization due to their older age, poor or lack of social
support, low socioeconomic status, and pre-existing
comorbidities (Antony et al., 2018). The study's objective was
to explore patients' perceptions about the factors that contribute
to rehospitalization and recommendations that minimize this
risk.
In the article by Burke et al., the authors also note that
readmissions are costly, especially among psychiatric patients.
The study seeks to investigate the influence of psychiatric
illness to readmission risk. According to the study, a psychiatric
sickness may contribute to readmissions within the first 30
days, which is related to increased resource utilization (Burke et
al., 2013). In New York hospitals, for example, mental illness
patients discharged from the hospitals were more likely to be
readmitted than their counterparts without mental illnesses. This
resulted in an increased length of stay by approximately a day
on average (Burke et al., 2013). The study's objective was to
evaluate the independent contribution of psychiatric illness and
substance abuse to the potentially avoidable 30-day
readmissions in medical patients. The study's purpose is to
determine the function of psychiatric illness and substance use
in the risk for medical readmission.
How do these two articles support the nurse practice issue you
chose?

10. According to the objectives of the two studies, it is clear that
both studies are set to find the relationship between
readmissions and psychiatric illness and substance use, and
other factors that affect readmissions and how to reduce the
risk. Antony et al. (2018) found that the participants cited
structural barriers such as the inability to access primary care
providers and restricted involvement of care providers in
medical choices as the main factors, although some thought that
readmission could not be prevented (Antony et al., 2018). The
study found that the most effective intervention was to increase
primary care providers during medical decision-making about
readmission alongside effective communication between
patients and their families (Antony et al., 2018).
Burke et al. (2013) found that patients treated for mental
illnesses were at a higher risk of avoidable readmissions, while
outpatient clients prescribed with psychiatric medication were
at a higher risk for all-cause readmissions. The study suggests
that inpatient medical providers' compulsory community
treatment and follow-up would be helpful interventions to
reduce readmission risk (Burke et al., 2013). These
interventions relate to the PICOT question since they are non-
treatment options that would help reduce readmissions in mental
illness patients.
Method of Study
In the article by Antony et al., the study was qualitative and
purposive sampling. It was applied to employ potential veteran
affairs (VA) patients who were above 18 years, readmitted
within the last 30 days after discharge, and were mentally
competent to give consent and were medically stable. The
participants were determined through a retrospective chart
review, and a talk was held with the ward nurse for
admissibility (Antony et al., 2018). After that, interviews of
between 20-30 minutes were held, and audiotapes and all
participants gave their written consent. An advantage of using
the interviews was that it identified essential contextual factors
that would not be otherwise found in a qualitative study

11. (Antony et al., 2018). However, the study involved a small
sample size through a non-probability method that limited the
probability of generalization. Moreover, the study mostly
involved Caucasian male patients; therefore, it would not
accurately present the theme across all VA patients and females.
The study by Burke et al. (2013) was a reflective group
study of repeated adult patients cleared from the Brigham and
Women's Hospital. The study used a mixture of inpatient and
outpatient administrative and clinical data to recognize study
participants. Patients were excluded if they left against medical
advice or were discharged to another facility. The exclusion was
also made in the case of death within the facility. The study
approach allowed for quick identification of a large cohort
unaffected by selection bias (Burke et al., 2013). The
disadvantage of the study method was that it was single-
centered and limited generalization while limiting its ability to
diagnose psychiatric disease conclusively. The two study
methods differed in sampling methods since one used
probability sampling, while the other used non-probability
sampling.
Results of Study
In the article by Antony et al., the mean age of the participants
was 71.6 years, with all participants having previous medical
situations or accounts of mental disorders. Of the 18
participants, 17 were male and one female (Antony et al., 2018).
The participants noted that inaccessible care providers and
limited care provider involvement in their readmissions
contributed to their readmissions. However, there were some
that thought that readmission was inevitable.
In the article by Burke et al., there were 1260
readmissions out of 6987 discharged patients (18%), where
5.6% (388) readmissions were potentially avoidable. The

12. multivariate analysis found that two or more prescribed
outpatient psychiatric drugs were related to increased all -cause
readmissions. In contrast, the discharge diagnosis of substance
abuse or anxiety was related to fewer all-cause admissions
(Burke et al., 2013). According to Antony et al., (2018),
strategies such as proactive post-discharge outreach for high-
risk patients, increased access for patient care, and patient
education was essential in light of the results. The study by
Burke et al. suggests that their findings be used to stratify
patients in hospital facilities in terms of risk.
Ethical Considerations
Ethical considerations in research involve processes such
as protecting the rights of the subjects, and publication of
research information. Some of the issues include informed
consent and respect for anonymity and confidentiality. Informed
consent means that the participants are fully aware of their
participation in the research, and knowingly agree to parti cipate
by giving a clear and manifest consent. In the article by Antony
et al., the participants gave a written consent form, which they
submitted before the study commenced (Antony et al., 2018).
Respect for confidentiality and anonymity is expressed when a
person's identity is not connected to their responses, and the
participant's identity is protected. Moreover, both studies
ensured confidentiality and anonymity by protecting personal
information and only publishing medical information relevant to
the studies. The study participants' identities were not revealed
in the studies.

13. References
Antony, S. M., Grau, L. E., & Brienza, R. S. (2018). A
qualitative study of perspectives concerning recent
rehospitalizations among a high-risk cohort of veteran patients
in Connecticut, USA.
BMJ Open,
8(6), e018200.
https://doi.org/10.1136/bmjopen-2017-018200
Burke, R. E., Donzé, J., & Schnipper, J. L. (2013). Contribution
of psychiatric illness and substance abuse to 30-day readmission
risk.
Journal of Hospital Medicine,
8(8), 450-455.
https://doi.org/10.1002/jhm.2044