Elderly With Heart Failure and How To Prevent Rehospitalization

Elderly people are a group of people that require delicate care and thus make it essential for nurses to ensure that they use the current best practice in the industry. Research done in ensure best practices at times become difficult on the part of the student nurses and even the qualified nurses. The terminology used in such research requires a critical reading, this is to ensure that the care provided by nurses are based on solid research. There is therefore a need for nurses to ensure that they critically appraise a research so that they can be able to identify best practice for the elderly. The critique will be on the research done by the Agency for healthcare research and quality (AHRQ) via its Evidence- based Practice Centers (EPCs).

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The researchers did not come up with their own measures. The instruments used were searched from the Cochrane library and the cumulative index to nursing and allied literature (CINAHL). The scales used had been published for a period beginning July 1 2007 to May 9, 2013. In order for the researchers to identify the randomized controlled trials, they had to use the health research and quality technology on the past researches that had been done on similar topics. The research were based on past articles that had researched on the topic. The researchers therefore had to look through past electronic data bases in other to find relevant non randomized trials.

There was a discussion on the testing tools that were used in the research. There were two members of the research team who were selected so that they could independently review each title and abstract. The purpose of reviewing the articles was to make a determination on its eligibility. There were studies that could be used to mark the articles for a possible inclusion. If the reviewers found articles that were no eligible then they could go ahead and recommend a full text review. The full text article could further undergo a full text review from two other independent members of the research team. Whenever the reviewer disagreed on the tools, then they were supposed to resolve the conflict through a discussion and a consensus. Another option for resolving the conflict by the reviewers would be to consult a senior member of the team.

The data used in the study by the researchers were extracted using a structure data forms. The forms acted as a medium for gathering important information that could be found in the articles used in the researchers. The interventions that were included in the different trials performed in the experiment were more likely to be diverse. They were classified in manner that the researchers believed it to be both descriptive and informative. There is an acknowledgement on the part of the researchers that it is possible for different results to be obtained when different categorization is used. The problem with the procedures of data collection used is that it made it difficult to classify the trials. It was difficult to categorize the trials in a distinct manner. A good example of such scenario is the trial by Rainsville as that categorized it as STS. In 2012 the same trail was categorized as case management by Cochrane review.

Another shortcomings of the data collection part was the publication bias and the selective reporting. The researchers, even though they made researches on unpublished outcomes, they still did not make it to find any direct evidence of the biasness of the data. The inclusion ad exclusion criteria used also did not accommodate for readmission rates or the mortality rates that were measured for a period more than six months (Jencks .SF, Williams .MV, Coleman. EA, 2009).

During the study there were adequate steps taken to ensure that there were high possible quality of data. An assessment of internal validity of the studies were performed and the researchers came into agreement to use pre-defined criteria on the basis of AHQR methods guide. There was a performance to assess the selection bias, detection bias and finally the attrition bias. During the study there inclusion of questions that dealt with adequacy of randomization, masking, methods of handling data and validity of the outcome measures. In order to assess the measurement bias of the related readmission ascertainment, the researchers had to determine whether the studies had an access to all data related to readmission or not. This was different from the normal one of only studying readmissions collection from a single institution data base. There was a criteria used in rating the studies. The studies could be rated as low, medium, high or bias. To further ensure the reliability of the data there were two reviewers who were independent. The work of the reviewers were to ensure that the data collected were up to the standards and not biased.

References

Centers for Medicare &Medicaid services, office of information services. Medicare ranking for all short stay hospitals by discharges. Fiscal year 2005 verses 2004, 2006.

https://www.effectivehealthcare.ahrq.gov/ehc/products/510/1910/heart-failure-readmission-report-130527.pdfJencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for services program. N Engl J Med 2009 April 2; 360(14): 1418-28Epub 2009/04/03.