The purpose of this assignment is to synthesize a literature review that will be used to draw conclusions
The purpose of this assignment is to synthesize a literature review that will be used to draw conclusions in order to propose an evidence-based practice change to address your identified nurse practice problem.
Using the “Literature Evaluation Table” assignment in Topic 1, and accompanying faculty feedback, you will synthesize the information created for your PICOT question into a literature review and evidence-based proposal.
In a 1,500-1,750-word paper, provide an overview that illustrates the research related to your particular PICOT question.
Use the following components from the “Literature Evaluation Table” to complete the assignment:
- Identified practice problem
- Two qualitative peer-reviewed research articles
- Two quantitative peer-reviewed research articles
Use the “Research Critiques and Evidence-Based Practice Proposal Guidelines” document to organize your paper.
You are required to cite a minimum of four peer-reviewed sources to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Expert Answer and Explanation
Research Critiques and Evidence-Based Practice Change Proposal
The nursing problem focuses on the effectiveness of multidisciplinary care teams in improving healthcare outcomes for patients with chronic diseases. Chronic diseases, such as diabetes, heart disease, and chronic obstructive pulmonary disease (COPD), require complex and continuous management that often exceeds the capacity of traditional single-provider care. These conditions frequently lead to high hospital readmission rates and can negatively impact patient satisfaction due to the fragmented nature of usual care.
The primary nursing problem here is how to coordinate comprehensive care that addresses all aspects of a patient’s condition, ensuring both effective management and continuity of care. The implementation of a multidisciplinary care team is proposed as a solution to this problem, involving a range of healthcare professionals such as physicians, nurses, dietitians, pharmacists, and social workers. This team-based approach aims to provide holistic and patient-centered care, which can lead to better management of chronic diseases.
Compared to usual care, which might involve sporadic visits to different specialists without coordinated communication, a multidisciplinary team works collaboratively to develop and follow a cohesive care plan. This approach is expected to improve healthcare outcomes by reducing hospital readmission rates and enhancing patient satisfaction. The six-month follow-up period is critical to assess the effectiveness of this intervention, providing sufficient time to observe changes in patient health status and measure the impact on their overall care experience.
PICOT Question
In patients with chronic diseases (P), how does the implementation of a multidisciplinary care team (I) compared to usual care (C) affect healthcare outcomes such as hospital readmission rates and patient satisfaction (O) within a six-month follow-up period (T)?
The intervention is the implementation of a multidisciplinary care team for patients with chronic diseases. This team-based approach involves various healthcare professionals working together to provide coordinated and comprehensive care. Patients with chronic diseases often experience fragmented care under usual care models, leading to poor health outcomes and high hospital readmission rates. This lack of coordinated care can also negatively impact patient satisfaction, highlighting the need for more integrated and effective care strategies.
Method of Studies
The four articles examined employ different methodologies to address their respective research questions. Brooks et al. (2023) used a qualitative method, conducting interviews with 22 health professionals to explore the development of interprofessional chronic disease management programs. This approach allowed for in-depth understanding of the successes and challenges faced by these teams.
Donzé et al. (2023) conducted a quantitative, randomized clinical trial involving 1386 patients to evaluate the impact of a multimodal transitional care intervention on hospital readmissions. The rigorous, controlled environment of this method enabled precise measurement of intervention effects. Mas et al. (2023) utilized a quantitative, retrospective cohort study to analyze pre- and post-intervention data of the ProPCC Programme, focusing on healthcare resource use and patient outcomes.
This method provided concrete evidence of the its impact over time. Lastly, Leung et al. (2024) carried out a mixed-method, retrospective study comparing 30-day unplanned readmission rates before and after the implementation of a goals-of-care program in a cancer center. This approach helped to assess the effectiveness of the intervention in a real-world clinical setting.
Results of Studies/Key Findings
The studies reviewed produced several key findings that collectively underscore the importance of a multidisciplinary approach to chronic disease management. Brooks et al. (2023) highlighted that while informal communication and collegial learning among health professionals led to improvements in patient care, there were also significant pitfalls associated with the lack of formal communication structures.
Specifically, the study found that informal communication could inadvertently create silos within the care team, resulting in fragmented care for patients with complex needs. The study emphasizes the necessity of formalized communication processes to optimize the coordination and deployment of clinical resources, ultimately enhancing patient outcomes.
In contrast, Donzé et al. (2023) concluded that their multimodal transitional care intervention did not significantly reduce 30-day unplanned readmission or death rates. This study, which involved a large sample of 1386 patients across multiple hospitals, highlighted the persistent challenges in preventing hospital readmissions, even when employing comprehensive, targeted interventions. The lack of statistically significant improvements in key outcomes, such as post-discharge healthcare use and patient satisfaction, suggests that multimodal interventions alone may not be sufficient to address the complexities of chronic disease management. This finding underscores the need for a more integrated and possibly individualized approach to transitional care.
Mas et al. (2023) provided a different perspective by demonstrating significant improvements in healthcare resource utilization through the ProPCC Programme. The study reported increases in primary care visits and reductions in emergency department visits and hospital stays, as well as an increase in the time patients spent at home. These outcomes indicate that an integrated care program, which effectively coordinates various aspects of patient care, can lead to better management of chronic conditions and more efficient use of healthcare resources. The positive results from this study support the notion that comprehensive, patient-centered care models can significantly enhance the quality of care for individuals with complex chronic conditions.
Similarly, Leung et al. (2024) found that implementing a goals-of-care program reduced 30-day unplanned readmission rates from 24.0% to 21.3%, with a notable reduction in 7-day readmission rates as well. This study underscores the effectiveness of a multidisciplinary approach in reducing hospital readmissions, particularly in a specialized setting such as a cancer center. The findings suggest that structured, goal-oriented care plans that involve multiple healthcare professionals can significantly improve patient outcomes. This reinforces the importance of integrating multidisciplinary care teams into chronic disease management to achieve better coordination and more effective patient care.
The anticipated outcomes for the PICOT question include reduced hospital readmission rates and improved patient satisfaction through the implementation of a multidisciplinary care team for chronic disease management. The outcomes of the four articles align with these expectations to varying degrees. Brooks et al. (2023) highlighted the importance of formal communication structures in multidisciplinary teams to enhance patient care, indirectly supporting reduced readmission rates.
Donzé et al. (2023) found no significant reduction in readmissions, indicating that not all multimodal interventions are equally effective. Mas et al. (2023) showed substantial improvements in healthcare resource use and patient outcomes, supporting the effectiveness of integrated care models. Leung et al. (2024) provided direct evidence that multidisciplinary approaches can reduce readmission rates, closely aligning with the anticipated outcomes of the PICOT question.
Proposed Evidence-Based Practice Change
The link between the PICOT question, the research articles, and the identified nursing practice problem highlights the critical need for an integrated, multidisciplinary approach to managing chronic diseases. The PICOT question explores the effect of a multidisciplinary care team on healthcare outcomes, particularly focusing on hospital readmission rates and patient satisfaction.
The articles reviewed provide substantial evidence that a multidisciplinary approach can lead to improved patient outcomes. However, the effectiveness of such an approach is contingent upon effective communication and coordination among the healthcare providers involved. The studies show that while multidisciplinary teams have the potential to enhance patient care, the lack of formal communication structures can lead to fragmented care, as indicated by Brooks et al. (2023).
Given this understanding, an evidence-based practice change is proposed: the establishment of a formalized multidisciplinary care team for chronic disease management within healthcare facilities. This team should include a diverse array of healthcare professionals, such as doctors, nurses, pharmacists, and social workers, all working together with structured communication protocols to ensure coordinated care.
The studies reviewed demonstrate that multidisciplinary approaches, when implemented with proper communication channels and protocols, can significantly reduce hospital readmissions and improve patient satisfaction. For instance, Leung et al. (2024) showed a notable decrease in readmission rates with the implementation of a structured goals-of-care program, reinforcing the need for formalized communication and coordination within multidisciplinary teams.
To assess the effectiveness of this proposed practice change, several patient outcomes should be monitored, including readmission rates, patient satisfaction, and overall healthcare costs. Comparing these metrics to baseline data will provide a clear indication of the impact of the multidisciplinary care team. It is essential to establish a continuous feedback loop where patient outcomes are regularly reviewed and the multidisciplinary team’s processes are adjusted as needed to improve care quality.
This approach ensures that the multidisciplinary team remains responsive to patient needs and continues to deliver high-quality, coordinated care. The ultimate goal is to create a sustainable model of chronic disease management that consistently reduces hospital readmissions, enhances patient satisfaction, and optimizes healthcare resources.
Conclusion
In conclusion, the literature review reveals that multidisciplinary care teams, when effectively implemented, can significantly enhance patient outcomes in chronic disease management. The qualitative insights from Brooks et al. (2023), the randomized clinical trial findings of Donzé et al. (2023), the retrospective analysis by Mas et al. (2023), and the real-world evidence from Leung et al. (2024) collectively support the need for structured and coordinated care approaches.
An evidence-based practice change involving the establishment of formal multidisciplinary teams with robust communication protocols is proposed to improve patient care outcomes in chronic disease management settings. Monitoring and evaluating the impact of this change will be crucial in ensuring its success and sustainability in reducing hospital readmissions and enhancing patient satisfaction.
References
Brooks, L., Elliott, J., Stolee, P., Boscart, V. M., Gimbel, S., Holisek, B., … & Heckman, G. A. (2023). Development, successes, and potential pitfalls of multidisciplinary chronic disease management clinics in a family health team: a qualitative study. BMC Primary Care, 24(1), 126. https://doi.org/10.1186/s12875-023-02073-x
Donzé, J., John, G., Genné, D., Mancinetti, M., Gouveia, A., Méan, M., … & Schnipper, J. (2023). Effects of a multimodal transitional care intervention in patients at high risk of readmission: the TARGET-READ randomized clinical trial. JAMA Internal Medicine, 183(7), 658-668. https://doi.org/10.1001/jamainternmed.2023.0791
Mas, M. À., Miralles, R., Ulldemolins, M. J., Garcia, R., Gràcia, S., Picaza, J. M., … & Estrada, O. (2023). Evaluating person-centred integrated care to people with complex chronic conditions: early implementation results of the ProPCC programme. International Journal of Integrated Care, 23(4). https://doi.org/10.5334%2Fijic.7585
Leung, C., Andersen, C. R., Wilson, K., Nortje, N., George, M., Flowers, C., … & Hui, D. (2024). The impact of a multidisciplinary goals-of-care program on unplanned readmission rates at a comprehensive cancer center. Supportive Care in Cancer, 32(1), 66. https://doi.org/10.1007/s00520-023-08265-6
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