The purpose of this initial paper is to briefly describe your search strategies when identifying two articles that pertain to an evidence-based practice topic of interest. Mine is on Avoiding Hospital Readmissions. I will be focusing as an individual on examining the sources of knowledge that contribute to professional nursing practice qualitative or quantitative design? Apply research principles to the interpretation of the content of published research studies. "What is the number of trends in 30-day post-discharge mortality among beneficiaries after the implementation of HRRP -- period 3 and 4, for mortality rate in myocardial infarctions?" (Wadhera, et al., 2018)
Clinical Question:
A. Describe problem
b. Significance of problem in terms of outcomes or statistics
c. Your PICOT question in support of the group topic
d. Purpose of your paper
B. Levels of Evidence
a. Type of question asked
b. Best evidence found to answer question
C. Search Strategy
a. Search terms
b. Databases used (you may use Google Scholar in addition to the library databases; start with the Library)
c. Refinement decisions made
d. Identification of two most relevant articles
D. Format
a. Correct grammar and spelling
b. Use of headings for each section
c. Use of APA format (sixth edition)
d. Page length: three to four pages
Clinical Question
45 points 28%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. What is your PICOT question? 4. Purpose of your paper. What will your paper do or describe? This is similar to a problem statement. “The purpose of this paper is to . . .”
Levels of Evidence
20 points 13% 1. What type of question are you asking (therapy, prognosis, meaning, etc.)? 2. What is the best type of evidence to be found to answer that question (e.g., RCT, cohort study, qualitative study)?
Search Strategy
65 points 41% 1. Search topic(s) provided. What did you use for search terms? 2. What database(s) did you use? Link your search with the PICOT question described above. 3. As you did your search, what decisions did you make in refinement to get your required articles down to a reasonable number for review? Were any limits used? If so, what? 4. Identify the two most relevant and helpful articles that will provide guidance for your next paper and the group’s work. Why were these two selected?
Format
30 points 18% 1. Correct grammar and spelling 2. Use of headings for each section: Clinical Question, Level of Evidence, Search Strategy, Conclusion 3. APA format (sixth ed.) 4. Paper length: three to four pages
Total worth 160 points
DIRECTIONS AND ASSIGNMENT CRITERIA Assign ment Criteria Points % Description Clinical Question 45
28 1. Problem is described. What is the focus of your group’s work.
Critical Review of Published ArticlesAccording to the syllabus, .docxfaithxdunce63732
Critical Review of Published Articles
According to the syllabus, MGMT 650 students are
… required to complete a critical review of one research orientated journal article. The article will be selected by the student with approval of the instructor from peer-reviewed journals in an area of interest to the student. The article reviewed will use descriptive statistics that the student has been exposed to in the first 4 - 6 weeks of this course. Students will choose articles to review from UMUC’s library resources.
For the article, students may select a topic of their interest. The empirical research article, “Academic procrastination and statistics anxiety” used for Sessions 1 and 2 Discussion assignments (see Conferences section), is an example of a descriptive statistical research article. In addition, the students are encouraged to use UMUC’s Library to locate an empirical research article. Finally, the instructor of the course must approve the article. Students should upload the pdf version of the article in the Workbook section of the online class.
Empirical Research Articles
If you never read an empirical research article, the following web sites will help you to understand the difference between a primary empirical research article and a secondary article:
1. http://www.nsu.edu/library/pdf/EmpiricalResearch.pdf
2. http://www.up.edu/showimage/show.aspx?file=12944
APA Writing Style
To help with the organization of the critique information in the 5- to 7-page report, the students are required to use APA format 6th edition with headings and subheadings.
Critique Report Format
The critique report format was adapted from the University of Michigan web site: http://open.umich.edu/sites/default/files/Topic8Assignment-CritiqueArticle.pdf.
1. Title page, which includes (a) title of the empirical research article and author’s name(s), (b) your name, (c) Turnitin reliability index score, (d) running head with continuous page numbers, and (e) date. The title page does not count towards the 5- to 7-pages for the critique report.
2. Problem statement and purpose (Answer the following questions; however, do not write the questions in the report.) In addition, from the empirical research report, include the page number(s) to answers the questions:
a. What were the purpose and/or problem of the research study?
b. What are the independent and dependent variables of the study? Correctly, identify the independent and dependent variables.
3. Review of literature and theoretical framework (Answer the following questions; however, do not write the questions in the report.) In addition, from the empirical research report, include the page number(s) to answers the questions:
a. What concepts/theories are included in the review? Please explain them.
b. Did the author discuss the independent and dependent variables? If so, provide examples from the literature review.
4. Hypotheses and/or research questions (Answer the following questions; however, do not wr.
Developing PICO QuestionsDetermining the topic of an evaluation .docxeve2xjazwa
Developing PICO Questions
Determining the topic of an evaluation is one of the most important steps of the evaluation process. In the process of selecting a topic for evaluation, researchers should reflect on what information needs to be gathered and how it will be used. A PICO question can provide the foundation for this process. The PICO question requires researchers to determine the population to be studied, select the intervention that occurred or will occur (such as a new system), have a baseline with which to compare the evaluation, and finally, have a standard to measure the outcome of the project. Using a PICO question as a guideline helps ensure the evaluation is focused and effective.
In this Discussion, you generate a PICO question that corresponds to the Evaluation Plan Focus you developed last week.
To prepare:
Develop a PICO question based on the Evaluation Plan Focus Assignment completed last week.
Reflect on why it is important that this question be answered. Identify the “who cares?” factor.
By Day tomorrow 12/28/2016, write a minimum of 550 words essay in APA format with a minimum of 3 reference from the list provided below. Include the level one headings as numbered below:
1)
Post
a summary of key points (evaluation goal, viewpoint, and model) from your Evaluation Plan Focus Assignment.
2)
Post your PICO question. Explain why you developed this question, and why it is important to be considered.
Required Readings
Friedman, C. P., & Wyatt, J. C. (2010). Evaluation methods in biomedical informatics (2nd ed.). New York, NY: Springer Science+Business Media, Inc.
Chapter 3, “Determining What to Study” (pp. 48–84)
This chapter focuses on how to identify the relevant questions to cover in an evaluation and how to ensure that the scope of the question is appropriate. It includes a description of different types of evaluations, including what they specifically focus on and the general type of questions they address.
Gschwandtner, T., Kaiser, K., & Miksch, S. (2011). Information requisition is the core of guideline-based medical care: Which information is needed for whom? Journal of Evaluation in Clinical Practice, 17(4), 713–721.
Retrieved from the Walden Library databases.
This article describes the construction of a comprehensive information source to be used in the development of computerized clinical practice guideline (CPG). The authors emphasize how the information source is designed to meet the informational requirements of anyone developing a CPG for any user group.
Lin, J. W., Chang, C. H., Lin, M. W., Ebell, M. H., & Chiang, J. H. (2011). Automating the process of critical appraisal and assessing the strength of evidence with information extraction technology. Journal of Evaluation in Clinical Practice, 17(4), 832–838.
Retrieved from the Walden Library databases.
The authors of this article explain a study that sought to create and evaluate a system to automatically determine a medical article’s e.
[Title]-Stem cell treatment and the positive impact on autoimmune .docxgerardkortney
[Title]-Stem cell treatment and the positive impact on autoimmune diseases.
Research Question-What positive impact has the use of the stem cell treatment in patients with autoimmune diseases?
Objectives of the project.
1. To investigate the use of stem cell treatment in autoimmune diseases.
2. To demonstrate the positive impact of using stem cells to treat autoimmune diseases.
3. To present through a systematic review of the literature therapeutic options with stem cells that have the ability to successfully treat patients with autoimmune diseases.
Theoretical Framework- La teoría de la consecución de objetivos desarrollada por Imogene King.
My job no needed PICOT question due to be a literature review.
My References-I Needs more references
Ahmed, Z., Imdad, A., Connelly, J. A., & Acra, S. (2019). Autoimmune Enteropathy: An Updated Review with Special Focus on Stem Cell Transplant Therapy. Digestive Diseases & Sciences, 64(3), 643–654. https://doi-org.librarylogin-cupey.uagm.edu/10.1007/s10620-018-5364-1
Snowden, J. A., Sharrack, B., Akil, M., Kiely, D. G., Lobo, A., Kazmi, M., Muraro, P. A., & Lindsay, J. O. (2018). Autologous haematopoietic stem cell transplantation (aHSCT) for severe resistant autoimmune and inflammatory diseases -- a guide for the generalist. Clinical Medicine, 18(4), 329–334. https://doi-org.librarylogin-cupey.uagm.edu/10.7861/clinmedicine.18-4-329
Ferreira Zombrilli, A., Leopoldo, V. C., Oliveira, M. C., Cirioli de Oliveira, M. de F., Ehmke Dolci, M., Merizio Martins Braga, F. T., & de Campos Pereira Silveira, R. C. (2019). Virtual learning object in hematopoietic stem cell transplantation for autoimmune diseases. Revista Brasileira de Enfermagem, 72(4), 994–1000. https://doi-org.librarylogin-cupey.uagm.edu/10.1590/0034-7167-2018-0669
Balassa, K., Danby, R., & Rocha, V. (2019). Haematopoietic stem cell transplants: principles and indications. British Journal of Hospital Medicine (17508460), 80(1), 33–39. https://doi-org.librarylogin cupey.uagm.edu/10.12968/hmed.2019.80.1.33
Van Laar, J. M., Naraghi, K., & Tyndall, A. (2015). Haematopoietic stem cell transplantation for poor-prognosis systemic sclerosis. Rheumatology, 54(12), 2126–2133. https://doi-org.librarylogin-cupey.uagm.edu/10.1093/rheumatology/kev117
Atkins, H., Freedman, M., Atkins, H. L., & Freedman, M. S. (2017). Five Questions Answered: A Review of Autologous Hematopoietic Stem Cell Transplantation for the Treatment of Multiple Sclerosis. Neurotherapeutics, 14(4), 888–893. https://doi-org.librarylogin-cupey.uagm.edu/10.1007/s13311-017-0564-5
Currò, D., Mancardi, G., & Currò, D. (2016). Autologous hematopoietic stem cell transplantation in multiple sclerosis: 20 years of experience. Neurological Sciences, 37(6), 857–865. https://doi-org.librarylogin-cupey.uagm.edu/10.1007/s10072-016-2564-3
Baharlou, R., Rashidi, N., Ahmadi-Vasmehjani, A., Khoubyari, M., Sheikh, M., & Erfanian, S. (2019). Immunomodulatory Effects of Human Adipose Tissue-derived Mesenchymal Ste.
Running head: RESEARCH TYPES
1
Title of PaperStudent NameWalden University
Class Number, Section Number, Class Name
Date of Submission
SEE PAGE 5
Title of Paper
Introduction to topic that gives the audience and idea of what you will be discussing in the paper. This should be a brief paragraph that provides an overview of the key points that will be addressed. This section should be concluded with a purpose statement. The purpose of this paper is …consider the intent of the application and list all requirements.
Research Methodologies
Discuss the attributes of quantitative and qualitative research methods and compare/contrast the type of information you can obtain from both types of research. Make sure you are referencing the course learning materials as well as some external references. You should have a minimum of three course learning resource references and two credible external references. Remember that web sites are only considered credible if they end in .gov, .edu, or .org.
Advantages and Disadvantages
Discuss the reality that there are advantages and disadvantages to both types of research.
Quantitative Research
Evaluate the advantages and disadvantages of quantitative research. When is it helpful and when is it not helpful. Consider things like type of information that you are seeking, ethics, time needed to complete, etc.
Qualitative Research
Evaluate the advantages and disadvantages of quantitative research. When is it helpful and when is it not helpful. Consider things like type of information that you are seeking, ethics, time needed to complete, etc. Also, make sure you address the argument that qualitative research is not real science. Is this true? Why or why not? What value does qualitative research have in nursing practice?
Summary
Write a one paragraph summary of the main points of the paper. This is not an area for adding new information. That should be in the body of your paper. Do not forget to appropriately cite in references in this section too. This is a good place to pull in your course learning resources again.
References
Last name, X. (Year of publication). Name of online article. Source. Retrieved from http:// www.nameofwebsite.com
Last name, X. X. (Year of publication). Name of book here. City, State Initial: Publisher.
Last name, X. X. (Year of publication). Name of journal article: Capitalize only letters after punctuation marks. The Journal of Whatever, Volume (Number), Page-Page. doi: number if available.
Last name, X. X. (Year of publication). Name of journal article: Capitalize only letters after punctuation marks. The Journal of Whatever, Volume (Number), Page-Page. doi: number if available.
Last name, X. X. (Year of publication). Name of journal article: Capitalize only letters after punctuation marks. The Journal of Whatever, Volume (Number), Page-Page. doi: number if available.
Last name, X. X. (Year of publication) ...
Course Project Part 3—Translating Evidence Into PracticeIn Part.docxbuffydtesurina
Course Project: Part 3—Translating Evidence Into Practice
In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.
Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.
To prepare:
Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
PLEASE REFER TO FILES ATTACHED BELOW
With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
Explore possible consequences of failing to adopt the evidence-based practice that you identified.
Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?
To complete:
In a 3- to 4-page paper:
1) Restate your PICOT question and its significance to nursing practice.
My PICOT question is:
does hand washing and appropriate staff dressing among the surgical ward nurses reduce cross infection during patient management?
2) Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles. Please refer to the articles below:
Aiken, A. M., Karuri, D. M., Wanyoro, A. K., & Macleod, J. (2012). Interventional studies for preventing surgical site infections in sub-Saharan Africa.
International Journal of Surgery
, 242-249. Doi: 10.1016/
j
.ijsu.2012.04.004
Al-Khawaldeh, O., Al-Hussami, M., & Darawad, M. (2015).
Influence of Nursing Students Handwashing Knowledge, Beliefs, and Attitudes on Their Handwashing Compliance
.
Scientific Research Publishing
. Doi:
http://dx.doi.org.ezp.waldenulibrary.org/10.4236/health.2015.75068
Bukhari, S., Hussain, W., Banjar, A., Almaimani, W., Karima, T., & Fatani, M. (2011).
Hand hygiene compliance rate among healthcare professionals.
PubMed - NCBI
.
Ncbi.nlm.nih.gov
. Retrieved 1 April 2016, from
http://www.ncbi.nlm.nih.gov/pubmed/21556474
3) Explain how the evidence-based practice that you identified contributes to better outcomes. In addi.
This presentation was funded by CDC and PEPFAR through the SUCCEED project at Stellenbosch University. The presentation was delivered by Ms Lynn Hendricks from the Centre for Evidence Based Health Care in July 2017
Critical Review of Published ArticlesAccording to the syllabus, .docxfaithxdunce63732
Critical Review of Published Articles
According to the syllabus, MGMT 650 students are
… required to complete a critical review of one research orientated journal article. The article will be selected by the student with approval of the instructor from peer-reviewed journals in an area of interest to the student. The article reviewed will use descriptive statistics that the student has been exposed to in the first 4 - 6 weeks of this course. Students will choose articles to review from UMUC’s library resources.
For the article, students may select a topic of their interest. The empirical research article, “Academic procrastination and statistics anxiety” used for Sessions 1 and 2 Discussion assignments (see Conferences section), is an example of a descriptive statistical research article. In addition, the students are encouraged to use UMUC’s Library to locate an empirical research article. Finally, the instructor of the course must approve the article. Students should upload the pdf version of the article in the Workbook section of the online class.
Empirical Research Articles
If you never read an empirical research article, the following web sites will help you to understand the difference between a primary empirical research article and a secondary article:
1. http://www.nsu.edu/library/pdf/EmpiricalResearch.pdf
2. http://www.up.edu/showimage/show.aspx?file=12944
APA Writing Style
To help with the organization of the critique information in the 5- to 7-page report, the students are required to use APA format 6th edition with headings and subheadings.
Critique Report Format
The critique report format was adapted from the University of Michigan web site: http://open.umich.edu/sites/default/files/Topic8Assignment-CritiqueArticle.pdf.
1. Title page, which includes (a) title of the empirical research article and author’s name(s), (b) your name, (c) Turnitin reliability index score, (d) running head with continuous page numbers, and (e) date. The title page does not count towards the 5- to 7-pages for the critique report.
2. Problem statement and purpose (Answer the following questions; however, do not write the questions in the report.) In addition, from the empirical research report, include the page number(s) to answers the questions:
a. What were the purpose and/or problem of the research study?
b. What are the independent and dependent variables of the study? Correctly, identify the independent and dependent variables.
3. Review of literature and theoretical framework (Answer the following questions; however, do not write the questions in the report.) In addition, from the empirical research report, include the page number(s) to answers the questions:
a. What concepts/theories are included in the review? Please explain them.
b. Did the author discuss the independent and dependent variables? If so, provide examples from the literature review.
4. Hypotheses and/or research questions (Answer the following questions; however, do not wr.
Developing PICO QuestionsDetermining the topic of an evaluation .docxeve2xjazwa
Developing PICO Questions
Determining the topic of an evaluation is one of the most important steps of the evaluation process. In the process of selecting a topic for evaluation, researchers should reflect on what information needs to be gathered and how it will be used. A PICO question can provide the foundation for this process. The PICO question requires researchers to determine the population to be studied, select the intervention that occurred or will occur (such as a new system), have a baseline with which to compare the evaluation, and finally, have a standard to measure the outcome of the project. Using a PICO question as a guideline helps ensure the evaluation is focused and effective.
In this Discussion, you generate a PICO question that corresponds to the Evaluation Plan Focus you developed last week.
To prepare:
Develop a PICO question based on the Evaluation Plan Focus Assignment completed last week.
Reflect on why it is important that this question be answered. Identify the “who cares?” factor.
By Day tomorrow 12/28/2016, write a minimum of 550 words essay in APA format with a minimum of 3 reference from the list provided below. Include the level one headings as numbered below:
1)
Post
a summary of key points (evaluation goal, viewpoint, and model) from your Evaluation Plan Focus Assignment.
2)
Post your PICO question. Explain why you developed this question, and why it is important to be considered.
Required Readings
Friedman, C. P., & Wyatt, J. C. (2010). Evaluation methods in biomedical informatics (2nd ed.). New York, NY: Springer Science+Business Media, Inc.
Chapter 3, “Determining What to Study” (pp. 48–84)
This chapter focuses on how to identify the relevant questions to cover in an evaluation and how to ensure that the scope of the question is appropriate. It includes a description of different types of evaluations, including what they specifically focus on and the general type of questions they address.
Gschwandtner, T., Kaiser, K., & Miksch, S. (2011). Information requisition is the core of guideline-based medical care: Which information is needed for whom? Journal of Evaluation in Clinical Practice, 17(4), 713–721.
Retrieved from the Walden Library databases.
This article describes the construction of a comprehensive information source to be used in the development of computerized clinical practice guideline (CPG). The authors emphasize how the information source is designed to meet the informational requirements of anyone developing a CPG for any user group.
Lin, J. W., Chang, C. H., Lin, M. W., Ebell, M. H., & Chiang, J. H. (2011). Automating the process of critical appraisal and assessing the strength of evidence with information extraction technology. Journal of Evaluation in Clinical Practice, 17(4), 832–838.
Retrieved from the Walden Library databases.
The authors of this article explain a study that sought to create and evaluate a system to automatically determine a medical article’s e.
[Title]-Stem cell treatment and the positive impact on autoimmune .docxgerardkortney
[Title]-Stem cell treatment and the positive impact on autoimmune diseases.
Research Question-What positive impact has the use of the stem cell treatment in patients with autoimmune diseases?
Objectives of the project.
1. To investigate the use of stem cell treatment in autoimmune diseases.
2. To demonstrate the positive impact of using stem cells to treat autoimmune diseases.
3. To present through a systematic review of the literature therapeutic options with stem cells that have the ability to successfully treat patients with autoimmune diseases.
Theoretical Framework- La teoría de la consecución de objetivos desarrollada por Imogene King.
My job no needed PICOT question due to be a literature review.
My References-I Needs more references
Ahmed, Z., Imdad, A., Connelly, J. A., & Acra, S. (2019). Autoimmune Enteropathy: An Updated Review with Special Focus on Stem Cell Transplant Therapy. Digestive Diseases & Sciences, 64(3), 643–654. https://doi-org.librarylogin-cupey.uagm.edu/10.1007/s10620-018-5364-1
Snowden, J. A., Sharrack, B., Akil, M., Kiely, D. G., Lobo, A., Kazmi, M., Muraro, P. A., & Lindsay, J. O. (2018). Autologous haematopoietic stem cell transplantation (aHSCT) for severe resistant autoimmune and inflammatory diseases -- a guide for the generalist. Clinical Medicine, 18(4), 329–334. https://doi-org.librarylogin-cupey.uagm.edu/10.7861/clinmedicine.18-4-329
Ferreira Zombrilli, A., Leopoldo, V. C., Oliveira, M. C., Cirioli de Oliveira, M. de F., Ehmke Dolci, M., Merizio Martins Braga, F. T., & de Campos Pereira Silveira, R. C. (2019). Virtual learning object in hematopoietic stem cell transplantation for autoimmune diseases. Revista Brasileira de Enfermagem, 72(4), 994–1000. https://doi-org.librarylogin-cupey.uagm.edu/10.1590/0034-7167-2018-0669
Balassa, K., Danby, R., & Rocha, V. (2019). Haematopoietic stem cell transplants: principles and indications. British Journal of Hospital Medicine (17508460), 80(1), 33–39. https://doi-org.librarylogin cupey.uagm.edu/10.12968/hmed.2019.80.1.33
Van Laar, J. M., Naraghi, K., & Tyndall, A. (2015). Haematopoietic stem cell transplantation for poor-prognosis systemic sclerosis. Rheumatology, 54(12), 2126–2133. https://doi-org.librarylogin-cupey.uagm.edu/10.1093/rheumatology/kev117
Atkins, H., Freedman, M., Atkins, H. L., & Freedman, M. S. (2017). Five Questions Answered: A Review of Autologous Hematopoietic Stem Cell Transplantation for the Treatment of Multiple Sclerosis. Neurotherapeutics, 14(4), 888–893. https://doi-org.librarylogin-cupey.uagm.edu/10.1007/s13311-017-0564-5
Currò, D., Mancardi, G., & Currò, D. (2016). Autologous hematopoietic stem cell transplantation in multiple sclerosis: 20 years of experience. Neurological Sciences, 37(6), 857–865. https://doi-org.librarylogin-cupey.uagm.edu/10.1007/s10072-016-2564-3
Baharlou, R., Rashidi, N., Ahmadi-Vasmehjani, A., Khoubyari, M., Sheikh, M., & Erfanian, S. (2019). Immunomodulatory Effects of Human Adipose Tissue-derived Mesenchymal Ste.
Running head: RESEARCH TYPES
1
Title of PaperStudent NameWalden University
Class Number, Section Number, Class Name
Date of Submission
SEE PAGE 5
Title of Paper
Introduction to topic that gives the audience and idea of what you will be discussing in the paper. This should be a brief paragraph that provides an overview of the key points that will be addressed. This section should be concluded with a purpose statement. The purpose of this paper is …consider the intent of the application and list all requirements.
Research Methodologies
Discuss the attributes of quantitative and qualitative research methods and compare/contrast the type of information you can obtain from both types of research. Make sure you are referencing the course learning materials as well as some external references. You should have a minimum of three course learning resource references and two credible external references. Remember that web sites are only considered credible if they end in .gov, .edu, or .org.
Advantages and Disadvantages
Discuss the reality that there are advantages and disadvantages to both types of research.
Quantitative Research
Evaluate the advantages and disadvantages of quantitative research. When is it helpful and when is it not helpful. Consider things like type of information that you are seeking, ethics, time needed to complete, etc.
Qualitative Research
Evaluate the advantages and disadvantages of quantitative research. When is it helpful and when is it not helpful. Consider things like type of information that you are seeking, ethics, time needed to complete, etc. Also, make sure you address the argument that qualitative research is not real science. Is this true? Why or why not? What value does qualitative research have in nursing practice?
Summary
Write a one paragraph summary of the main points of the paper. This is not an area for adding new information. That should be in the body of your paper. Do not forget to appropriately cite in references in this section too. This is a good place to pull in your course learning resources again.
References
Last name, X. (Year of publication). Name of online article. Source. Retrieved from http:// www.nameofwebsite.com
Last name, X. X. (Year of publication). Name of book here. City, State Initial: Publisher.
Last name, X. X. (Year of publication). Name of journal article: Capitalize only letters after punctuation marks. The Journal of Whatever, Volume (Number), Page-Page. doi: number if available.
Last name, X. X. (Year of publication). Name of journal article: Capitalize only letters after punctuation marks. The Journal of Whatever, Volume (Number), Page-Page. doi: number if available.
Last name, X. X. (Year of publication). Name of journal article: Capitalize only letters after punctuation marks. The Journal of Whatever, Volume (Number), Page-Page. doi: number if available.
Last name, X. X. (Year of publication) ...
Course Project Part 3—Translating Evidence Into PracticeIn Part.docxbuffydtesurina
Course Project: Part 3—Translating Evidence Into Practice
In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.
Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.
To prepare:
Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
PLEASE REFER TO FILES ATTACHED BELOW
With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
Explore possible consequences of failing to adopt the evidence-based practice that you identified.
Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?
To complete:
In a 3- to 4-page paper:
1) Restate your PICOT question and its significance to nursing practice.
My PICOT question is:
does hand washing and appropriate staff dressing among the surgical ward nurses reduce cross infection during patient management?
2) Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles. Please refer to the articles below:
Aiken, A. M., Karuri, D. M., Wanyoro, A. K., & Macleod, J. (2012). Interventional studies for preventing surgical site infections in sub-Saharan Africa.
International Journal of Surgery
, 242-249. Doi: 10.1016/
j
.ijsu.2012.04.004
Al-Khawaldeh, O., Al-Hussami, M., & Darawad, M. (2015).
Influence of Nursing Students Handwashing Knowledge, Beliefs, and Attitudes on Their Handwashing Compliance
.
Scientific Research Publishing
. Doi:
http://dx.doi.org.ezp.waldenulibrary.org/10.4236/health.2015.75068
Bukhari, S., Hussain, W., Banjar, A., Almaimani, W., Karima, T., & Fatani, M. (2011).
Hand hygiene compliance rate among healthcare professionals.
PubMed - NCBI
.
Ncbi.nlm.nih.gov
. Retrieved 1 April 2016, from
http://www.ncbi.nlm.nih.gov/pubmed/21556474
3) Explain how the evidence-based practice that you identified contributes to better outcomes. In addi.
This presentation was funded by CDC and PEPFAR through the SUCCEED project at Stellenbosch University. The presentation was delivered by Ms Lynn Hendricks from the Centre for Evidence Based Health Care in July 2017
Course Project Part 3—Translating Evidence Into PracticeIn Pa.docxbuffydtesurina
Course Project: Part 3—Translating Evidence Into Practice
In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.
Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.
To prepare:
Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
Explore possible consequences of failing to adopt the evidence-based practice that you identified.
Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?
To complete:
In a 3- to 4-page paper:
1) Restate your PICOT question and its significance to nursing practice.
My PICOT question is:
does hand washing and appropriate staff dressing among the surgical ward nurses reduce cross infection during patient management?
2) Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles. Please refer to the articles below:
Aiken, A. M., Karuri, D. M., Wanyoro, A. K., & Macleod, J. (2012). Interventional studies for preventing surgical site infections in sub-Saharan Africa.
International Journal of Surgery
, 242-249. Doi: 10.1016/
j
.ijsu.2012.04.004
Al-Khawaldeh, O., Al-Hussami, M., & Darawad, M. (2015).
Influence of Nursing Students Handwashing Knowledge, Beliefs, and Attitudes on Their Handwashing Compliance
.
Scientific Research Publishing
. Doi: http://dx.doi.org.ezp.waldenulibrary.org/10.4236/health.2015.75068
Bukhari, S., Hussain, W., Banjar, A., Almaimani, W., Karima, T., & Fatani, M. (2011).
Hand hygiene compliance rate among healthcare professionals.
PubMed - NCBI
.
Ncbi.nlm.nih.gov
. Retrieved 1 April 2016, from http://www.ncbi.nlm.nih.gov/pubmed/21556474
3) Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcom.
NURS-6052N-37, Essent of Evidence-Based Pract.2017Discussion-1.docxcarlibradley31429
NURS-6052N-37, Essent of Evidence-Based Pract.2017
Discussion:-1
Nursing Research and Evidence-Based Practice
In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.
Based on this evidence, you can formulate a question. In this Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).
To prepare:
Consider a recent clinical experience in which you were providing care for a patient.
Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?
What questions have you thought about in a particular area of care such as a procedure or policy?
Review Chapter 2, pages 31–34 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.
Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.
Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.
Learning Resources
Required Readings
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 1, “Introduction to Nursing Research in an Evidence-Based Practice Environment”
This chapter provides an introduction to nursing research, its history, and the evolution of evidence-based practice. It includes an overview of credible sources of evidences and a description of the different paradigms used in nursing research.
Chapter 2, “Evidence-Based Nursing: Translating Research Evidence into Practice”
The focus of this chapter includes an overview of the key aspects of evidence-based practice, a review of how to identify credible research and appraise its value, and, finally, a discussion on how to take the identified evidence and convert it into a practice.
Chapter 3, “Key Concepts and Steps in Qualitative and Quantitative Research.
(1) Critique Template for a Qualitative StudyNURS 6052Week.docxkatherncarlyle
(1): Critique Template for a Qualitative Study
NURS 6052
Week 6 Assignment: Application: Critiquing Quantitative, Qualitative, or Mixed Methods Studies (due by Day 7 of Week 7)
Date:
Your name:
Article reference (in APA style):
URL:
What is a critique? Simply stated, a critique is a critical analysis undertaken for some purpose. Nurses critique research for three main reasons: to improve their practice, to broaden their understanding, and to provide a base for the conduct of a study.
When the purpose is to improve practice, nurses must give special consideration to questions such as these:
· Are the research findings appropriate to my practice setting and situation?
· What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness?
· How might a proposed change in practice trigger changes in other aspects of practice?
To help you synthesize your learning throughout this course and prepare you to utilize research in your practice, you will be critiquing a qualitative, quantitative, or mixed-methods research study of your choice.
If the article is unavailable in a full-text version through the Walden University Library, you must e-mail the article as a PDF or Word attachment to your Instructor.
QUALITATIVE RESEARCH CRITIQUE
1. Research Issue and Purpose
What is the research question or issue of the referenced study? What is its purpose? (Sometimes ONLY the purpose is stated clearly and the question must be inferred from the introductory discussion of the purpose.)
2. Researcher Pre-understandings
Does the article include a discussion of the researcher’s pre-understandings? What does the article disclose about the researcher’s professional and personal perspectives on the research problem?
3. Literature Review
What is the quality of the literature review? Is the literature review current, relevant? Is there evidence that the author critiqued the literature or merely reported it without critique? Is there an integrated summary of the current knowledge base regarding the research problem, or does the literature review contain opinion or anecdotal articles without any synthesis or summary of the whole? (Sometimes the literature review is incorporated into the introductory section without being explicitly identified.)
4. Theoretical or Conceptual Framework
Is a theoretical or conceptual framework identified? If so, what is it? Is it a nursing framework or one drawn from another discipline? (Sometimes there is no explicitly identified theoretical or conceptual framework; in addition, many “nursing” research studies draw on a “borrowed” framework, e.g., stress, medical pathology, etc.)
5. Participants
Who were the participants? Is the setting or study group adequately described? Is the setting appropriate for the research question? What type of sampling strategy was used? Was it appropriate? Was the sample size adequate? Did t ...
Searching Databases (APA 7 format and at least 3-4 references)Wh.docxrtodd280
Searching Databases (APA 7 format and at least 3-4 references)
When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.
The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.
In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.
To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
Review the Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course.
By Day 3 of Week 4
Post a brief description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Then, post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.
By Day 6 of Week 4
Respond
to at least
two
of your colleagues
on two different days
and provide further suggestions on how their database search might be improved.
Mike RE: Discussion - Week 4/Initial (at least 2-3 references and APA 7 format)
Given the diverse nature of the health care industry, the ubiquitous array of multi faceted axillary services, the sector we service the most sometimes becomes the focus of our interest given the opportunity and longevity in such an institution. For the purpose of .
COMPLETED WEEK 2In 350-400 Words1. Share an example of evidencLynellBull52
COMPLETED WEEK 2
In 350-400 Words
1. Share an example of evidence-based practice from your work setting.
B & C. Describe how qualitative and quantitative research results can be used to solve practice problems. This is known as translational research.
2. Refer back to last module's discussion board item #4 in which you identified one or two potential problems that you are considering for your DNP Project. As we move into the building blocks for evidence, try to think about what you want to improve through your DNP project.
A. State the problem that you are considering for your DNP project.
B. Find a peer-reviewed quantitative research article that addresses this problem.
C & D. State the type of research design and the associated level of evidence in the article.
E. What critical appraisal questions did you use to critique this article from Melnyk Chapter 5? Please list both the question and the answer to each question. (Use the questions that match the research design in the article).
F. How can you use this evidence from your chosen article to solve your clinical problem?
RESOURCES
Corey, G. (2020).
Theory and practice of counseling and psychotherapy, enhanced. Cengage.
Denise F. Polit, & Cheryl Tatano Beck. (2017).
Nursing research : Generating and assessing evidence for nursing practice (Tenth edition ed.). Wolters Kluwer.
Knight, C., & Wheeler, K. (2020).
Case study approach to psychotherapy for advanced practice psychiatric nurses. Springer Publishing Company, Incorporated.
Moran, K. J., Burson, R., & Conrad, D. (2019a).
The doctor of nursing practice project (3rd ed.). Jones & Bartlett Learning, LLC.
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2019).
Translation of evidence into nursing and healthcare (3rd ed.). Springer Publishing Company, Incorporated.
ANSWER
Share an example of evidence-based practice from your work setting. Describe how qualitative and quantitative research results can solve practice problems.
The care given to adolescents who sustain mild traumatic brain injuries while participating in extracurricular activities is an example of evidence-based treatment in the school context, as I learned in my previous role as a school nurse. With experience as both a nurse and a coach (crucial in the absence of an athletic trainer at the school), this individual was looked to for advice if a student had a concussion or other head trauma while participating in a sport (Knight & Wheeler, 2020). Both quantitative and qualitative research methods can produce evidence for nursing practice and address issues that arise in the field. The findings of quantitative studies would be in the form of numerical, statistical data. Studies of phenomena or a more holistic focus can be gathered through qualitative research's use of narrative materials, available research methods, an ...
COMPLETED WEEK 2In 350-400 Words1. Share an example of evidencTaunyaCoffman887
COMPLETED WEEK 2
In 350-400 Words
1. Share an example of evidence-based practice from your work setting.
B & C. Describe how qualitative and quantitative research results can be used to solve practice problems. This is known as translational research.
2. Refer back to last module's discussion board item #4 in which you identified one or two potential problems that you are considering for your DNP Project. As we move into the building blocks for evidence, try to think about what you want to improve through your DNP project.
A. State the problem that you are considering for your DNP project.
B. Find a peer-reviewed quantitative research article that addresses this problem.
C & D. State the type of research design and the associated level of evidence in the article.
E. What critical appraisal questions did you use to critique this article from Melnyk Chapter 5? Please list both the question and the answer to each question. (Use the questions that match the research design in the article).
F. How can you use this evidence from your chosen article to solve your clinical problem?
RESOURCES
Corey, G. (2020).
Theory and practice of counseling and psychotherapy, enhanced. Cengage.
Denise F. Polit, & Cheryl Tatano Beck. (2017).
Nursing research : Generating and assessing evidence for nursing practice (Tenth edition ed.). Wolters Kluwer.
Knight, C., & Wheeler, K. (2020).
Case study approach to psychotherapy for advanced practice psychiatric nurses. Springer Publishing Company, Incorporated.
Moran, K. J., Burson, R., & Conrad, D. (2019a).
The doctor of nursing practice project (3rd ed.). Jones & Bartlett Learning, LLC.
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2019).
Translation of evidence into nursing and healthcare (3rd ed.). Springer Publishing Company, Incorporated.
ANSWER
Share an example of evidence-based practice from your work setting. Describe how qualitative and quantitative research results can solve practice problems.
The care given to adolescents who sustain mild traumatic brain injuries while participating in extracurricular activities is an example of evidence-based treatment in the school context, as I learned in my previous role as a school nurse. With experience as both a nurse and a coach (crucial in the absence of an athletic trainer at the school), this individual was looked to for advice if a student had a concussion or other head trauma while participating in a sport (Knight & Wheeler, 2020). Both quantitative and qualitative research methods can produce evidence for nursing practice and address issues that arise in the field. The findings of quantitative studies would be in the form of numerical, statistical data. Studies of phenomena or a more holistic focus can be gathered through qualitative research's use of narrative materials, available research methods, an ...
HOSP3075 Brand Analysis Paper 1This is the first of three assignme.docxsimonithomas47935
HOSP3075 Brand Analysis Paper 1
This is the first of three assignments you will complete by studying the hotel brand you have chosen. Please organize your paper using the topic headings below. You must use at least four sources to help you (including the company website). Use MLA format, and remember to cite your sources within the paper. Please double space.
Brand Overview and History (1/2 to 1 page)
Provide a brief history of the brand, with a timeline. Explain the geographic locations of the brand’s hotel properties, for example – “primarily in the Southwestern United States”, or “in the US, Canada, and Europe”. What is this brand’s parent company (if there is one)? What are the other brands in the company portfolio, and how does the brand you selected fit in?
Target Markets (1 to 2 pages)
Identify and describe two of the brand’s target markets.
In your description of each market, describe its geographic, demographic, psychographic, and/or behavioral characteristics. For example your brand might pursue a Leisure Transient Market that has these characteristics: millennial (demographic - life cycle), strivers (psychographic - lifestyle), from the USA (geographic - state), seeks free WIFI (behavioral – benefits sought).
Brand Position (1/2 to 1 page)
Describe the position of your brand. Start by making a clear, one or two-sentence positioning statement. Then provide some details, including any points-of-parity or points-of difference. Also, write a “brand mantra” for your brand. (See pages 65-67.)
Brand Elements (1 to 2 pages)
1. Identify and describe the brand elements (also known as brand identities). Elements include the brand name, URL, logo, symbols, characters, spokespersons, slogans, jingles, signage, and more.
2. Choose one of the brand elements, and analyze it based on the “criteria for choosing brand elements” as described in Chapter 4.
Conclusion (1/2 page)
Based on what you have learned about this brand so far, what is your opinion about its future?
Works Cited
Please use MLA format for your Works Cited page.
Research Proposal Part-2
Course Title and Code
Research Methods, C39RE
Course Lecturer
Dr. Esinath Ndiweni
Title of Research Proposal
Occupational Stress Management: Stress, Burnout and Coping among Nurses operating at Emergency Departments in Abu Dhabi
Student Name
Jesvin Joseph Augustine
HWID
H00259465
Program title:
B.A. Business and Finance
Word Count:
1854
Table of Contents
Introduction……………………………………………………………………………………………………………………………………..3
· Research Aim and Objectives……………………………………………………………………………………………….3
Research Strategy…………………………………………………………………………………………………………………………….3
· Research Philosophy…………………………………………………………………………………………………………….3
· Research Approach………………………………………………………………………………………………………………3
Data Collection Methods………………………………………………………………………………………………………………….4
· Semi-structured Interviews…………………………………………………………………………………………………..4
· Web-based Survey Questionnaires……………………………………………………………………………………….5.
Course Code EDU7702-8Course Start Date 02152016Sec.docxvanesaburnand
Course Code: EDU7702-8
Course Start Date: 02/15/2016
Section: Synthesis: Research problem, method, design
Week: 7
Activity: Develop Research Methodology for Hypothetical Research Study
Activity Due Date: 04/03/2016
Activity Description
For Week 6, you developed the research problem, purpose, and questions for both a qualitative and a quantitative research study. For this task, choose one of the research problems and questions that
you developed in Week 6 (either the qualitative or the quantitative) and develop the methodology for the chosen study.
Then, next week you will develop the methodology for the second study and then combine the methodology section with other elements of the study to create a concept paper. (Thus, you may want to
choose the study of most interest to you and develop the methodology for that study as part of the assignment for Week 8).
There are several documents in the NCU dissertation center that will be helpful in developing the research methodology for your Week 7 and Week 8 assignments. These include the concept paper
templates and the proposal templates. Details regarding the research methods for the dissertation are explained in Chapter 3 of the dissertation proposal. The dissertation proposal template shows the
sections that should be included in Chapter 3 of the dissertation proposal. These sections include the following:
1. Research Methods and Design(s)
2. Population
3. Sample
4. Materials/Instruments
5. Operational Definitions of Variables (Quantitative/Mixed Studies Only)
6. Data Collection, Processing, and Analysis
7. Assumptions
8. Limitations
9. Delimitations
10. Ethical Assurances
11. Summary
In developing the methodology section for this week’s assignment, you will want to address Sections 1-6 and Section 10. You will find a discussion of these sections below that will help you develop
these sections of the research methodology.
(1) Research Methods and Design: Explain the methodology and design that you will use to address the research purpose and questions. Will you use the qualitative methodology or the quantitative
methodology? Explain your reasoning for the methodology that you will use to answer the research questions. Why is the specific methodology appropriate for answering the research questions? Which
of the designs is appropriate for your study? Refer to Section 5 for a review of the qualitative and quantitative designs. Then, explain the design that you will use. When is this design appropriate for use
and why is the design appropriate for your research purpose and questions? You will want to cite sources for your reasoning to use the methodology that you use. Be sure to explain why the
methodology and design is appropriate for your study.
Potential sources for defending the methodology and design include the following:
Cozby, P. & Bates, S. (2012). Methods in behavioral research. Boston, MA: McGraw Hill Higher Education.
Creswell, J. W. (2014). Research design: Qu.
Running head 11Concept and statistics (Refe.docxtoddr4
Running head: 1
1
Concept and statistics (Referencias)
The more items, the more serious
Which is Why is it important?
At the end of the introduction say the purpose ...
Significance of the Practice Problem
Here he said he has to show that work is extremely important, that's why we're doing it.
What
As
When
Where
Research Question
PICOT Question + OBJETIVOS
Objectives: 3 objectives
Steps to answer the question, show how you answer the question.
Theoretical Framework
It's 2 theories
He says here is to choose any theory from those nurse Example Callista Roy. .or the others
And another theory that is NOT nursing, can be psychology ,,Freud,Erickson ....
And explain how these relate
Synthesis of the Literature
He wants 20 articles
According to Author such and collaborators ... Say
who studied? ,
showing chose
what a result
There are 20 paragraphs .... and everyone has to say about the article
Author, anus, type of study, #de sample and result ....
Practice Recommendations
In the end in the articles we recommend something, of each of the 20 articles, therefore it would be 10- 20 recommendations, because some articles may match.
Example Kirenia and Michel proposed this... without matching..
Project Description
THIS IS THE MOST IMPORTANT THING
Write this the same, putting it like this,
This project will be completed through a literature review. This will be carried out through Google Scholar, CINHAL, Ana G. Mendez Virtual Libraries, WorldCat, PubMed, Internet database. The research will be peer reviewed. A minimum 30 articles of no more than 5 years will be reviewed. I will use some keywords for my search like: Probiotic, Ventilator-Associated Pneumonia, ICU, conventional methods.
The results obtained from the study will contribute to determine if the probiotic use in prevention of ventilator associated pneumonia is more effective than the conventional method, with a more cost-effective result.
All information collected in this review will be kept in a locked dresser in the principal investigator's office for a period of 5 years. Both, the principal investigator and the mentor will have access to this material. After this time (5 years), the data will be eliminated with a paper shredder and discarded.
Project Evaluation Results
Summarize tables with all citation will be presented in appendix A&B; appendix A will be used for the summary of primary research evidence, and appendix B will be used for the summary of the systematic reviews.
Appendix A will include the citation, question or hypothesis, and theoretical foundation, research designated and sample size, key findings, recommendations or implications, and level of evidence, of each article. Appendix B will include citations, question, search strategy, inclusion/exclusion criteria, data, extraction and analysi.
#35538 Topic Week 10 Weighing the EvidenceNumber of Pages 1 .docxAASTHA76
#35538 Topic: Week 10: Weighing the Evidence
Number of Pages: 1 (Double Spaced)
Number of sources: 3
Writing Style: APA
Type of document: Dissertation Chapter - Discussion
Academic Level:Master
Category: Nursing
Language Style: English (U.S.)
Order Instructions: ATTACHED
Please follow the instructions of the discussion. Included the text book Polick & Beck (2017) in the references.I attached the order 3335318 that is needed to complete this work.
When conducting original research, the final step researchers must complete is weighing the evidence and interpreting the meanings of their data, statistics, and analyses. This is the culmination of the research process in which all of the research methods and designs can be synthesized into a meaningful conclusion. In this stage, researchers should formulate explanations for what their data indicates, determine whether the data answer their initial research question, identify areas of uncertainty, and consider directions for further research.
In this Discussion, you focus on one of the research articles that you identified for Part 2 of the Course Project (Literature Review). You then explore the process of how the researchers generated conclusions based on their data, consider other possible interpretations of their data, and formulate ideas for further research.
To prepare:
-Review this week’s Learning Resources, focusing on how researchers find meaning in their data and generate sound conclusions. Pay particular attention to Table 2 in the article, “Study Design in Medical Research.”
-Revisit the 5 articles that you identified in Part 2 of the Course Project(order 3335318). Select one to consider for the purpose of this Discussion.
-Read sections of the chosen article where the data is presented, analyzed, and interpreted for meaning. What reasoning process did the researchers use to formulate their conclusions? What explanation did they give to support their conclusions? Were there any weaknesses in their analysis or conclusions?
Consider possible alternate conclusions that the researchers could have drawn based on their data.
-Examine the findings that the article presents and consider how well they addressed the researcher’s initial question(s). -What additional research could be done to build on these findings and gain a fuller understanding of the question?
Required Readings
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Review Chapter 2, Fig. 2.1
Chapter 29, “Systematic Reviews of Research Evidence: Meta-analysis, Metasynthesis, and Mixed Studies Review”
This chapter focuses on the different types of systematic reviews. The chapter discusses the advantages of this type of analysis and the steps for conducting a meta-analysis or metasynthesis.
Dingle, P. (2011). Statin statistics: Lies and deception. Positive Health, 180, 1.
Retrieved from the.
Create a 3-5 page submission in which you develop a PICO(T) questiCruzIbarra161
Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.
Introduction
PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.
It stands for:
· P – Patient/population/problem.
· I – Intervention.
· C – Comparison (of potential interventions, typically).
· O - Outcome(s).
· T - Time frame (if time frame is relevant).
The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.
You are encouraged to complete the Vila Health PICO(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.
Reference
Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.
Professional Context
As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.
PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison on the outcome you desire.
Scenario
For this assessment, please use a health care issue of interest from your current or past nursing practice.
If you do not have an issue of interest from your personal nursing practice, then review the optional Case Stu ...
The QuestionIs management in the public sector similar to or di.docxhelen23456789
The Question:
Is management in the public sector similar to or different from management in the private sector? Support your answer with at least one citation from the text, and provide at least one example.
Required Textbooks
Title
:
Public Management: A Three-Dimensional Approach
Author:
Carolyn J.Hill and Laurence E. Lynn Jr
ISBN:
978-0-87289-348-1
Publisher:
Congressional Quarterly Press
.
The Question To Be AnsweredWhat managers most often want to kn.docxhelen23456789
The Question To Be Answered:
'What managers most often want to know about their organization's culture is how to change it. Regardless of the perspective adopted, all organization culture researchers acknowledge that top managers are powerful members of an organization's culture. And, because power grants them a disproportionate share of attention, their behavior becomes a role model for others, their words are carefully attended, and their directives are obeyed. But what is recommended to managers on the basis of culture theory differs markedly according to the perspectives adopted' (Hatch and Cunliffe, 2013: 185).
Choose two of the four perspectives and discuss their different views on organisational culture and how their advice to managers who are seeking to influence organisational culture might be different.
The four perspectives are Modernism, Critical Theory, Symbolic Interpretive and Postmodernism.
I would pefer if focused on Modernism and Symbolic Interpretive.
Required word count 2000 words excluding the references.
Required readings
(located on blackboard site):
1.Chapter 6 and pp 311-318
(Hatch and Cunliffe)
2.Fleming, P and Spicer, A. (2003) ‘Working at a cynical distance: Implications for power, subjectivity and resistance’
3.Wilson, F. (2014) ‘Chapter 11: Culture’ in
Organisational Behaviour and Work
, pp. 224-241.
4.Xu, Y., and Weller, P.,
Inside the World Bank,
“The Staff and Their organizational Culture”, pp. 74-82.
Recommended readings
(located on blackboard site):
1.Martin, J. & Frost, P. 2012, ‘Chapter 30: The organisational culture war games' in Gittell, Jody Hoffer., Godwyn, Mary & Gittell, Jody Hoffer,
Sociology of organizations : structures and relationships
, Pine Forge Press/Sage, Thousand Oaks, Calif., pp. 315-336
2.Zhang, C. & Iles, P. 2014, ‘Chapter 11:Organisational culture' in Rees, Gary & Smith, Paul,
Strategic human resource management : an international perspective
, SAGE, Los Angeles, pp. 383-439.
.
The question What is Life” sounds like the premise of some bad lat.docxhelen23456789
The question "What is Life?” sounds like the premise of some bad late night soul-searching movie, but it is the basis upon which astrobiologists must search for life forms in the universe.
Find two articles on the web about the requirements for life or a unique living organism. The article should be written for a public audience, not in an academic journal.
.
the question is notions of visibility are central concepts within T.docxhelen23456789
the question is: notions of visibility are central concepts within TY's practice and concerns. What methods does Ty implement to open conversation on the presence of the trans body in terms of representation and politics?
info for the Guest
http://www.tyrras.com/u-r-here.html
he is transgender male.
.
The question is Research Plan and the topic for my research is Impac.docxhelen23456789
The question is Research Plan and the topic for my research is Impact of Organizational Culture on the procedure and technique of Accounting Research Plan.
The references should be in Harvard Style including:
Research Background
Research Question and Research Objectives
Theoretical Foundation
Ethical Consideration
References and Referencing Skills
1000 words+-(10%) (excluding reference list)
.
More Related Content
Similar to The purpose of this initial paper is to briefly describe your sear.docx
Course Project Part 3—Translating Evidence Into PracticeIn Pa.docxbuffydtesurina
Course Project: Part 3—Translating Evidence Into Practice
In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.
Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.
To prepare:
Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
Explore possible consequences of failing to adopt the evidence-based practice that you identified.
Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?
To complete:
In a 3- to 4-page paper:
1) Restate your PICOT question and its significance to nursing practice.
My PICOT question is:
does hand washing and appropriate staff dressing among the surgical ward nurses reduce cross infection during patient management?
2) Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles. Please refer to the articles below:
Aiken, A. M., Karuri, D. M., Wanyoro, A. K., & Macleod, J. (2012). Interventional studies for preventing surgical site infections in sub-Saharan Africa.
International Journal of Surgery
, 242-249. Doi: 10.1016/
j
.ijsu.2012.04.004
Al-Khawaldeh, O., Al-Hussami, M., & Darawad, M. (2015).
Influence of Nursing Students Handwashing Knowledge, Beliefs, and Attitudes on Their Handwashing Compliance
.
Scientific Research Publishing
. Doi: http://dx.doi.org.ezp.waldenulibrary.org/10.4236/health.2015.75068
Bukhari, S., Hussain, W., Banjar, A., Almaimani, W., Karima, T., & Fatani, M. (2011).
Hand hygiene compliance rate among healthcare professionals.
PubMed - NCBI
.
Ncbi.nlm.nih.gov
. Retrieved 1 April 2016, from http://www.ncbi.nlm.nih.gov/pubmed/21556474
3) Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcom.
NURS-6052N-37, Essent of Evidence-Based Pract.2017Discussion-1.docxcarlibradley31429
NURS-6052N-37, Essent of Evidence-Based Pract.2017
Discussion:-1
Nursing Research and Evidence-Based Practice
In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.
Based on this evidence, you can formulate a question. In this Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).
To prepare:
Consider a recent clinical experience in which you were providing care for a patient.
Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?
What questions have you thought about in a particular area of care such as a procedure or policy?
Review Chapter 2, pages 31–34 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.
Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.
Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.
Learning Resources
Required Readings
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 1, “Introduction to Nursing Research in an Evidence-Based Practice Environment”
This chapter provides an introduction to nursing research, its history, and the evolution of evidence-based practice. It includes an overview of credible sources of evidences and a description of the different paradigms used in nursing research.
Chapter 2, “Evidence-Based Nursing: Translating Research Evidence into Practice”
The focus of this chapter includes an overview of the key aspects of evidence-based practice, a review of how to identify credible research and appraise its value, and, finally, a discussion on how to take the identified evidence and convert it into a practice.
Chapter 3, “Key Concepts and Steps in Qualitative and Quantitative Research.
(1) Critique Template for a Qualitative StudyNURS 6052Week.docxkatherncarlyle
(1): Critique Template for a Qualitative Study
NURS 6052
Week 6 Assignment: Application: Critiquing Quantitative, Qualitative, or Mixed Methods Studies (due by Day 7 of Week 7)
Date:
Your name:
Article reference (in APA style):
URL:
What is a critique? Simply stated, a critique is a critical analysis undertaken for some purpose. Nurses critique research for three main reasons: to improve their practice, to broaden their understanding, and to provide a base for the conduct of a study.
When the purpose is to improve practice, nurses must give special consideration to questions such as these:
· Are the research findings appropriate to my practice setting and situation?
· What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness?
· How might a proposed change in practice trigger changes in other aspects of practice?
To help you synthesize your learning throughout this course and prepare you to utilize research in your practice, you will be critiquing a qualitative, quantitative, or mixed-methods research study of your choice.
If the article is unavailable in a full-text version through the Walden University Library, you must e-mail the article as a PDF or Word attachment to your Instructor.
QUALITATIVE RESEARCH CRITIQUE
1. Research Issue and Purpose
What is the research question or issue of the referenced study? What is its purpose? (Sometimes ONLY the purpose is stated clearly and the question must be inferred from the introductory discussion of the purpose.)
2. Researcher Pre-understandings
Does the article include a discussion of the researcher’s pre-understandings? What does the article disclose about the researcher’s professional and personal perspectives on the research problem?
3. Literature Review
What is the quality of the literature review? Is the literature review current, relevant? Is there evidence that the author critiqued the literature or merely reported it without critique? Is there an integrated summary of the current knowledge base regarding the research problem, or does the literature review contain opinion or anecdotal articles without any synthesis or summary of the whole? (Sometimes the literature review is incorporated into the introductory section without being explicitly identified.)
4. Theoretical or Conceptual Framework
Is a theoretical or conceptual framework identified? If so, what is it? Is it a nursing framework or one drawn from another discipline? (Sometimes there is no explicitly identified theoretical or conceptual framework; in addition, many “nursing” research studies draw on a “borrowed” framework, e.g., stress, medical pathology, etc.)
5. Participants
Who were the participants? Is the setting or study group adequately described? Is the setting appropriate for the research question? What type of sampling strategy was used? Was it appropriate? Was the sample size adequate? Did t ...
Searching Databases (APA 7 format and at least 3-4 references)Wh.docxrtodd280
Searching Databases (APA 7 format and at least 3-4 references)
When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.
The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.
In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.
To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
Review the Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course.
By Day 3 of Week 4
Post a brief description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Then, post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.
By Day 6 of Week 4
Respond
to at least
two
of your colleagues
on two different days
and provide further suggestions on how their database search might be improved.
Mike RE: Discussion - Week 4/Initial (at least 2-3 references and APA 7 format)
Given the diverse nature of the health care industry, the ubiquitous array of multi faceted axillary services, the sector we service the most sometimes becomes the focus of our interest given the opportunity and longevity in such an institution. For the purpose of .
COMPLETED WEEK 2In 350-400 Words1. Share an example of evidencLynellBull52
COMPLETED WEEK 2
In 350-400 Words
1. Share an example of evidence-based practice from your work setting.
B & C. Describe how qualitative and quantitative research results can be used to solve practice problems. This is known as translational research.
2. Refer back to last module's discussion board item #4 in which you identified one or two potential problems that you are considering for your DNP Project. As we move into the building blocks for evidence, try to think about what you want to improve through your DNP project.
A. State the problem that you are considering for your DNP project.
B. Find a peer-reviewed quantitative research article that addresses this problem.
C & D. State the type of research design and the associated level of evidence in the article.
E. What critical appraisal questions did you use to critique this article from Melnyk Chapter 5? Please list both the question and the answer to each question. (Use the questions that match the research design in the article).
F. How can you use this evidence from your chosen article to solve your clinical problem?
RESOURCES
Corey, G. (2020).
Theory and practice of counseling and psychotherapy, enhanced. Cengage.
Denise F. Polit, & Cheryl Tatano Beck. (2017).
Nursing research : Generating and assessing evidence for nursing practice (Tenth edition ed.). Wolters Kluwer.
Knight, C., & Wheeler, K. (2020).
Case study approach to psychotherapy for advanced practice psychiatric nurses. Springer Publishing Company, Incorporated.
Moran, K. J., Burson, R., & Conrad, D. (2019a).
The doctor of nursing practice project (3rd ed.). Jones & Bartlett Learning, LLC.
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2019).
Translation of evidence into nursing and healthcare (3rd ed.). Springer Publishing Company, Incorporated.
ANSWER
Share an example of evidence-based practice from your work setting. Describe how qualitative and quantitative research results can solve practice problems.
The care given to adolescents who sustain mild traumatic brain injuries while participating in extracurricular activities is an example of evidence-based treatment in the school context, as I learned in my previous role as a school nurse. With experience as both a nurse and a coach (crucial in the absence of an athletic trainer at the school), this individual was looked to for advice if a student had a concussion or other head trauma while participating in a sport (Knight & Wheeler, 2020). Both quantitative and qualitative research methods can produce evidence for nursing practice and address issues that arise in the field. The findings of quantitative studies would be in the form of numerical, statistical data. Studies of phenomena or a more holistic focus can be gathered through qualitative research's use of narrative materials, available research methods, an ...
COMPLETED WEEK 2In 350-400 Words1. Share an example of evidencTaunyaCoffman887
COMPLETED WEEK 2
In 350-400 Words
1. Share an example of evidence-based practice from your work setting.
B & C. Describe how qualitative and quantitative research results can be used to solve practice problems. This is known as translational research.
2. Refer back to last module's discussion board item #4 in which you identified one or two potential problems that you are considering for your DNP Project. As we move into the building blocks for evidence, try to think about what you want to improve through your DNP project.
A. State the problem that you are considering for your DNP project.
B. Find a peer-reviewed quantitative research article that addresses this problem.
C & D. State the type of research design and the associated level of evidence in the article.
E. What critical appraisal questions did you use to critique this article from Melnyk Chapter 5? Please list both the question and the answer to each question. (Use the questions that match the research design in the article).
F. How can you use this evidence from your chosen article to solve your clinical problem?
RESOURCES
Corey, G. (2020).
Theory and practice of counseling and psychotherapy, enhanced. Cengage.
Denise F. Polit, & Cheryl Tatano Beck. (2017).
Nursing research : Generating and assessing evidence for nursing practice (Tenth edition ed.). Wolters Kluwer.
Knight, C., & Wheeler, K. (2020).
Case study approach to psychotherapy for advanced practice psychiatric nurses. Springer Publishing Company, Incorporated.
Moran, K. J., Burson, R., & Conrad, D. (2019a).
The doctor of nursing practice project (3rd ed.). Jones & Bartlett Learning, LLC.
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2019).
Translation of evidence into nursing and healthcare (3rd ed.). Springer Publishing Company, Incorporated.
ANSWER
Share an example of evidence-based practice from your work setting. Describe how qualitative and quantitative research results can solve practice problems.
The care given to adolescents who sustain mild traumatic brain injuries while participating in extracurricular activities is an example of evidence-based treatment in the school context, as I learned in my previous role as a school nurse. With experience as both a nurse and a coach (crucial in the absence of an athletic trainer at the school), this individual was looked to for advice if a student had a concussion or other head trauma while participating in a sport (Knight & Wheeler, 2020). Both quantitative and qualitative research methods can produce evidence for nursing practice and address issues that arise in the field. The findings of quantitative studies would be in the form of numerical, statistical data. Studies of phenomena or a more holistic focus can be gathered through qualitative research's use of narrative materials, available research methods, an ...
HOSP3075 Brand Analysis Paper 1This is the first of three assignme.docxsimonithomas47935
HOSP3075 Brand Analysis Paper 1
This is the first of three assignments you will complete by studying the hotel brand you have chosen. Please organize your paper using the topic headings below. You must use at least four sources to help you (including the company website). Use MLA format, and remember to cite your sources within the paper. Please double space.
Brand Overview and History (1/2 to 1 page)
Provide a brief history of the brand, with a timeline. Explain the geographic locations of the brand’s hotel properties, for example – “primarily in the Southwestern United States”, or “in the US, Canada, and Europe”. What is this brand’s parent company (if there is one)? What are the other brands in the company portfolio, and how does the brand you selected fit in?
Target Markets (1 to 2 pages)
Identify and describe two of the brand’s target markets.
In your description of each market, describe its geographic, demographic, psychographic, and/or behavioral characteristics. For example your brand might pursue a Leisure Transient Market that has these characteristics: millennial (demographic - life cycle), strivers (psychographic - lifestyle), from the USA (geographic - state), seeks free WIFI (behavioral – benefits sought).
Brand Position (1/2 to 1 page)
Describe the position of your brand. Start by making a clear, one or two-sentence positioning statement. Then provide some details, including any points-of-parity or points-of difference. Also, write a “brand mantra” for your brand. (See pages 65-67.)
Brand Elements (1 to 2 pages)
1. Identify and describe the brand elements (also known as brand identities). Elements include the brand name, URL, logo, symbols, characters, spokespersons, slogans, jingles, signage, and more.
2. Choose one of the brand elements, and analyze it based on the “criteria for choosing brand elements” as described in Chapter 4.
Conclusion (1/2 page)
Based on what you have learned about this brand so far, what is your opinion about its future?
Works Cited
Please use MLA format for your Works Cited page.
Research Proposal Part-2
Course Title and Code
Research Methods, C39RE
Course Lecturer
Dr. Esinath Ndiweni
Title of Research Proposal
Occupational Stress Management: Stress, Burnout and Coping among Nurses operating at Emergency Departments in Abu Dhabi
Student Name
Jesvin Joseph Augustine
HWID
H00259465
Program title:
B.A. Business and Finance
Word Count:
1854
Table of Contents
Introduction……………………………………………………………………………………………………………………………………..3
· Research Aim and Objectives……………………………………………………………………………………………….3
Research Strategy…………………………………………………………………………………………………………………………….3
· Research Philosophy…………………………………………………………………………………………………………….3
· Research Approach………………………………………………………………………………………………………………3
Data Collection Methods………………………………………………………………………………………………………………….4
· Semi-structured Interviews…………………………………………………………………………………………………..4
· Web-based Survey Questionnaires……………………………………………………………………………………….5.
Course Code EDU7702-8Course Start Date 02152016Sec.docxvanesaburnand
Course Code: EDU7702-8
Course Start Date: 02/15/2016
Section: Synthesis: Research problem, method, design
Week: 7
Activity: Develop Research Methodology for Hypothetical Research Study
Activity Due Date: 04/03/2016
Activity Description
For Week 6, you developed the research problem, purpose, and questions for both a qualitative and a quantitative research study. For this task, choose one of the research problems and questions that
you developed in Week 6 (either the qualitative or the quantitative) and develop the methodology for the chosen study.
Then, next week you will develop the methodology for the second study and then combine the methodology section with other elements of the study to create a concept paper. (Thus, you may want to
choose the study of most interest to you and develop the methodology for that study as part of the assignment for Week 8).
There are several documents in the NCU dissertation center that will be helpful in developing the research methodology for your Week 7 and Week 8 assignments. These include the concept paper
templates and the proposal templates. Details regarding the research methods for the dissertation are explained in Chapter 3 of the dissertation proposal. The dissertation proposal template shows the
sections that should be included in Chapter 3 of the dissertation proposal. These sections include the following:
1. Research Methods and Design(s)
2. Population
3. Sample
4. Materials/Instruments
5. Operational Definitions of Variables (Quantitative/Mixed Studies Only)
6. Data Collection, Processing, and Analysis
7. Assumptions
8. Limitations
9. Delimitations
10. Ethical Assurances
11. Summary
In developing the methodology section for this week’s assignment, you will want to address Sections 1-6 and Section 10. You will find a discussion of these sections below that will help you develop
these sections of the research methodology.
(1) Research Methods and Design: Explain the methodology and design that you will use to address the research purpose and questions. Will you use the qualitative methodology or the quantitative
methodology? Explain your reasoning for the methodology that you will use to answer the research questions. Why is the specific methodology appropriate for answering the research questions? Which
of the designs is appropriate for your study? Refer to Section 5 for a review of the qualitative and quantitative designs. Then, explain the design that you will use. When is this design appropriate for use
and why is the design appropriate for your research purpose and questions? You will want to cite sources for your reasoning to use the methodology that you use. Be sure to explain why the
methodology and design is appropriate for your study.
Potential sources for defending the methodology and design include the following:
Cozby, P. & Bates, S. (2012). Methods in behavioral research. Boston, MA: McGraw Hill Higher Education.
Creswell, J. W. (2014). Research design: Qu.
Running head 11Concept and statistics (Refe.docxtoddr4
Running head: 1
1
Concept and statistics (Referencias)
The more items, the more serious
Which is Why is it important?
At the end of the introduction say the purpose ...
Significance of the Practice Problem
Here he said he has to show that work is extremely important, that's why we're doing it.
What
As
When
Where
Research Question
PICOT Question + OBJETIVOS
Objectives: 3 objectives
Steps to answer the question, show how you answer the question.
Theoretical Framework
It's 2 theories
He says here is to choose any theory from those nurse Example Callista Roy. .or the others
And another theory that is NOT nursing, can be psychology ,,Freud,Erickson ....
And explain how these relate
Synthesis of the Literature
He wants 20 articles
According to Author such and collaborators ... Say
who studied? ,
showing chose
what a result
There are 20 paragraphs .... and everyone has to say about the article
Author, anus, type of study, #de sample and result ....
Practice Recommendations
In the end in the articles we recommend something, of each of the 20 articles, therefore it would be 10- 20 recommendations, because some articles may match.
Example Kirenia and Michel proposed this... without matching..
Project Description
THIS IS THE MOST IMPORTANT THING
Write this the same, putting it like this,
This project will be completed through a literature review. This will be carried out through Google Scholar, CINHAL, Ana G. Mendez Virtual Libraries, WorldCat, PubMed, Internet database. The research will be peer reviewed. A minimum 30 articles of no more than 5 years will be reviewed. I will use some keywords for my search like: Probiotic, Ventilator-Associated Pneumonia, ICU, conventional methods.
The results obtained from the study will contribute to determine if the probiotic use in prevention of ventilator associated pneumonia is more effective than the conventional method, with a more cost-effective result.
All information collected in this review will be kept in a locked dresser in the principal investigator's office for a period of 5 years. Both, the principal investigator and the mentor will have access to this material. After this time (5 years), the data will be eliminated with a paper shredder and discarded.
Project Evaluation Results
Summarize tables with all citation will be presented in appendix A&B; appendix A will be used for the summary of primary research evidence, and appendix B will be used for the summary of the systematic reviews.
Appendix A will include the citation, question or hypothesis, and theoretical foundation, research designated and sample size, key findings, recommendations or implications, and level of evidence, of each article. Appendix B will include citations, question, search strategy, inclusion/exclusion criteria, data, extraction and analysi.
#35538 Topic Week 10 Weighing the EvidenceNumber of Pages 1 .docxAASTHA76
#35538 Topic: Week 10: Weighing the Evidence
Number of Pages: 1 (Double Spaced)
Number of sources: 3
Writing Style: APA
Type of document: Dissertation Chapter - Discussion
Academic Level:Master
Category: Nursing
Language Style: English (U.S.)
Order Instructions: ATTACHED
Please follow the instructions of the discussion. Included the text book Polick & Beck (2017) in the references.I attached the order 3335318 that is needed to complete this work.
When conducting original research, the final step researchers must complete is weighing the evidence and interpreting the meanings of their data, statistics, and analyses. This is the culmination of the research process in which all of the research methods and designs can be synthesized into a meaningful conclusion. In this stage, researchers should formulate explanations for what their data indicates, determine whether the data answer their initial research question, identify areas of uncertainty, and consider directions for further research.
In this Discussion, you focus on one of the research articles that you identified for Part 2 of the Course Project (Literature Review). You then explore the process of how the researchers generated conclusions based on their data, consider other possible interpretations of their data, and formulate ideas for further research.
To prepare:
-Review this week’s Learning Resources, focusing on how researchers find meaning in their data and generate sound conclusions. Pay particular attention to Table 2 in the article, “Study Design in Medical Research.”
-Revisit the 5 articles that you identified in Part 2 of the Course Project(order 3335318). Select one to consider for the purpose of this Discussion.
-Read sections of the chosen article where the data is presented, analyzed, and interpreted for meaning. What reasoning process did the researchers use to formulate their conclusions? What explanation did they give to support their conclusions? Were there any weaknesses in their analysis or conclusions?
Consider possible alternate conclusions that the researchers could have drawn based on their data.
-Examine the findings that the article presents and consider how well they addressed the researcher’s initial question(s). -What additional research could be done to build on these findings and gain a fuller understanding of the question?
Required Readings
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Review Chapter 2, Fig. 2.1
Chapter 29, “Systematic Reviews of Research Evidence: Meta-analysis, Metasynthesis, and Mixed Studies Review”
This chapter focuses on the different types of systematic reviews. The chapter discusses the advantages of this type of analysis and the steps for conducting a meta-analysis or metasynthesis.
Dingle, P. (2011). Statin statistics: Lies and deception. Positive Health, 180, 1.
Retrieved from the.
Create a 3-5 page submission in which you develop a PICO(T) questiCruzIbarra161
Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.
Introduction
PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.
It stands for:
· P – Patient/population/problem.
· I – Intervention.
· C – Comparison (of potential interventions, typically).
· O - Outcome(s).
· T - Time frame (if time frame is relevant).
The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.
You are encouraged to complete the Vila Health PICO(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.
Reference
Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.
Professional Context
As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.
PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison on the outcome you desire.
Scenario
For this assessment, please use a health care issue of interest from your current or past nursing practice.
If you do not have an issue of interest from your personal nursing practice, then review the optional Case Stu ...
The QuestionIs management in the public sector similar to or di.docxhelen23456789
The Question:
Is management in the public sector similar to or different from management in the private sector? Support your answer with at least one citation from the text, and provide at least one example.
Required Textbooks
Title
:
Public Management: A Three-Dimensional Approach
Author:
Carolyn J.Hill and Laurence E. Lynn Jr
ISBN:
978-0-87289-348-1
Publisher:
Congressional Quarterly Press
.
The Question To Be AnsweredWhat managers most often want to kn.docxhelen23456789
The Question To Be Answered:
'What managers most often want to know about their organization's culture is how to change it. Regardless of the perspective adopted, all organization culture researchers acknowledge that top managers are powerful members of an organization's culture. And, because power grants them a disproportionate share of attention, their behavior becomes a role model for others, their words are carefully attended, and their directives are obeyed. But what is recommended to managers on the basis of culture theory differs markedly according to the perspectives adopted' (Hatch and Cunliffe, 2013: 185).
Choose two of the four perspectives and discuss their different views on organisational culture and how their advice to managers who are seeking to influence organisational culture might be different.
The four perspectives are Modernism, Critical Theory, Symbolic Interpretive and Postmodernism.
I would pefer if focused on Modernism and Symbolic Interpretive.
Required word count 2000 words excluding the references.
Required readings
(located on blackboard site):
1.Chapter 6 and pp 311-318
(Hatch and Cunliffe)
2.Fleming, P and Spicer, A. (2003) ‘Working at a cynical distance: Implications for power, subjectivity and resistance’
3.Wilson, F. (2014) ‘Chapter 11: Culture’ in
Organisational Behaviour and Work
, pp. 224-241.
4.Xu, Y., and Weller, P.,
Inside the World Bank,
“The Staff and Their organizational Culture”, pp. 74-82.
Recommended readings
(located on blackboard site):
1.Martin, J. & Frost, P. 2012, ‘Chapter 30: The organisational culture war games' in Gittell, Jody Hoffer., Godwyn, Mary & Gittell, Jody Hoffer,
Sociology of organizations : structures and relationships
, Pine Forge Press/Sage, Thousand Oaks, Calif., pp. 315-336
2.Zhang, C. & Iles, P. 2014, ‘Chapter 11:Organisational culture' in Rees, Gary & Smith, Paul,
Strategic human resource management : an international perspective
, SAGE, Los Angeles, pp. 383-439.
.
The question What is Life” sounds like the premise of some bad lat.docxhelen23456789
The question "What is Life?” sounds like the premise of some bad late night soul-searching movie, but it is the basis upon which astrobiologists must search for life forms in the universe.
Find two articles on the web about the requirements for life or a unique living organism. The article should be written for a public audience, not in an academic journal.
.
the question is notions of visibility are central concepts within T.docxhelen23456789
the question is: notions of visibility are central concepts within TY's practice and concerns. What methods does Ty implement to open conversation on the presence of the trans body in terms of representation and politics?
info for the Guest
http://www.tyrras.com/u-r-here.html
he is transgender male.
.
The question is Research Plan and the topic for my research is Impac.docxhelen23456789
The question is Research Plan and the topic for my research is Impact of Organizational Culture on the procedure and technique of Accounting Research Plan.
The references should be in Harvard Style including:
Research Background
Research Question and Research Objectives
Theoretical Foundation
Ethical Consideration
References and Referencing Skills
1000 words+-(10%) (excluding reference list)
.
The question Go to httpwww.heritage.orgindexRanking.aspx (.docxhelen23456789
The question:
Go to
http://www.heritage.org/index/Ranking.aspx (Links to an external site.)Links to an external site.
to see the Heritage Foundation’s ranking of economic freedom in different countries. Click on any country to see how that country performed on ten different factors deemed important for economic freedom. Do you think if there seems to be a correlation between economic freedom and economic growth? Summarize your findings.
.
The Question As the global recession evolved into a sovereign.docxhelen23456789
The Question:
As the global recession evolved into a sovereign (government) debt crisis in the euro zone in 2010, many economists and policymakers started to question the survival of the euro, and in 2011, some even predicted an abandonment of the euro. The ultimate fate of the euro will help to answer the question of whether independent countries with diverse economies could successfully maintain a joint monetary policy and a single currency. Do you think the euro will survive? Discuss the pros and cons of the euro (a single currency) in the context of the current crises in the euro zone.
Requirements
Length: 1-2 pages, maximum 2 pages.
Must be typed on 8.5x11 paper (single space).
.
The quesion is What are the characteristics of transnational tele.docxhelen23456789
The quesion is: What are the characteristics of transnational television?
This is in relation to this reading
Chalaby, J. K. (2005), ‘Towards an Understanding of Media Transnationalism’, in J. K. Chalaby (ed.),
Transnational Television Worldwide: Towards A New Media Order
, London: I. B. Tauris, pp. 1-13.
This assesses your understanding of unit readings and lectures up to Week 4. Choose one question from each week’s tutorial activities in Weeks 2, 3 & 4 and write short answers to these questions (150-200 words each). The question above is only in relation to week 3 reading.
I have already done all the reasearch, which i will send to you, my main problem is needing to cut it down to 150-200 words and to re-word it so it isnt plagarised!!!
I would like someone who has experience with International Communictions and this topic, so if needed they can put their own spin and add any info I may have missed.
I am looking for someone whom I can start using on a regular basis, and I trust.
If you do well there will be more work to help me with!!
please do asap!
.
The Queen of TreesThis video shows the intimate relationship.docxhelen23456789
The Queen of Trees
This video shows the intimate relationships within a community of organisms in an African savannah ecosystem. Your task is to complete the questions and map out the connections among the various organisms within the community. You should indicate the trophic level to which the organism belongs, its relationship to the Queen and any other direct relationships to other organisms in the community. The connections within the community should be illustrated. The figure on page 3 of this handout gives an example of how to illustrate those connections. The arrow tips point in the directions of where the energy is flowing. For example, the fruit bats feed on the fruit of the fig tree so the arrow is a one-way directions towards the bats.
To submit this quiz: download the template, as you watch the video complete the table below, complete the questions on page 3, and complete the construction of your food web illustrating the connections listed in the table and then upload your document.
If you do not know how to construct the food web electronically, you may draw your food web, scan a digital image (or take a photo) of the food web and submit it.
Trophic levels
: The position that an organisms occupies in a food chain. It shows the flow of energy through an ecosystem. Energy is always lost from one trophic level to the next.
· Producers - autotrophic organisms using solar or chemical energy to produce all the organic nutrients for an ecosystem.
· Consumers - heterotrophic organisms that cannot make their own food. They get energy from the chemical bonds in the nutrients they eat.
· Primary consumers (herbivores) - eat primary producers (plants).
o Conversion efficiency: only 10 to 20 percent of the available energy passes from producers to primary consumers.
· Secondary consumers (carnivores) - eat primary consumers (herbivores).
o Conversion efficiency: only 5 to 10 percent of the available energy passes from primary consumers to secondary consumers.
· Tertiary consumers (carnivores) - eat secondary consumers (carnivores).
o The conversion efficiency for tertiary consumers may be as low as 1%.
· Omnivores - eat both plants and animals.
· Decomposers - break down dead tissues and wastes.
Table 1 – Relationships and trophic levels
Organism
Trophic Level
Connections with the Queen/community
Sycamore Fig Tree
Primary producer
Fig wasp
Grey Horn Bill
Secondary consumer
Uses the Queen as a nesting site, consumes insects that prey on queen
Caterpillars
Giraffes
Fig Cadidid
Pink Mantis
Vinegar Flies
Parasitic Nematodes
Ants
Hilda bug nymphs
Bees
Fig Cicadas
Monkeys
Gecko
Spider
Crocodile
Elephants
Tiger beetles
Butterflies
Seed bugs
Fruit bats
Primary consumers
Seed dispersal for the Queen
Questions
How does the Queen protect herself from predation?
What do t.
The quesion is What are the characteristics of transnational te.docxhelen23456789
The quesion is:
What are the characteristics of transnational television?
This is in relation to this reading
Chalaby, J. K. (2005), ‘Towards an Understanding of Media Transnationalism’, in J. K. Chalaby (ed.),
Transnational Television Worldwide: Towards A New Media Order
, London: I. B. Tauris, pp. 1-13.
This assesses your understanding of unit readings and lectures up to Week 4. Choose one question from each week’s tutorial activities in Weeks 2, 3 & 4 and write short answers to these questions (150-200 words each).
The question above is only in relation to week 3 reading.
I have already done all the reasearch, which i will send to you, my main problem is needing to cut it down to 150-200 words and to re-word it so it isnt plagarised!!!
I would like someone who has experience with International Communictions and this topic, so if needed they can put their own spin and add any info I may have missed.
I am looking for someone whom I can start using on a regular basis, and I trust. If you do well there will be more work to help me with!!
.
The quasi-science of anticipating environmental and competitive ch.docxhelen23456789
The quasi-science of anticipating environmental and competitive changes and estimating their importance to an organizations operation refers to
a. environmental scanning
[removed]
B.
SWOT analysis
[removed]
C.
business analysis
[removed]
D.
technological forecasting
.
the quastion Lets Use the Scientific Method !You are Captai.docxhelen23456789
the quastion
Let's Use the Scientific Method !
You are Captain Kirk on the USS Enterprise. You have traveled unexpectedly to a parallel universe. You come upon a planet that looks like Earth.
Use the Scientific Method to:
1) Make a hypothesis about your discovery
2) Design a way to testing your hypothesis
3) Determine whether your hypothesis is correct and whether it can be transformed into a theory.
+I attachment the lecture you can check it
.
The Qualitative Research Studies Adolescent Behaviors & Social .docxhelen23456789
The Qualitative Research Studies: Adolescent Behaviors & Social Media
Must be at least 1,200 words in length (not including title, abstract, and reference pages)
Must reference at least two scholarly sources (see
Scholarly, Peer-Reviewed, and Other Credible Sources (Links to an external site.)
), in addition to any required readings cited.
Must include the three articles analyzed in the reference list.
Must include title, abstract, and reference pages.
My projected research topic is Adolescent Behaviors, I am interested in the influence of the media on an adolescent’s behavior skills (research focus). I wanted to choose a topic that really interested me, but over the past few weeks, I’ve debated with myself, because I’ve been scared, that I won’t find enough resources for any other topic. So far, I think there is a ton of information on adolescents and how the media effects/enhanced their behaviors, I figured this would be a great start. This topic is personal for me, I’ve worked with so many children, and in recent years, I’ve witness a dramatic behavior change in multiple teens, and it was all related to something that stemmed from the media.
I could start this research with the factors that affect adolescent development: physical, cognitive, social and behavioral development. According to Yale researchers, Valkenburg and Piotroswski (2017), there’s been significant changes in the media landscape, meaning there’s not just the traditional media is not the only barrier. Adolescents have their own phones, iPads, tablets, and computers, which gives them a more direct access to the media.
For the quantitative resource to support this topic, I chose
The Journal of Korean Academy of Nursing
, which states, “To achieve the aim, a
quantitative
research design was used, involving questionnaires with data collected from 393 Saudi students aged 13-18 years
”
(Yoo and Ham, 2019). The second resource I found supports a qualitative study in this field, stating (Using a
qualitative
analysis approach, we found six major themes. Although entertainment media provided media role models for expected behavior in romantic relationships, it was also associated with the development of unrealistic relational expectations and perceived pressure to be in a romantic relationship.
According to these studies, adolescents with reported social media use had greater odds of increased suicidal ideation and suicide risk than those with no reported use, but these relationships were not statistically significant.
Social media use in adolescents with a psychiatric admission may be associated with the risk of self-injurious behaviors and could be a marker of impulsivity. Additional work should guide the assessment of social media use as part of a routine adolescent psychiatric history.
References:
Valkenburg, P. M., and Piotrowski, J. T. (2017). Plugged in. Retrieved from
https://yalebooks.yale.edu/sites/default/files/files/Media/9780300228090_UPDF.pd.
The reflective essay took an emotional appeal. I can sense both sy.docxhelen23456789
The reflective essay took an emotional appeal. I can sense both sympathy and empathy in certain parts of it. I think at some point or another we have all swallowed our pride and moved forward. The purpose or goal of the essay was to explain what the writer overcame during the current term to help him get better. What seem to be a good direction is explaining something that you have overcome this semester during the course. What you took from this was more than an academic challenge, it was the beginning of a personal growth. My overall impression of what you have as your draft is good job, stay on focus with this. The aspects you have touched on with your writing has been ethos, pathos, and kairo. Although you limited help from others, it was time you moved away from that. I would incorporate more about class and maybe throughout your understanding the first few weeks before asking for help. What led you to finally opening up. Give a few examples in your intro of pride in your academics before this that went well and others that didn’t. I’ve read your assignments assignment last week and this has a stronger feel to it. I would highly recommend that each paragraph you ask yourself why? Then from that answer within you expand on it and tie it in with academics.
To be more reflective in your essay I would go back to what was your reasoning for not asking for help in the past, when did you know it was time to let that go, and how will this help you academically from now on.
Yes, the essay is easy to follow I would advise not go off focus here, I could see how that could happen in an assignment where you are talking about something personal such as this.
Ask yourself why and what I recently learned myself is the so what and now what structuring.
Good luck!
Format: 1500 word response
About this assessment
Critical reflection is an assignment that is designed to assess the student's ability to reflect, describe, explain, justify and demonstrate knowledge of one or more of the main principles of the Leadership subject.
This is a two-part assessment item where you are required to address each of Parts A and B individually. The assessment requires the students to write two short reflective pieces using the theories and concepts covered in Parts A and B. Each reflective piece should be a minimum of 750 words each, not exceeding 1500 words in total (plus or minus 10%). Use minimum of 9 references from credible sources for this assessment. Both written works should be submitted as one, single document.
Part A: Reflective Piece (750 words)
The impact of leadership style often manifests in the quality of relationships which a leader builds over time with others, in particular subordinates and peers. Drawing from two situations from your own experience as a leader (or from a leader you have witnessed), discuss one example where you (or a leader) demonstrated a high level of emotional intelligence, and in another example where you (or a leader) allo.
The red coler with file are very importantAttached Files Fixedv.docxhelen23456789
The red coler with file are very important
Attached Files:
FixedvsGrowth.pdf
(
384.466 KB
)
Read the short (seriously, it took me like 20 mins tops) article and do a write up (150 words minimum) on it.
Ideas for write up portion:
What kind of learner identity are you? Why do do you identify as that kind of learner? What is your relationship with struggling in school? How do you deal with struggle? When do you see things as a learning oportunity?
Points: 20 (which is a lot in this class)
(Do not forget I am international student, please)
http://www.nais.org/about/index.cfm?ItemNumber=145867
You can see these information on wibsite and I will put on this page because you have to read this a story.
SCHOOL MATTERS
Brainology
Transforming Students’ Motivation to Learn
Carol S. Dweck
Winter 2008
This is an exciting time for our brains. More and more research is showing that our brains change
constantly with learning and experience and that this takes place throughout our lives.
Does this have implications for students' motivation and learning? It certainly does. In my
research in collaboration with my graduate students, we have shown that what students believe about
their brains — whether they see their intelligence as something that's fixed or
Photoillustration: Michael Northrup
something that can grow and change — has profound effects on their motivation, learning, and school
achievement (Dweck, 2006). These different beliefs, or mindsets, create different psychological
worlds: one in which students are afraid of challenges and devastated by setbacks, and one in which
students relish challenges and are resilient in the face of setbacks.
How do these mindsets work? How are the mindsets communicated to students? And, most important, can
they be changed? As we answer these questions, you will understand why so many students do not
achieve to their potential, why so many bright students stop working when school becomes
challenging, and why stereotypes have such profound effects on students' achievement. You will also
learn how praise can have a negative effect on students' mindsets, harming their motivation to
learn.
Mindsets and Achievement
Many students believe that intelligence is fixed, that each person has a certain amount and that's
that. We call this a fixed mindset, and, as you will see, students with this mindset worry about
how much of this fixed intelligence they possess. A fixed mindset makes challenges threatening for
students (because they believe that their fixed ability may not be up to the task) and it makes
mistakes and failures demoralizing (because they believe that such setbacks reflect badly on their
level of fixed intelligence).
It is the belief that intelligence can be developed that opens students to a love of learning, a
belief in the power of effort and constructive, determined reactions to setbacks.
Other students believe that intelligence is something that can be cultivated through e.
The References MUST BE THIS BOOK AND WHATEVER SOURCE YOU WANT TO SI.docxhelen23456789
The References: MUST BE THIS BOOK AND WHATEVER SOURCE YOU WANT TO SITE.
Harvey, C. and Allard, J. (2014) Understanding and Managing Diversity (6th ed.) NJ: Pearson- Prentice Hall. ISBN: 9780133548198
MUST BE ATLEAST 300 WORDS WITH TWO CITED SOURCES EACH!
1. Discussion Board Three
Individual Perspectives on Diversity II
Briefly summarize chap 8 and discuss how you can develop the skills needed to increase your Emotional Intelligence.
2. Discussion Board Four
Group Perspectives on Diversity I
How do gender differences impact how we communicate in the workplace? What strategies can be employed to improve communication? Discuss one example of intentional information use in the context of your organization (could be something that you witnessed or something that happened to you) (focus on Ch. 20, 27-28)
3. Discussion Board Five
Group Perspectives on Diversity II
Identify a belief, value or attitude of yours that you can attribute to your religion and examine its impact on your work and career. Discuss how your religion could affect your role and performance in a multicultural workplace.
BOOK INFO BELOW!
The Chapter 8
on The Emotional Connection of Distinguishing Differences and Conflict
Carole G. Parker
In recent years, diversity in organizations has been an exciting, stimulating, frustrating, and intriguing topic. Some organizations continue to struggle for diversity whereas others have a fully integrated diverse workforce. The challenge to increase and manage diversity continues to be critical to organizational goals, particularly as more organizations, large and small, transact business internationally. Some organizations work to appreciate diversity and value differences, whereas others continue to discount differences and diversity. Smart managers today realize the importance of balance in work groups. Attempts to incorporate differences in age, gender, race, culture, sexual preference, and styles of being in their organizations to capitalize on the incredible potential diversity offers are occurring. Managing differences requires energy, commitment, tolerance, and finally, appreciation among all parties involved. Differences among people are not inherently good or bad; there is no one “right” way to deal with differences. Learning to manage and ultimately appreciate differences requires learning, emotional growth, and stretching the boundaries of all participants. Although differences can be challenging, they also lead to very important benefits, both to individuals, groups and organizations.
How Differences Are Often Managed
What action and factors must be uppermost in selecting the most appropriate approach to addressing differences? Often avoidance or repression is used to manage differences. The avoidance of differences often takes the form of associating with individuals of similar backgrounds, experiences, beliefs, and values. This strategy enables an environment of mutual support and predictability. Those.
The Reason Why Excelsior College Is My ChoiceEnglish 101Runn.docxhelen23456789
The Reason Why Excelsior College Is My Choice
English 101
Running head: THE REASON WHY EXCELSIOR 1
THE REASON WHY EXCELSIOR COLLEGE IS MY CHOICE 3
March 2, 2019
The Reason Why Excelsior College is my Choice
Am I too old to go back to college? This is a question I have posed to myself and my family for almost a year while I researched colleges to attend. I knew I wanted to go back to school so that I could get an associate’s degree in nursing. I already went the vocational school route in order to gain my licensed practical nursing diploma and took my state boards to obtain my license so I need the associate’s degree in order to take the NYS Boards to obtain my registered nursing license. I have to have both hands-on nursing classes as well as regular classes such as English and Science along with a few others. I knew I really did not want to go to a regular school if it could be helped because I like the ability to be similar to your peers in an online environment as you really don’t know the ages of your classmates. It does not matter if they are young or old; they just want to do the same thing as you: learn.
The search was on to either find an online school that had both types of classes I would need or to take my regular classes in an online setting and then transfer to a brick and mortar school to take my hands on classes. Well I narrowed my choice to Excelsior College because they had a nursing degree program but I was still not sure if I wanted to fully take all of my courses here. After researching further, I realized that I would not be able to obtain financial aid for my nursing degree if I took it solely through Excelsior. I did find a local school around me that would allow me to take just my hands-on classes through them. I would just need to make sure to take all the necessary regular classes first here at Excelsior.
Well, I had made my decision on how I would proceed so I filled out the online application and paid my non-refundable application fee. I waited with baited breath to find out if I would be accepted or not because this is going to determine my immediate future and the future of my family. I breathed such a sigh of relief when I received the welcome email. After speaking with my admissions counselor and the registers office in great lengths, I realized I would have to matriculate into the liberal arts program in order to gain financial aid. I got a list of the courses I needed to take to be able to transfer into the local school and waited to hear back from my academic advisor who was still being assigned to me.
After a telephone call with my academic advisor, it was determined that I was only allowed to take 9 credits for the Spring semester so I ended up taking this fifteen week English course, PSY 101, and PSY 235 in the Spring II section because I did not have any prior degree credits. The ability to learn quickly and have constant support from my family, my fellow classmates, an.
The recovery phase of any disaster event creates a huge requirement .docxhelen23456789
The recovery phase of any disaster event creates a huge requirement for manpower for cleanup, repair, and restoration. Traditionally, a sizable segment of the manpower pool is provided by volunteers from NGOs, churches, community organizations, schools, etc. What are the advantages to using volunteers? What are the disadvantages?
.
The reevaluation process in special education is addressed at least .docxhelen23456789
The reevaluation process in special education is addressed at least every three years to determine whether the student continues to need special education and related services due to their diagnosed disability. Teachers working with students with disabilities should be aware of the rationale and purpose for the reevaluation. There are also legal provisions that must be followed to document the scope and sequence of the evaluation process. All teachers need to be aware of their role and responsibility to participate fully and be a collaborative team member with both staff and family.
Review the different reevaluation requirements under IDEA. Discuss the different types of reevaluations and associated process steps.
Design a 5 slide digital presentation appropriate for a schoolwide professional development opportunity on the topic of special education reevaluations for K‐8.
Within your presentation, address the following:
Triennial reevaluations: Use of assessments to support continued eligibility, required consent, participants, and scope of the evaluation.
Support your presentation with a scholarly resource.
Rubic: Triennial Revaluations
Thoroughly and insightfully summarizes triennial evaluations regarding use of assessments to support continued eligibility, required consent, participants, and scope of the evaluation.
.
The recruitment of employees is a critical part of the HR function a.docxhelen23456789
The recruitment of employees is a critical part of the HR function and it is also been a function that has changed vastly for many organizations.
Research Recruitment of employees and explain/identify:
Strategic recruiting regarding EEO, Diversity, Gender-Neutral, and Generational Differences.
How technology and social media affect recruiting for employers and candidates.
Advantages and/or disadvantages of internal and external recruiting methods.
Paper Requirements:
Write a 3-4 page double-spaced, 12 font, and APA formatted paper that addresses the items above.
Do not use first person. This paper isn't your opinion. Your paper is guided by your research.
The 3-4 pages is counted from the introduction through the conclusion. It does not include the title page or reference page.
Include a title page properly formatted in APA.
You Do NOT need to include an abstract
Make sure to include an Introduction to your paper. Y
our introduction needs to include a strong preview sentence.
Create
headings
in the body of the paper (between the Introduction and Conclusion) that are named based on the content in that section of the paper. For example, your headings could be the trends you identified. Please review the
APA Heading Format Guidelines (Links to an external site.)Links to an external site. (Links to an external site.)
in order to develop a good understanding of how to format the headings in your paper.
Include a Reference page. You must include a minimum of 5 references (textbook and 4 scholarly peer-reviewed journal articles from Welder Library E-Resources).
Please refer to the rubric for the grading requirements.
Your submission will go through turnitin. Turnitin evaluates the originality score of your paper. Your turnitin score should be 25% or less.
.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Pride Month Slides 2024 David Douglas School District
The purpose of this initial paper is to briefly describe your sear.docx
1. The purpose of this initial paper is to briefly describe your
search strategies when identifying two articles that pertain to an
evidence-based practice topic of interest. Mine is on Avoiding
Hospital Readmissions. I will be focusing as an individual on
examining the sources of knowledge that contribute to
professional nursing practice qualitative or quantitative design?
Apply research principles to the interpretation of the content of
published research studies. "What is the number of trends in 30-
day post-discharge mortality among beneficiaries after the
implementation of HRRP -- period 3 and 4, for mortality rate in
myocardial infarctions?" (Wadhera, et al., 2018)
Clinical Question:
A. Describe problem
b. Significance of problem in terms of outcomes or statistics
c. Your PICOT question in support of the group topic
d. Purpose of your paper
B. Levels of Evidence
a. Type of question asked
b. Best evidence found to answer question
C. Search Strategy
a. Search terms
b. Databases used (you may use Google Scholar in addition to
the library databases; start with the Library)
c. Refinement decisions made
d. Identification of two most relevant articles
D. Format
a. Correct grammar and spelling
b. Use of headings for each section
2. c. Use of APA format (sixth edition)
d. Page length: three to four pages
Clinical Question
45 points 28%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. What is your
PICOT question? 4. Purpose of your paper. What will your
paper do or describe? This is similar to a problem statement.
“The purpose of this paper is to . . .”
Levels of Evidence
20 points 13% 1. What type of question are you asking (therapy,
prognosis, meaning, etc.)? 2. What is the best type of evidence
to be found to answer that question (e.g., RCT, cohort study,
qualitative study)?
Search Strategy
65 points 41% 1. Search topic(s) provided. What did you use
for search terms? 2. What database(s) did you use? Link your
search with the PICOT question described above. 3. As you did
your search, what decisions did you make in refinement to get
your required articles down to a reasonable number for review?
Were any limits used? If so, what? 4. Identify the two most
relevant and helpful articles that will provide guidance for your
next paper and the group’s work. Why were these two selected?
Format
30 points 18% 1. Correct grammar and spelling 2. Use of
headings for each section: Clinical Question, Level of Evidence,
Search Strategy, Conclusion 3. APA format (sixth ed.) 4. Paper
length: three to four pages
3. Total worth 160 points
DIRECTIONS AND ASSIGNMENT CRITERIA Assign ment
Criteria Points % Description Clinical Question 45
28 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. What is
your PICOT question? 4. Purpose of your paper. What will your
paper do or describe? This is similar to a
problem statement. “The purpose of this paper is to . . .” Levels
of Evidence 20 13 1. What type of
question are you asking (therapy, prognosis, meaning, etc.)? 2.
What is the best type of evidence to be
found to answer that question (e.g., RCT, cohort study,
qualitative study)? Search Strategy 65 41 1.
Search topic(s) provided. What did you use for search terms? 2.
What database(s) did you use? Link your
search with the PICOT question described above. 3. As you did
your search, what decisions did you make
in refinement to get your required articles down to a reasonable
number for review? Were any limits
used? If so, what? 4. Identify the two most relevant and helpful
articles that will provide guidance for
your next paper and the group’s work. Why were these two
selected? Format 30 18 1. Correct grammar
and spelling 2. Use of headings for each section: Clinical
Question, Level of Evidence, Search Strategy,
4. Conclusion 3. APA format (sixth ed.) 4. Paper length: three to
four pages
The purpose of
this initial paper is to briefly describe your search strategies
when identifying two articles
that pertain to an evidence
-
based practice topic of interest
. Mine is on
Avoiding Hospital
Readmissions. I
will be focusing as an individual on
e
xamin
ing
the sources of knowledge that contribute to professional
nursing practic
e
qualitative or quantitative design?
A
pply research principles to the interpretation of the
content of published research studies.
"What is the number of
trends in 30
-
day post
-
discharge mortality
among beneficiaries after the implementation of HRRP
--
period 3 and 4, for mortality rate in myocardial
5. infarctions?" (Wadhera, et al., 2018)
Clinical Question
:
A
. Describe problem
b. Significance of problem in terms of outcomes or statistics
c. Your PICOT question in support of the group to
pic
d. Purpose of your paper
B
. Levels of Evidence
a. Type of question asked
b. Best evidence found to answer question
C.
Search Strategy
6. a. Search terms
b. Databases used (you may use Google Scholar in addition to
the library databases; start with the
Lib
rary)
c. Refinement decisions made
d. Identification of two most relevant articles
D.
Format
a. Correct grammar and spelling
b. Use of headings for each section
c. Use of APA format (sixth edition)
The purpose of this initial paper is to briefly describe your
search strategies when identifying two articles
that pertain to an evidence-based practice topic of interest.
Mine is on Avoiding Hospital Readmissions. I
will be focusing as an individual on examining the sources of
knowledge that contribute to professional
nursing practice qualitative or quantitative design? Apply
research principles to the interpretation of the
content of published research studies. "What is the number of
trends in 30-day post-discharge mortality
among beneficiaries after the implementation of HRRP -- period
3 and 4, for mortality rate in myocardial
7. infarctions?" (Wadhera, et al., 2018)
Clinical Question:
A. Describe problem
b. Significance of problem in terms of outcomes or statistics
c. Your PICOT question in support of the group topic
d. Purpose of your paper
B. Levels of Evidence
a. Type of question asked
b. Best evidence found to answer question
C. Search Strategy
a. Search terms
b. Databases used (you may use Google Scholar in addition to
the library databases; start with the
Library)
c. Refinement decisions made
d. Identification of two most relevant articles
D. Format
a. Correct grammar and spelling
b. Use of headings for each section
c. Use of APA format (sixth edition)
Running head: 1
NURSING 2
8. Nursing
Vanessa Noa
Grand Canyon University
05/10/2020
Nursing
Patient safety is a critical issue in care delivery in skilled
nursing facilities (SNFs). Given the complexity arising from the
prevention of falls, SNFs need to take better fall prevention
practices to enhance the quality of care service delivery. The
practices to prevent falls for short-term rehabilitative stays
should be tailored by skilled nursing staff and successfully
implemented and sustained to align with healthcare priorities
that work best for the patients. Different researches by different
scholars on patient’s fall give detailed literature on how skilled
nursing facilities improve the situation through nurse education
to ensure the safety of patients in nursing home healthcare.
Comparison of Research Question
Studies by the eight authors on patient safety as a crucial
issue in nursing home healthcare focused on why patient falls
are a dominant issue and what can be done to solve the problem.
For instance, Katrina, H. (2018), in his research, wants to get
9. detailed knowledge of why falls remain an issue and complex
issues and what measures can resolve the issue undermining
patient safety. Katrina, H. (2018), Jang and Lee, (2015); and
Uymaz and Nahcivan, (2016) their research question studies on
how education program is a solution to this challenging issue.
Generally, the research by these eight different authors base
their question on factors leading to falls and measures to
prevent patient falls.
The research questions for the eight studies seeks to
research on evidence-based interventions that have shown
effectiveness in minimizing patient falls in nursing home
healthcare. Kuhlenschmidt et al., (2016) and Minnier et al.,
(2019) base his research question on falls among cancer patients
who need early interventions to help them from getting into the
problem. According to the questions in comparison, the problem
statement is how healthcare specialists can intervene by
exhibiting a positive attitude toward teamwork to find solutions
to patient falls.
Comparison of Sample Populations
The eight researches recruit its sample from populations
sharing the same charcate4ristics to give reliable and valid
findings. In all eight samples, the sample sizes are
recommendable because they do not exceed 1000, in which the
samples are drawn between 50 to 100 participants. The
statistical population of the researches provides researchers
with a base for drawing statistical inferences based on a random
sample taken from the population (Zhao et al., 2019). For
instance, the generalization of patient falls in all researches is
based on what causes exists now, ever existed, or what will
exist in the future in skilled nursing facilities.
General Findings
The formation of teams, offering education, improved
education on falls among community older people, and
interprofessional community services can help in combating
patient falls within skilled nursing facilities. These methods for
fall prevention involve managing of underlying fall risk factors
10. of patients (Howard, 2018). The methods focus on education as
a training tool for nurses and patients on how the problem takes
place and how it can be prevented.
Comparison of The Limitations of The Study
Characteristics of design or methodology impact and influence
the findings’ interpretation from the research, hence leading to
a significant limitation. The characteristics are constraints on
generalizability and applications of the findings to practice (S.
R., 2016). Also, the study limitations are its flaws resulting
from the unavailability of resources, small sample size, and
flawed methodologies (Murray, 2016). There is no evident study
that is flawless or includes all likely aspects. Therefore, the
listing of the limitations reflects transparency and honesty in
findings. These limitations undermine the answering of the
research questions; hence the study cannot address them
correctly.
Accessing the target population is a limitation. The studies
depended on accessing patients, skilled nursing facilities, and
the authority to access confidential information of patients. In
the healthcare setting, patient confidentiality and privacy is
critical and strictly followed. In the data collection section, this
issue may undermine getting reliable and valid results that can
display a comparison on answering the research question.
Further, inadequate literature review limits the reliability of the
research (Sullivan, et al., 2015). Literature in any research
forms a basis for the researcher to set a strong foundation for
achieving the objectives. If literature is unavailable, the
research problem becomes narrow and cannot guarantee to solve
the problem under study.
Conclusion and Recommendations
Prevention of falls in the elderly long-term care facilities is
critical to patient safety.
Elderly is vulnerable to falls and fall-related injuries within
skilled nursing facilities. The implementation of educational
programs to equip nurses with detailed knowledge on curbing
patient falls will improve patient safety. Among pediatric
11. patients, evidence-based interventions can help in preventing
falls. Studies have evaluated the effectiveness of interventions
and strategies on the incidence of falls in nursing home
patients. Giving skills and motivating staff is essential in long-
term care facilities since nurses learn how to follow guidelines
in maintaining patient safety. It is recommendable that;
I. Involvement of pediatric staff to influence the program’s
success
II. Inspire nurses to develop a positive attitude to attain
interprofessional teamwork events’ goals
III. Educate patients on medications to assist in reducing the
risk of falls
IV. Customize education program to keep with the perceived
risk of falls among patients
References
Howard, K. (2018). Improving Fall Rates Using Bedside
Debriefings and Reflective Emails: One Unit’s Success
Story. MEDSURG Nursing, 27(6), 388–391.
Jang, M., & Lee, Y. (2015). The Effects of an Education
Program on Home Renovation for Fall Prevention of Korean
Older People. Educational Gerontology, 41(9), 653–669.
https://doi.org/10.1080/03601277.2015.1033219
12. Kuhlenschmidt, M. L., Reeber, C., Wallace, C., Yanwen Chen,
Barnholtz-Sloan, J., & Mazanec, S. R. (2016). Tailoring
Education to Perceived Fall Risk in Hospitalized Patients with
Cancer: A Randomized, Controlled Trial. Clinical Journal of
Oncology Nursing, 20(1), 84–89.
https://doi.org/10.1188/16.CJON.84-89
Minnier, W., Leggett, M., Persaud, I., & Breda, K. (2019). Four
Smart Steps: Fall Prevention for Community-Dwelling Older
Adults. Creative Nursing, 25(2), 169–175.
https://doi.org/10.1891/1078-4535.25.2.169
Murray, E. (2016). Quality Improvement. Implementing a
Pediatric Fall Prevention Policy and Program. Pediatric
Nursing, 42(5), 256–259.
Sullivan, K., Charrette, A., Massey, C., Bartlett, D., Walker, C.,
Bond, I., … Fong, J. J. (2015). Interprofessional education with
a community fall prevention event. Journal of Interprofessional
Care, 29(4), 374–376.
https://doi.org/10.3109/13561820.2014.969834
Uymaz, P. E., & Nahcivan, N. O. (2016). Evaluation of a nurse-
led fall prevention education program in Turkish nursing home
residents. Educational Gerontology, 42(5), 299–309.
https://doi.org/10.1080/03601277.2015.1109403
Zhao, Y. (Lucy), Bott, M., He, J., Kim, H., Park, S. H., &
Dunton, N. (2019). Evidence on Fall and Injurious Fall
Prevention Interventions in Acute Care Hospitals. Journal of
Nursing Administration, 49(2), 86–92.
https://doi.org/10.1097/NNA.0000000000000715
13. Association of the Hospital Readmissions Reduction Program
With Mortality Among Medicare Beneficiaries Hospitalized
for Heart Failure, Acute Myocardial Infarction, and Pneumonia
Rishi K. Wadhera, MD, MPP, MPhil; Karen E. Joynt Maddox,
MD, MPH; Jason H. Wasfy, MD, MPhil; Sebastien Haneuse,
PhD;
Changyu Shen, PhD; Robert W. Yeh, MD, MSc
IMPORTANCE The Hospital Readmissions Reduction Program
(HRRP) has been associated with
a reduction in readmission rates for heart failure (HF), acute
myocardial infarction (AMI), and
pneumonia. It is unclear whether the HRRP has been associated
with change in patient mortality.
OBJECTIVE To determine whether the HRRP was associated
with a change in patient mortality.
DESIGN, SETTING, AND PARTICIPANTS Retrospective
cohort study of hospitalizations for HF,
AMI, and pneumonia among Medicare fee-for-service
beneficiaries aged at least 65 years
across 4 periods from April 1, 2005, to March 31, 2015. Period
1 and period 2 occurred before
the HRRP to establish baseline trends (April 2005-September
2007 and October
14. 2007-March 2010). Period 3 and period 4 were after HRRP
announcement (April 2010 to
September 2012) and HRRP implementation (October 2012 to
March 2015).
EXPOSURES Announcement and implementation of the HRRP.
MAIN OUTCOMES AND MEASURES Inverse probability–
weighted mortality within 30 days of
discharge following hospitalization for HF, AMI, and
pneumonia, and stratified by whether
there was an associated readmission. An additional end point
was mortality within 45 days of
initial hospital admission for target conditions.
RESULTS The study cohort included 8.3 million
hospitalizations for HF, AMI, and pneumonia,
among which 7.9 million (mean age, 79.6 [8.7] years; 53.4%
women) were alive at discharge.
There were 3.2 million hospitalizations for HF, 1.8 million for
AMI, and 3.0 million for pneumonia.
There were 270 517 deaths within 30 days of discharge for HF,
128 088 for AMI, and 246 154 for
pneumonia. Among patients with HF, 30-day postdischarge
mortality increased before the
announcement of the HRRP (0.27% increase from period 1 to
period 2). Compared with this
baseline trend, HRRP announcement (0.49% increase from
period 2 to period 3; difference in
change, 0.22%, P = .01) and implementation (0.52% increase
from period 3 to period 4;
difference in change, 0.25%, P = .001) were significantly
associated with an increase in
postdischarge mortality. Among patients with AMI, HRRP
announcement was associated with a
decline in postdischarge mortality (0.18% pre-HRRP increase vs
15. 0.08% post-HRRP
announcement decrease; difference in change, −0.26%; P = .01)
and did not significantly change
after HRRP implementation. Among patients with pneumonia,
postdischarge mortality was
stable before HRRP (0.04% increase from period 1 to period 2),
but significantly increased after
HRRP announcement (0.26% post-HRRP announcement
increase; difference in change, 0.22%,
P = .01) and implementation (0.44% post-HPPR implementation
increase; difference in change,
0.40%, P < .001). The overall increase in mortality among
patients with HF and pneumonia was
mainly related to outcomes among patients who were not
readmitted but died within 30 days of
discharge. For all 3 conditions, HRRP implementation was not
significantly associated with an
increase in mortality within 45 days of admission, relative to
pre-HRRP trends.
CONCLUSIONS AND RELEVANCE Among Medicare
beneficiaries, the HRRP was significantly
associated with an increase in 30-day postdischarge mortality
after hospitalization for HF and
pneumonia, but not for AMI. Given the study design and the
lack of significant association of
the HRRP with mortality within 45 days of admission, further
research is needed to
understand whether the increase in 30-day postdischarge
mortality is a result of the policy.
JAMA. 2018;320(24):2542-2552. doi:10.1001/jama.2018.19232
Editorial page 2539
Supplemental content
17. established under the Affordable Care Act (ACA) in2010 and
required that the Centers for Medicare & Med-
icaid Services (CMS) impose financial penalties on hospitals
with higher-than-expected 30-day readmission rates for pa-
tients with heart failure, acute myocardial infarction, and pneu-
monia, beginning in 2012.1 After the announcement of the
HRRP, readmission rates among Medicare beneficiaries de-
clined for target conditions nationwide.2,3 Recently, how-
ever, policy makers and physicians have raised concern that
the HRRP may have also had unintended consequences
that adversely affected patient care, potentially leading to in-
creased mortality.4,5 For instance, the financial penalties im-
posed by the HRRP may have inadvertently pushed some phy-
sicians to avoid indicated readmissions, potentially diverted
hospital resources and efforts away from other quality im-
provement initiatives, or worsened quality of care at resource-
poor hospitals that are often penalized by the program. How-
ever, it is also possible that the same mechanisms by which
some hospitals have reduced readmissions, such as im-
proved coordination and transitions of care, resulted in reduc-
tions in mortality.
Understanding whether the HRRP has been associated
with changes in mortality at the patient level is important as
policy makers evaluate this program, particularly given the
ongoing expansion of the HRRP to include other conditions6
and the almost $2 billion in financial penalties that have been
imposed on hospitals since 2012.7 This study aims to answer
3 questions. First, compared with past trends, was the
announcement or implementation of the HRRP associated
with a change in mortality within 30 days of discharge fol-
lowing hospitalization for heart failure, acute myocardial
infarction, or pneumonia? Second, was the HRRP associated
with a change in the distribution of patients who experienced
death and no readmission, readmission and no death, read-
18. mission and death, or no death and no readmission during
the 30 days after discharge? Third, was the HRRP associated
with a change in mortality within 45 days of hospital admis-
sion for target conditions?
Methods
Institutional review board approval, including waiver of the
requirement of participant informed consent because the data
were deidentified, was provided by the Beth Israel Deacon-
ess Medical Center.
Study Cohort
We used Medicare Provider Analysis and Review files to iden-
tify hospital admissions and discharges at short-term acute care
hospitals from April 1, 2005, through March 31, 2015, with
a principal discharge diagnosis of heart failure, acute myo-
cardial infarction, or pneumonia. Study cohorts were de-
fined using International Classification of Diseases, Ninth
Revision, Clinical Modification codes used in the publicly re-
ported CMS readmission and mortality measures.8-10 We in-
cluded Medicare beneficiaries aged 65 years or older in the
analysis. We excluded patients who were discharged against
medic al advice, were not enrolled in Medic are fee-for-
service for at least 30 days after discharge (absent death),
or were enrolled in Medicare fee-for-service for less than 1
year before hospitalization. Transfers to other hospitals were
linked to a single index hospitalization. To examine 30-day
postdischarge outcomes, we also excluded patients who
died during hospitalization. Comorbidities were defined using
CMS hierarchical condition categories based on Medicare
claims up to 1 year before hospitalization.11 Specifically, we
used
covariates in the CMS risk-adjustment models for heart fail-
ure, acute myocardial infarction, and pneumonia,12-14 as has
been done in previous studies.2,15 The race/ethnicity of all pa-
19. tients was identified based on claims files and was desig-
nated into the following fixed categories: white, black, or other.
Race/ethnicity was included as a covariate in the analysis be-
cause it is associated with mortality for target conditions.16
Study Periods
We identified 4 nonoverlapping study periods of equal dura-
tion for index hospitalization. We chose to evaluate differ-
ences in outcomes between time periods, rather than annual
trends, for 2 reasons. First, we were interested in changes in
outcomes among time periods defined by their relationship to
the announcement and implementation of the HRRP, rather
than within-period trends. Second, this strategy avoids as-
sumptions on how the HRRP imposes its effect on different pa-
tient groups (eg, assumptions on main effects and interaction
terms) and of a linear relationship between outcomes and time
and continuous confounders in a conventional logistic or mul-
tinominal regression model.
We identified 2 study periods before the HRRP was estab-
lished to examine baseline trends in outcomes. The first study
period included hospitalizations from April 2005 to Septem-
ber 2007 (period 1) and the second included hospitalizations
from October 2007 to March 2010 (period 2). Two periods af-
ter the HRRP was established were also included: 1 following
the initial announcement of HRRP with passage of the ACA
from April 2010 through September 2012 (period 3) and the
other between October 2012 and March 2015 (period 4), which
Key Points
Question Was the announcement and implementation of the
Hospital Readmissions Reduction Program (HRRP) associated
with
an increase in patient-level mortality?
Findings In this retrospective cohort study that included
21. cardial infarction, and pneumonia was evaluated, which has
been done in previous hospital-level analyses.17-19 The follow-
ing 30-day postdischarge outcome subgroups were also ex-
amined: (1) death and no readmission, (2) readmission and
death, (3) readmission and no death, and (4) no readmission
and no death. These subgroup outcomes were examined to try
to provide mechanistic insights on the relationship between
readmission and mortality. To fully assess trends in mortality
related to a complete clinical episode, 45-day patient mortal-
ity rates following admission (postadmission mortality) were
also evaluated, because efforts to reduce readmissions could
potentially encompass care during hospitalization and might
influence discharge timing and location of death. This mea-
sure included varying hospital lengths of stay and captured
both in-hospital and 30-day postdischarge deaths for the ma-
jority of the cohort.
Statistical Analysis
To account for a potential imbalance in case mix between study
periods, a propensity score approach (ie, the probability of
being in a specific period given the demographics and comor-
bidities of the patient and calendar month of hospitalization)
was used to standardize populations among periods. Patient
demographics, comorbidities, and seasonal indicators (calen-
dar month) from period 4 were used as a reference to re-
weight observed outcomes in all other study periods. Logis-
tic regression models were fit on data from periods 1 and 4 to
obtain a propensity score for period 1. The propensity score was
then used to weight the outcomes in period 1, generating event
rates through inverse probability weighting (IPW) that would
have been observed if period 1 had the same case mix as pe-
riod 4. Similarly, separate logistic regression models were fit
to data from periods 2 and 4 and periods 3 and 4 to provide
IPW-adjusted event rates in periods 2 and 3, respectively. This
approach allowed the calculated distribution of each out-
22. come in each of the 4 periods to be based on the same case mix
(ie, the case mix from period 4).20 Because the primary aim
was to understand the association of the HRRP with mortal-
ity at the individual level, we did not examine hospital-level
effects in the analysis.
To establish the change in rates of outcomes after the an-
nouncement of the HRRP, the change in event rates between
periods 2 and 3 was calculated. Similarly, the change in rates
of outcomes between periods 3 and 4 was also calculated to
examine the change in outcomes between the announce-
ment and the implementation of the HRRP (Figure 1).
To isolate the association between the HRRP and the out-
comes, we sought to remove secular trends for each out-
come. To do so, the change in outcomes between periods 1 and
2 was computed to establish a baseline trend in outcomes be-
fore the announcement and implementation of the HRRP. This
difference was then subtracted from the change in outcomes
after the announcement of the HRRP (between periods 2 and
3) to account for trends that were unrelated to the HRRP. Simi-
larly, the baseline difference was also subtracted from the
change in outcomes after the implementation of the HRRP, be-
tween periods 3 and 4.
Additional Analyses
Several sensitivity analyses were performed. First, patients
enrolled in hospice were excluded because greater use of
hospice care at the end of life might shift deaths that previ-
ously occurred within a hospital to the postdischarge setting
over time.21,22 Second, because 1 hospitalization was ran-
domly selected for patients that experienced multiple hospi-
talizations in a given study period, the main analysis was
repeated using the first hospitalization for each patient in
each study period as well as all hospitalizations for each
23. Figure 1. Study Periods and Analytic Approach in a Study of the
Association Between the Hospital
Readmissions Reduction Program (HRRP) and Mortality
Period 1
(April 2005-
September 2007)
Period 2
(October 2007-
March 2010)
Period 3
(April 2010-
September 2012)
Period 4
(October 2012-
April 2015)
Baseline change
in mortality before
HRRP announcement
Difference in change in mortality prior
to HRRP (A) compared with change
after HRRP announcement (B)
Difference in change in mortality before HRRP (A)
compared with change after HRRP implementation (C)
Change in mortality
25. was repeated using outcome regression within each study
period to generate predicted outcomes for the case-mix in
period 4, which were then directly compared across periods
to ensure the results were not sensitive to the analytic
approach used.
More details on the methodologic approach are provided
in the Supplement. Significance testing was performed using
z tests, with standard error estimates that accounted for in-
verse probability weighting. Statistical tests were 2-sided at a
significance level of .05. The false discovery rate (FDR) based
multiple comparison procedure was used to assess the statis-
tical significance of the difference in the change in mortality-
related end points (eg, aggregate mortality, mortality with or
without readmission) at the FDR level of 0.05.23,24 Analyses
were performed using SAS version 9.4 (SAS Institute).
Results
There were 8 326 688 Medicare fee-for-service hospitaliza-
tions for heart failure, acute myocardial infarction, and pneu-
monia from April 1, 2005, to March 31, 2015, among which
7 948 937 patients were alive at hospital discharge. The mean
(SD) age of the study population was 79.6 (8.7) years,
4 246 45 4 partic ipants (53.4%) were women, 6 802 296
(85.6%) were white, and 738 198 (9.3%) were black. There
were 3.2 million hospitalizations for heart failure, 1.8 million
for acute myocardial infarction, and 3.0 million for pneumo-
nia and, overall, there were 270 517 deaths from heart failure,
128 088 deaths from ac ute myoc ardial infarction, and
246 154 deaths from pneumonia within 30 days of discharge.
Baseline patient demographics were similar among the 4
study periods; comorbidities are shown in Table 1 for patients
alive at discharge. Observed trends in 30-day postdischarge
and 45-day postadmission outcomes for target conditions are
shown in Figure 2 and eTables 1 and 2 in the Supplement.
26. HRRP and 30-Day Postdischarge Mortality
Among patients with heart failure, IPW-adjusted postdis-
charge mortality (Figure 3A and eTable 3 in the Supplement)
increased before the announcement or implementation
of the HRRP (0.27% increase from period 1 to period 2;
Table 2). Relative to this baseline trend, the announcement
of the HRRP was significantly associated with an increase in
postdischarge mortality (0.49% increase from period 2 to
period 3; 0.22% difference between the change from period
1 to period 2 and period 2 to period 3; P = .01). An analysis
stratified by whether there was an associated readmission
showed that this change was entirely driven by a significant
increase in mortality without readmission (0.27% increase
from period 1 to period 2 vs 0.53% increase from period 2 to
period 3; 0.26% difference between the change from period
1 to period 2 and period 2 to period 3; P < .001). In addition,
HRRP implementation was significantly associated with an
increase in postdischarge mortality overall relative to base-
line trends (0.52% increase from period 3 to period 4; 0.25%
difference between the change from period 1 to period 2 and
period 3 to period 4; P = .001), which was also explained by
an increase in death without readmission.
In contrast, among patients with acute myocardial infarc-
tion (Figure 3B), HRRP announcement was significantly asso-
ciated with a decline in postdischarge mortality (Table 2;
0.18% increase from period 1 to period 2 vs 0.08% decrease
from period 2 to period 3; −0.26% difference between the
change from period 1 to period 2 and period 2 to period 3;
P = .01). Compared with baseline trends, HRRP implementa-
tion was not associated with a significant change in mortality
(0.15% increase from period 3 to period 4; −0.03% difference
between the change from period 1 to period 2 and period 3 to
period 4; P = .69).
27. Postdischarge mortality among patients with pneumonia
(Figure 3C) was relatively stable before the HRRP (0.04%
increase from period 1 to period 2), but increased signifi-
cantly after announcement of the HRRP (Table 2; 0.26%
increase from period 2 to period 3; 0.22% difference between
the change from period 1 to period 2 and period 2 to period 3;
P = .01). This overall change was driven by an increase in
patients who were not readmitted but died within 30 days of
discharge (0.09% increase from period 1 to period 2 vs 0.32%
increase from period 2 to period 3; 0.23% difference between
the change from period 1 to period 2 and period 2 to period 3;
P = .003). In addition, compared with baseline trends, HRRP
implementation was also significantly associated with an
increase in mortality overall (0.44% increase from period 3 to
period 4; 0.40% difference between the change from period 1
to period 2 and period 3 to period 4; P < .001) and among
stratified mortality outcomes of death and no readmission
(0.09% from period 1 to period 2 vs 0.38% from period 3 to
period 4; 0.30% difference between the change from period 1
to period 2 and period 3 to period 4; P < .001) and readmis-
sion and death (0.05% decrease from period 1 to period 2 vs
0.05% increase from period 3 to period 4; 0.11% difference
between the change from period 1 to period 2 and period 3 to
period 4; P = .003).
All P values less than .05 for the 18 comparisons involv-
ing 3 end points (total mortality, mortality without readmis-
sion, and mortality with readmission), 2 differences in change
(post-HRRP announcement trends and post-HRRP implemen-
tation trends compared with pre-HRRP trends) and 3 condi-
tions (heart failure, acute myocardial infarction, and pneu-
monia) were also significant at the FDR level of 0.05 (Table 2).
Other 30-Day Postdischarge Outcomes
Inverse probability-weighted readmissions without death
within 30 days declined significantly following the announce-
29. https://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2
018.19232&utm_campaign=articlePDF%26utm_medium=article
PDFlink%26utm_source=articlePDF%26utm_content=jama.2018
.19232
http://www.jama.com/?utm_campaign=articlePDF%26utm_medi
um=articlePDFlink%26utm_source=articlePDF%26utm_content
=jama.2018.19232
rates steadily increased before the announcement of the HRRP
(Table 2; 0.15% increase from period 1 to period 2). Compared
with this baseline trend, the HRRP announcement was sig-
nificantly associated with an increase in mortality (0.42% in-
crease from period 2 to period 3; 0.27% difference between the
change from period 1 to period 2 and period 2 to period 3;
P = .01). However, mortality did not significantly change af-
ter HRRP implementation (0.32% increase from period 3 to pe-
riod 4; 0.17% difference between the change from period 1 to
period 2 and period 3 to period 4; P = .06).
Postadmission mortality declined among patients hospi-
talized for acute myocardial infarction before the announce-
ment of the HRRP (0.24% decline from period 1 to period 2), a
trend that did not significantly change after the HRRP an-
nouncement (0.35% decline from period 2 to period 3; −0.12%
difference between the change from period 1 to period 2 and
period 2 to period 3; P = .39). Following the HRRP implemen-
tation, postadmission mortality continued to decline (0.44%
from period 3 to period 4), but did not significantly differ from
baseline trends (−0.21% difference between the change from
period 1 to period 2 and period 3 to period 4: P = .06).
Among patients hospitalized for pneumonia, postadmis-
sion mortality was relatively stable before the HRRP (0.05%
increase from period 1 to period 2), and did not significantly
30. change after the HRRP announcement (0.15% decline from pe-
riod 2 to period 3; −0.20% difference between the change from
period 1 to period 2 and period 2 to period 3; P = .07) and
imple-
mentation (0.14% increase from period 3 to period 4; 0.09%
difference between the change from period 1 to period 2 and
period 3 to period 4; P = .30).
Table 1. Baseline Characteristics of Patients Discharged After
Hospitalization for Heart Failure,
Acute Myocardial Infarction, or Pneumoniaa
Participants, %
Period 1
(April 2005-
September 2007)
Period 2
(October 2007-
March 2010)
Period 3
(April 2010-
September 2012)
Period 4
(October 2012-
March 2015)
Hospitalizations 2 283 774 2 011 915 1 857 337 1 795 911
Demographics
Age, mean (SD), y 79.5 (8.5) 79.7 (8.7) 79.7 (8.9) 79.6 (9.0)
Women 54.4 53.7 53.1 52.2
34. proach (eTables 13 and 14 in the Supplement).
Discussion
Overall, the announcement and implementation of the HRRP
was associated with a significant increase in mortality within
30 days of discharge among Medicare beneficiaries hospi-
talized for heart failure and pneumonia, but not for acute
myocardial infarction. Although 30-day postdischarge mor-
tality for heart failure was increasing before the HRRP, this
increase accelerated after the announcement and implemen-
tation of the program. In addition, postdischarge …
EVIDENCE-
BASED CARE
SHEET
Author
Hillary Mennella, DNP, ANCC-BC
Cinahl Information Systems, Glendale, CA
Reviewers
Darlene Strayer, RN, MBA
Cinahl Information Systems, Glendale, CA
Jocelyn Cajanap-Gantman, RN, MSN,
FNP, CNS
Sepsis Coordinator, Glendale Adventist
Medical Center
Nursing Executive Practice Council
Glendale Adventist Medical Center,
36. $26 billion, with potentially preventable readmissions
accounting for approximately $17
billion of that cost(1)
› All healthcare providers are responsible for identifying patient
discharge needs and
developing a thorough discharge plan to reduce the risk for
hospital readmissions(3)
› In accordance with the legislative passing of the Affordable
Care Act (ACA), the
United States Centers for Medicare and Medicaid Services
(CMS) established the
Hospital Readmissions Reduction Program (HRRP) to decrease
the frequency of hospital
readmissions of Medicare beneficiaries. Effective October 1,
2012, the provisions of the
HRRP permit the CMS to reduce payments to hospitals under
the inpatient prospective
payment system (IPPS) for readmission rates that are reviewed
by CMS and determined
to be excessive. The HRRP adjusts hospital reimbursement
based on the data for
excessive readmissions following patient admissions for acute
myocardial infarction
(AMI), congestive heart failure (CHF), pneumonia (PN),
coronary artery bypass graft
(CABG), chronic obstructive lung disease (COPD), stroke, and
complications related to
readmissions for total hip/knee replacements
(THR/TKR)(4,9,12)
• Under the HRRP, readmission is defined by the CMS as “an
admission to a subsection
hospital within 30 days of a discharge from the same or another
subsection hospital”(4)
37. – The hospital readmission rate is calculated from the date of
discharge, plus 30 days.
For example, for a patient who is discharged on October 1, the
last day for the
postdischarge follow-up period is October 31
– The CMS recognizes 30 days as an industry standard that is
strongly influenced by the
quality of care
– Hospital readmissions exclude those involving a patient’s
death in the hospital,
enrollment in the Medicare fee-for-service program, hospital
admission after at least
30 days post-hospital discharge, and planned hospital
readmission (i.e., a nonacute
readmission for a scheduled procedure)
– CMS does not consider preventability when calculating
readmission rates(11)
- A standard for identifying and defining what is considered to
be a preventable
readmission does not exist(11)
– Hospital readmission rates are assigned a “yes/no”
readmission status regardless of the
number of readmissions for a patient during the 30-day
postdischarge time period
› Each year during the period 2003–2004, according to billing
claims from the CMS, an
estimated 2.3 million Medicare beneficiaries were readmitted to
the hospital within 30
days of discharge. Investigators in a study of 11,855,702
38. Medicare beneficiaries reported
that(8)
• 19.6% were discharged from the hospital and rehospitalized
within 30 days
– Of this group, 50.25% did not have a bill for a follow-upvisit
to a physician’s office
between the time of discharge to the community and
rehospitalization
• 34% were discharged from the hospital and rehospitalized
within 30 days
– An estimated 10% were planned hospital readmissions
• 67.1% of Medicare beneficiaries with medical conditions who
were discharged from the hospital were rehospitalized or
died within the first year after discharge
• 51.5% of Medicare beneficiaries who were discharged from
the hospital after surgical procedures were rehospitalized or
died within the first year after discharge
– Of this group, 70.5% were rehospitalized with a medical
condition
› The CMS began reporting the 30-day mortality rates for the
quality outcome measures for AMI and CHF in 2007 and
for PN in 2008. These quality outcome measures are publicly
reported in an effort by CMS to increase transparency and
accountability of hospitals for patient care services and
treatment(2,12)
• The CMS recommends that hospitals review their 30-day
mortality outcome measures in conjunction with their 30-day
39. hospital readmission data in order to modify the quality and
type of care provided to reduce hospital readmissions
› The financial penalties for the HRRP were calculated by the
CMS using data from July 2008 through June 2011 for the
readmission rates for all hospitalizations for AMI, PN, and
CHF; these rates were adjusted for age, gender, patient frailty,
and coexisting medical conditions and compared with the actual
readmission rates over the same period of time using a
methodology that is endorsed by the National Quality Forum
(NQF)(4,9,12)
• A hospital’s calculated readmission rate for MI, PN, CHF,
COPD, CABG, stroke, and THR/TKR is the performance
measure of that hospital’s readmission rate compared with the
national average for a hospital’s set of patients with the same
applicable conditions
• For the fiscal year 2013, hospital readmission rates were
calculated from data on discharges from July 1, 2008, through
June 30, 2011
• In the fiscal year 2014, an estimated 80% of hospitals were
penalized, at a cost of $428 million(1)
• Kaiser Health News (KHN) reported 4 out of 5 hospitals were
penalized for readmissions based on patient discharge data
analyzed between July 2013 and June 2016(13)
– The average penalty between October 1, 2017 and September
30, 2018 is expected to be 0.73% for each payment
Medicare makes per patient(13)
› The CMS levied financial penalties of up to 1% of hospital
reimbursement rates for readmission of Medicare beneficiaries.
The financial penalties increased to 2% in 2014 and to a
40. maximum of 3% in 2015(9)
› The CMS 30-day hospital readmission measures are federally
mandated to be publicly available under the Hospital Inpatient
Quality Reporting Program(12)
› The CMS provides hospitals with Hospital-Specific Reports
(HSRs) under the Hospital Inpatient Quality Reporting
(IQR) program to promote hospital quality improvement efforts.
The HSRs provide detailed information on a hospital’s
readmission rates, discharge data, and specific risk factor
data(4,12)
› Investigators analyzing the publicly available data from July
2008 through June 2011 for 3,282 hospitals found that
large hospitals, teaching hospitals, and safety-net hospitals (i.e.,
a hospital system that provides care to a large number of
uninsured or low-income patients) had higher readmission rates
compared with small hospitals and non-teaching hospitals.
Of this sample, 2,189 hospitals, or 66.7% of hospitals, will
receive financial penalties as a result of the HRRP.
Investigators
call for additional research to determine why large hospitals,
teaching hospitals, and safety-net hospitals have higher
readmission rates than small and non-teaching hospitals(10)
› Researchers evaluating the impact of community factors on
hospital readmission rates noted that a large portion of
readmission rates is affected by the characteristics of the local
healthcare community (e.g., quality of nursing homes, access
to primary care), specifically the county where the hospital is
located. This suggests that penalizing hospitals with high
readmission rates might not be equitable and that interventions
aimed at community-based readmission reduction strategies
might result in improved outcomes(6)
41. › As new data emerge on hospital readmission rates, the CMS
should consider the impact on underserved medical
communities and make necessary adjustments to the policies
regarding hospital readmission. Debate exists about financially
penalizing hospitals for excessive readmission rates. Experts
argue that the CMS rules are inherently discriminatory toward
hospitals that serve low-income groups and/or severely ill
patients. Experts argue the following issues:(9,12)
• At the inception of the HRRP, the CMS did not adjust for
socioeconomic status (SES) or severity of comorbid illness in
the
calculation of the hospital readmission measures
– The CMS argued that adjustment for SES implies that it is
acceptable for low-income patient groups to receive less than
standard quality of care
– Experts contend that the CMS should adjust for SES to place
all hospitals at the same level
– Researchers have suggested weighting HRRP penalties
according to the timing of readmissions. For example, hospital
readmission within the first few days after discharge can
indicate poor discharge planning compared with hospital
readmission 3 weeks after discharge, which is more likely to
indicate the severity of the patient’s underlying illness and/
or comorbid diseases. This suggestion offers hospitals the
opportunity to make improvements to their discharge planning
process while caring for severely ill and low-income groups of
patients
• Events leading to hospital readmissions might be out of the
hospital’s control. Hospitals serving a larger population of
42. patients from a lower SES often have higher rates for
readmission compared to the national average resulting in lower
Medicare reimbursements. Patients from a lower SES can have
difficulty procuring follow-up appointments, food, and
medications after discharge(5)
– Patients that are eligible for Medicare and Medicaid are
defined as “dual-eligibles.” They tend to be medically complex
patients with high levels of healthcare utilization. As a result of
the 21st Century Cures Act of 2016 the CMS proposed
changes for calculating financial penalties under the HRRP
beginning fiscal year 2019 among hospitals with high
readmission rates of patients from low SES backgrounds. The
new calculations are risk-adjustment strategies that include
comparisons of social economic risk factors among
hospitals(7,14)
• The HRRP was criticized by experts that the program had the
potential to exacerbate disparities in patient care and generate
disincentives to provide care for patients with severe illness
and/or complex comorbidities
What We Can Do
› Become knowledgeable about hospital readmissions so you
can adhere to the CMS quality outcome measures and the
HRRP; share this information with your colleagues
› Review publicly available hospital readmission rates to
compare your organization against national benchmarks; for
more
information, see http://www.qualitynet.org
› Collaborate with colleagues in your facility to
• review your HSR to promote hospital quality improvement
efforts
43. • develop an individualized discharge plan for your patients
• provide high-quality healthcare to your patients to promote
positive patient outcomes and reduce the risk for hospital
readmissions
Coding Matrix
References are rated using the following codes, listed in order
of strength:
M Published meta-analysis
SR Published systematic or integrative literature review
RCT Published research (randomized controlled trial)
R Published research (not randomized controlled trial)
C Case histories, case studies
G Published guidelines
RV Published review of the literature
RU Published research utilization report
QI Published quality improvement report
L Legislation
PGR Published government report
PFR Published funded report
PP Policies, procedures, protocols
44. X Practice exemplars, stories, opinions
GI General or background information/texts/reports
U Unpublished research, reviews, poster presentations or
other such materials
CP Conference proceedings, abstracts, presentation
References
1. Boozary, A. S., Manchin, J., III, & Wicker, R. F. (2015). The
Medicare Hospital Readmissions Reduction Program: Time for
reform. JAMA: Journal of the American Medical
Association, 314(4), 347-348. doi:10.1001/jama.2015.6507 (R)
2. Centers for Medicare and Medicaid Services. (2017).
Outcomes measures. Retrieved June 15, 2018, from
https://www.cms.gov/medicare/quality-initiatives-patient-
assessment-
instruments/hospitalqualityinits/outcomemeasures.html (G)
3. Centers for Medicare and Medicaid Services. (2013).
Revision to State Operations Manual (SOM), Hospital Appendix
A - Interpretive Guidelines for 42 CFR 482.43, Discharge
Planning. Retrieved June 15, 2018, from
https://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-
States-and-Regions-Items/Survey-and-Cert-Letter-13-32.html
(G)
4. Centers for Medicare and Medicaid Services. (2018, April
27). Readmissions reduction program. Retrieved June 15, 2018,
from
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/AcuteInpatientPPS/Readmissions-Reduction-
45. Program.html (G)
5. Changes to readmissions rule will help, but no panacea.
(2017). Case Management Advisor, 28(9), 14-15. (X)
6. Herrin, J., St. Andre, J., Kenward, K., Joshi, M. S., Audet, A.
J., & Hines, S. C. (2015). Community factors and hospital
readmission rates. Health Services Research, 50(1),
20-39. doi:10.111/1475-6773.12177 (R)
7. Hospitals can now factor socioeconomic status into
readmissions. (2017). Hospital Case Management, 25(3), 41-42.
(GI)
8. Jencks, S. F., Williams, M. V., & Coleman, E. A. (2009).
Rehospitalizations among patients in the Medicare fee-for-
service program. New England Journal of Medicine, 360(14),
1418-1428. doi:10.1056/NEJMsa0803563 (R)
9. Joynt, K. E., & Jha, A. K. (2013). A path forward on
Medicare readmissions. New England Journal of Medicine,
368(13), 1175-1177. doi:10.1056/NEJMp1300122 (GI)
10. Joynt, K. E., & Jha, A. K. (2013). Characteristics of
hospitals receiving penalties under the Hospital Readmissions
Reduction Program. JAMA, 309(4), 342-343. doi:10.1001/
jama.2012.94856 (R)
11. Lavenberg, J. G., Leas, B., Unscheid, C. A., Williams, K.,
Goldman, D. R., & Kripalani, S. (2014). Assessing
preventability in the quest to reduce hospital readmissions.
Journal
of Hospital Medicine, 9(9), 598-603. doi:10.1002/jhm.2226 (R)
47. Effects
Min Chen1 and David C. Grabowski2
Abstract
This study examines whether the Hospital Readmissions
Reduction Program (HRRP),
which penalizes hospitals with excess readmissions for certain
conditions, has reduced
hospital readmissions and led to unintended consequences. Our
analyses of Florida
hospital administrative data between 2008 and 2014 find that
the HRRP resulted in
a reduction in the likelihood of readmissions by 1% to 2% for
traditional Medicare
(TM) beneficiaries with heart failure, pneumonia, or chronic
obstructive pulmonary
disease. Readmission rates for Medicare Advantage (MA)
beneficiaries and privately
insured patients with heart attack and heart failure decreased
even more than TM
patients with the same target condition (e.g., for heart attack,
the likelihood for TM
beneficiaries to be remitted is 2.2% higher than MA
beneficiaries and 2.3% higher
than privately insured patients). We do not find any evidence of
cost-shifting, delayed
readmission, or selection on discharge disposition or patient
income. However,
the HRRP reduced the likelihood of Hispanic patients with
target conditions being
admitted by 2% to 4%.
Keywords
Medicare, readmissions, hospital, discharge
48. This article, submitted to Medical Care Research and Review on
30 June 2017, was revised and accepted
for publication on November 6, 2017.
1Florida International University, Miami, FL, USA
2Harvard Medical School, Boston, MA, USA
Corresponding Author:
Min Chen, College of Business, Florida International
University, 11200 SW 8th Street,
Miami, FL 33199, USA.
Email: [email protected]
744611MCRXXX10.1177/1077558717744611Medical Care
Research and ReviewChen and Grabowski
research-article2017
https://us.sagepub.com/en-us/journals-permissions
https://journals.sagepub.com/home/mcr
mailto:[email protected]
http://crossmark.crossref.org/dialog/?doi=10.1177%2F10775587
17744611&domain=pdf&date_stamp=2017-12-03
644 Medical Care Research and Review 76(5)
Introduction
Hospital readmissions are common and costly. In 2011, the U.S.
Medicare program
paid for 1.8 million 30-day readmissions with a total cost of $24
billion (Hines, Barrett,
Marguerit, Jiang, Joanna, & Steiner, 2014). Some readmissions
could be prevented
with better quality of care (Axon & Williams, 2011), and the
Medicare Payment
49. Advisory Commission (MedPAC) estimates that a 10%
reduction in avoidable read-
missions would save the Medicare program at least $1 billion
(MedPAC, 2013). To
achieve both better outcomes for patients and greater savings
for Medicare, the
Affordable Care Act (ACA) created the Hospital Readmissions
Reduction Program
(HRRP), which applies financial penalties to acute care
hospitals with higher-than-
expected readmission rates among Medicare fee-for-service
(FFS) beneficiaries in the
30-days following discharge for certain target conditions.
Since October 2012, the HRRP has targeted three conditions:
acute myocardial
infarction (AMI), congestive heart failure, and pneumonia.
Beginning in October
2014, total hip or knee replacement and chronic obstructive
pulmonary disease
(COPD) were also included in the program. The Centers for
Medicare and Medicaid
Services (CMS) calculates the average risk-adjusted, 30-day
hospital-readmission
rates for patients with each targeted condition and penalizes
hospitals that perform
worse than the national average. For Fiscal Year (FY) 2013, the
maximum penalty for
a hospital with excess readmissions was 1% of its total
Medicare base payment. The
penalty went up to 2% of the Medicare base payment for FY
2014, and 3% for FY
2015 forward (CMS, 2016).
New Contribution
50. Prior studies have examined the initial three target conditions
(i.e., AMI, heart failure,
and pneumonia) and suggested that the HRRP has lowered 30-
day readmissions
among Medicare FFS beneficiaries (Carey & Lin, 2015;
Gerhardt et al., 2013;
Zuckerman, Sheingold, Orav, Ruhter, & Epstein, 2016). Using
Medicare FFS claims
data, two recent articles compared the changes in readmission
rates by hospital penalty
status and confirmed that hospitals with the lowest pre-HRRP
performance had the
greatest improvement (Desai et al., 2016; Wasfy et al., 2017).
How readmissions
change among Medicare Advantage beneficiaries and privately
insured patients, how-
ever, is still somewhat unclear and vitally important. Because
the HRRP penalties only
apply to traditional Medicare patients, one way that a hospital
could recoup lost
Medicare reimbursements as a result of excess readmissions
would be to readmit more
privately insured or Medicare Advantage patients. In this study,
we exploit a state-
based all-payer dataset (through 2014) to examine the overall
impact of the HRRP on
readmissions among traditional Medicare, Medicare Advantage,
and privately insured
patients, respectively. We examine not only the aforementioned
three originally tar-
geted conditions but also the two new penalty conditions (i.e.,
COPD and total hip or
knee replacement).
Furthermore, we explore several other potential consequences of
the HRRP across
51. targeted and nontargeted conditions. First, we examine the
impact of the HRRP on
Chen and Grabowski 645
readmissions post–30 days to detect if the HRRP has simply
delayed readmissions.
Next, we examine whether the HRRP led to any “cherry
picking” of low-risk patients
at admission. Finally, we examine whether the HRRP led to
increased skilled nursing
facility (SNF) or home health agency (HHA) discharges.
Conceptual Framework
The HRRP is a very direct policy instrument. Hospitals are
financially penalized for
excess 30-day readmissions for the target conditions.
Medicare’s goal in implementing
the HRRP was to encourage hospitals to reduce 30-day
readmissions through better
hospital care. In response to the HRRP, we hypothesize that
hospitals will lower read-
missions for these target conditions assuming the cost of
reducing readmissions is
below the amount of the readmission penalty. We also assume
that hospitals want to
avoid any negative reputation effects associated with being
penalized (Winborn,
Alencherril, & Pagán, 2014), which might lead them to lower
readmissions even if the
cost of doing so exceeds the readmission penalty.
Because the HRRP is a relatively blunt policy, we expect it to
52. incent hospitals to
change their behaviors in both intended and unintended ways. In
terms of unintended
consequences, strong potential exists for what economists term
the multitasking prob-
lem in which providers direct their efforts toward those metrics
for which they might
be penalized while shirking on those metrics for which they are
not penalized. Under
the HRRP, hospitals would have the incentive to push any
readmissions out past day
30 when they are no longer penalized for the readmission.
Critics have suggested that
hospitals might dodge the HRRP penalties by increasingly
placing returning patients
within 30 days of discharge on observation status (Himmelstein
& Woolhandler, 2015;
Noel-Miller & Lind, 2015). Observation stays are billed as
outpatient services rather
than readmissions to acute care and would not be counted in the
HRRP penalty calcu-
lation. Between 2006 and 2013, observation stays increased by
96% for Medicare
patients (MedPAC, 2015). One recent study, however, did not
find a statistically
significant increase in observation stays for targeted versus
nontargeted conditions
(Zuckerman et al., 2016).
Another unintended consequence would be to discharge patients
with a low risk of
readmission to costlier postacute care settings because the
hospitals are only at risk for
readmissions under the HRRP and not postdischarge spending.
Thus, at the margin,
hospitals have the incentive to increase discharges to home
53. health and skilled nursing
facilities for the HRRP target conditions if such discharges
would help hospitals reduce
readmission rates. From Medicare’s perspective, spending on
these postacute services
would likely more than offset any potential savings from
decreased 30-day
readmissions.
Finally, the HRRP’s readmission measures adjust for
demographic characteristics
associated with higher rates of hospital readmissions (such as
age) and severity.
However, they do not allow risk adjustment based on patients’
race, ethnicity, or socio-
economic status. Because patients with low socioeconomic
status are found to have
higher readmission rates than the overall population (Hu,
Gonsahn, & Nerenz, 2014),
646 Medical Care Research and Review 76(5)
hospitals may respond to the omission of these risk factors by
selecting patients on
race and socioeconomic status associated with lower rates of
hospital readmissions.
Method
Data and Outcome Variables
We construct our hospital admissions and readmissions
measures using the State
Inpatient Discharge data, collected and maintained by the
54. Florida Agency for Health
Care Administration. The data contain detailed information on
all inpatient stays in
Florida from Quarter 1 of 2008 to Quarter 4 of 2014 and a
unique patient identifier that
allows us to track a patient’s historical visits across hospitals
over time. In addition, we
used Medicare Hospital Compare data released in July 2009 (for
the period July 2005–
June 2008) to examine baseline risk-adjusted readmission rates
at the inpatient pro-
spective payment system (IPPS) hospitals in the United States.
We adapt methods used in the prior studies to construct index
hospitalization and
30-day all-cause readmission at the patient level. Specifically,
we code index hospital-
izations as stays in which no inpatient discharge had occurred
within the previous 30
days. Hence, a hospitalization is either an index stay or a
readmission. We then iden-
tify target conditions by the principal diagnosis or procedure of
the index hospitaliza-
tion, using Healthcare Cost and Utilization Project’s (HCUP’s)
Clinical Classifications
Software (CCS). CCS is a tool that collapses diagnosis and
procedure codes from the
International Classification of Diseases, 9th Revision, Clinical
Modification
(ICD-9-CM).1 We used the single level CCS diagnosis code 100
for AMI, 108 for
heart failure, 122 for pneumonia, and 127 for COPD. The CCS
procedure code used
for total hip and knee replacement is 152-153. The ICD-9 codes
used to identify total
hip and knee replacement are 81.51 (primary hip replacement)
55. and 81.54 (primary
knee replacement). In addition, we follow the prior literature
(Carey & Lin, 2015;
Mellor, Daly, & Smith, 2016) and select gastrointestinal
conditions with Medicare
Severity Diagnosis Related Group (MS-DRG) codes 329-331,
377-379, and 391-392
to be our control group of Medicare index hospitalizations.2
Similarly, we define two additional indicator variables when
readmission occurred
within 45 days or 60 days, respectively, and compared them to
the 30-day readmission
to identify if readmission occurred within 31 to 45 days or 31 to
60 days. Finally, we
use the disposition of the patient at discharge to code dummy
variables indicating
whether the patient was discharged to an SNF or HHA.
Control Variables
To control for heterogeneity associated with changes in
readmission and other out-
comes over time, our models include a rich set of patient-level
covariates. The covari-
ates include demographics such as sex, age group, race, primary
payer, income
category, and rural/urban location. We also constructed time-
varying clinical measures
for severity adjustment, including (1) indicators of high severity
with major
Chen and Grabowski 647
56. complications/comorbidities based on the MS-DRG codes and
(2) the number of
comorbid conditions compiled from a set of 29 binary variables
identifying coexisting
medical conditions that are not directly related to the main
reason for index admission
(refer to HCUP’s Elixhauser Comorbidity Software for
details).3
We identify and exclude certain index hospitalizations
following the rules specified
in the technical reports of constructing 30-day all cause
readmission rates prepared for
CMS: (1) hospitalizations during which patients died, (2)
discharged against medical
advice, and (3) discharged or transferred to another acute care
facility. For AMI admis-
sions, we also excluded cases with same-day discharges. The
analysis sample contains
951,215 index admissions from 156 hospitals.
Statistical Analysis
We use a difference-in-differences (DD) method to compare
changes in outcomes of
patients in the treatment group before and after the HRRP
relative to changes in out-
comes of the control group. The treatment group consists of
Medicare FFS beneficia-
ries aged at least 65 years old and with one of the five HRRP
target conditions as the
primary diagnosis for their index admission. For each condition
we use three different
comparison groups for a total of 15 models. The first
comparison group consists of
hospital admissions among Medicare FFS patients aged 65 years
57. and older and with
gastrointestinal conditions as their primary diagnosis. The
second comparison group
includes hospitalizations of each of the five target conditions
among Medicare
Advantage patients aged 65 years and older. The third
comparison group comprises
privately insured patients with those five target conditions.
We estimate the following model:
Y Post Treatment Post
Treatment X Hospi
iht t i t
i it
= +
+ + +
∗ +α µ µ
µ β
1 2
3 � ttalh iht+ε
(1)
where Yiht is an indicator for a study outcome for patient i at
hospital h in time period
t. More specifically, we first examine if the patient was
readmitted within 30 days of
discharge and if there is any delayed readmission after 30 days
but within 45 or 60
58. days of discharge. We also examine if the patient was
discharged to a costlier postacute
care setting (i.e., a SNF or a HHA). Finally, we examine
whether the HRRP reduced
the likelihood of admitting minority patients or lower income
patients. Minority
patients are indicated by whether the patient is Black or of
Hispanic ethnicity. We iden-
tify a patient to be in a lower income region if the patient
resides in a ZIP code wherein
the estimated annual median household income is in the bottom
two quartiles. Each of
these outcome measures represents a separate regression.
Postt is a dummy variable set to 1 if the observation is from the
posttreatment
period in either the treatment or a comparison group. We use
2008-2009 as the pre-
HRRP period and 2012-2014 as the post-HRRP period for AMI,
heart failure, and
pneumonia. For the two newly added conditions (i.e., COPD and
total hip or knee
replacement), we use 2014 as the post-HRRP period. Treatmenti
indicates whether the
648 Medical Care Research and Review 76(5)
index admission was a hospitalization targeted by the HRRP,
and equals zero if the
index admission was part of a comparison group. The
interaction effect of Postt *
Targeti represents our key variable of interest, the DD estimate
of the impact of the
HRRP. Xit is a vector that captures the time-varying patient
59. characteristics (listed in
Table 1). The hospital fixed effects (Hospitalh) are used to
control for the unobserved,
time-invariant differences across hospitals.
Thus, we use pre-HRRP levels for the target admissions and
concurrent changes
from the precontract to postcontract period in the nontarget
admissions to establish
counterfactuals that would be expected in the absence of HRRP
program, and we esti-
mate changes that differed from this expectation (i.e., the
differential change or the
change attributable to the HRRP). For all the regression
analyses, the standard errors
are clustered at the level of the hospital to allow for an arbitrary
covariance matrix
within the clusters.
Because penalties are based on whether a hospital’s readmission
rate exceeds the
national average, hospitals with a baseline readmission rate
above the threshold are at
greater risk of the penalty and thus have stronger incentives to
improve. In July 2009,
the CMS Hospital Compare website began to publicly report
IPPS hospitals’ perfor-
mance in 30-day readmission rates for AMI, heart failure, and
pneumonia, respectively.
For each IPPS hospital with more than 25 cases, its performance
is classified into three
categories: “better than U.S. national rate,” “no different than
U.S. National Rate,” or
“worse than U.S. national rate.” We use the national rate for the
period July 2005 to
June 2008 obtained from CMS’s Hospital Compare data as the
60. baseline threshold rate
and compare the hospital specific average 30-day readmission
rates to the national
average to define if a hospital is “at risk” for any penalty.4
Given that penalties are
based on a hospital’s past 3-year average readmission
performance, partial responses
might be observed immediately after ACA passage but before
penalties go into effect.
Using historic readmission rates prior to ACA passage allows us
to test the full effects
of the HRRP. To examine how the impact of HRRP varies
across hospitals with differ-
ent risks of facing the penalty, we divide the sample into two
groups based on whether
patients were admitted into a hospital with its baseline
readmission rate above the
threshold rate, and then we re-estimate the DD model on both of
the subsamples.
We further compare this DD estimate of patients treated at
hospitals at risk for
HRRP penalties versus those patients treated at hospitals not at
risk for penalties. More
formally, we estimate the triple difference model (DDD)
specified below:
Y Post Target Risk Post Target Post
Risk
iht t i h t i t
h
= + + +
61. +
∗ ∗ ∗
∗
α µ µθ 1 2
µµ γ
γ γ β
3 1
2 3
Target Risk Post
Target Risk X Year
i h t
i h it t iht
∗ +
+ + + + +ε
(2)
Compared with Equation (1), the added variable Riskh is an
indicator variable that
specifies whether a hospital is at risk for HRRP penalties, which
equals to 1 if hospital
h’s baseline readmission rate is above the national average and
0 otherwise. The inter-
action effect of Postt * Targeti * Riskh represents our key
variable of interest, the triple
difference estimate of the impact of the HRRP.
126. d
de
vi
at
io
ns
a
re
in
b
ra
ck
et
s.
650 Medical Care Research and Review 76(5)
As noted above, the DDD approach implicitly assumes that
hospitals at-risk and
not at-risk for the HRRP share the same readmission shocks in a
given hospital and
year that are unrelated to the HRRP policy. The DD approach,
which instead used
as controls the within-hospital readmission shocks among
patients not included in
the HRRP program, may actually be preferable. Because little
basis exists for distin-
127. guishing these approaches ex ante, these models are probably
best viewed as com-
plementary approaches for exploring the validity of this study’s
key results.
We conduct additional analyses to explore potential sources of
bias. We compare
trends in each outcome between the targeted and nontargeted
admissions during the
pre-HRRP period. Similar pre-HRRP trends would support our
assumption that
changes from the pre-HRRP to post-HRRP periods would have
been similar for the
target and nontarget conditions in the absence of the HRRP
program. Considering that
CMS began publicly reporting hospital performance in July
2009 and hospitals might
start to respond by changing their behavior since then, we
restrict the pre-HRRP period
to be the first two quarters of 2009 and reestimated all the
specifications using the
alternative sample and the results stay robust.
Results
We observe several notable trends when examining the 30-day
all cause readmis-
sions by condition from 2008 to 2014 (see Figure 1). First, the
30-day readmission
rates of FFS patients followed similar trends from 2008 to 2009
across the five target
conditions and gastrointestinal condition. Second, the 30-day
readmission rates of
FFS patients with each of the five target conditions decreased or
stayed relatively
stable from 2012 to 2014, while the FFS patients with
128. gastrointestinal conditions
Figure 1. Thirty-day all-cause readmission trend by condition.
Note. HF = heart failure; PN = pneumonia; HIP = total hip or
knee replacement; GI = gastrointestinal
conditions.
Chen and Grabowski 651
experienced an increase in their 30-day readmission rate during
the same time
period. Finally, within the same condition, the 30-day
readmission rates of FFS and
Medicare Advantage patients followed similar trends from 2008
to 2009. We there-
fore use 2008-2009 as the pre-HRRP comparison period. When
comparing across
payers for a given target condition, we also observe that
Medicare readmissions
rates were consistently higher than the rates for privately
insured patients. Table 1
reports the descriptive statistics of the whole sample and by
each of the five target
conditions as well as the gastrointestinal condition. Compared
with the national
average, our sample has slightly higher 30-day all-cause
readmission rates in AMI
and heart failure and comparable readmission rates in
pneumonia, COPD, and total
hip or knee replacement.
We next examine the DD estimates on HRRP targeted
admissions using three dif-
ferent comparison groups (see Table 2). Compared with
129. Medicare FFS patients with
gastrointestinal conditions as the primary diagnosis, there was a
1% to 2% decrease in
30-day readmissions for comparable heart failure, pneumonia,
and COPD patients.
However, when compared with Medicare Advantage patients
with the same target
condition, we observe a statistically significant increase in 30-
day Medicare FFS read-
mission for AMI, heart failure, and pneumonia. Similarly, when
compared with
privately insured patients, 30-day readmissions for Medicare
FFS patients admitted
with AMI and heart failure increased. The results reveal that
although the HRRP tar-
geted Medicare FFS patients only, hospital readmission rates
declined substantially in
the MA and privately insured population after the HRRP,
especially among cardiac
related admissions. This may suggest that there are spillover
effects from the HRRP
extending to MA and privately insured patients. We then restrict
our attention to MA
and privately insured patients admitted with one of the five
HRRP target conditions
and compare changes in their readmissions to those of MA and
privately insured
Table 2. Difference-in-Differences (DID) Estimates of the
Effect of the Hospital
Readmissions Reduction Program on Medicare FFS 30-Day
Readmissions.
Medicare FFS patients
with GI conditions as
130. control
Medicare FFS with
Medicare Advantage,
same condition as control
Medicare FFS with
private insurance, same
condition as control
DID impact DID impact DID impact
(1) (2) (3)
(1) Heart attack −0.004 (0.005) 0.022*** (0.008) 0.023***
(0.007)
(2) Heart failure −0.007** (0.004) 0.012** (0.005) 0.020***
(0.008)
(3) Pneumonia −0.006* (0.003) 0.010* (0.006) 0.007 (0.005)
(4) Chronic obstructive
pulmonary disease
−0.018** (0.005) 0.005 (0.007) −0.006 (0.008)
(5) Total hip or knee
angioplasty
0.013 (0.008) 0.01 (0.011) 0.002 (0.007)
Note. FFS = fee-for-service; GI = gastrointestinal. All models
include control variables listed in Table 1 as well as hospital
fixed effects. The standard errors are clustered at hospital level.
Robust standard errors in parentheses.
*p < .1. **p < .05. ***p < .01.
131. 652 Medical Care Research and Review 76(5)
patients with gastrointestinal conditions, respectively. The DD
estimates reported in
Appendix Table A1 confirmed that after passage of the HRRP,
hospitals reduced car-
diac-related readmissions not only for Medicare FFS patients,
but also for MA and
privately insured patients.
Next, we reran the DD estimation conditional on hospitals’
baseline readmission
performance (see Table 3). Compared with admissions with
gastrointestinal condi-
tions, index hospitalizations with target conditions at a hospital
“at risk” for penalties
had statistically significant lower …