EBP Research Table Assignment

EBP Research Table Assignment

EBP Research Table Assignment

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Week 5 assignment CLC: EBP Research Table Citation Include the APA reference note. Abstract/Purpose Craft a 100-150 word summary of the research. Research/Study Describe the design of the relevant research or study in the article. Methods Describe the methods used, including tools, systems, etc. Setting/Subject Identify the population and the setting in which the study was conducted. Findings/Results Identify the relevant findings, including any specific data points that may be of interest to your EBP project. Variables Describe the independent and dependent variables in the research/study. Implication for Practice Articulate the value of the research to the EBP project your group has chosen. Independent Variable Dependent Variable

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Evidence Table
Evidence-Based Practice in Nursing
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Source
Issue Related to EBP
Design Type*
Study Design & Study Outcome Measure(s)
Study Setting & Study Population
Study Intervention
Key Findings
Berner 2003121
Local opinion leaders.
Group randomized controlled trial (RCT). Evidence level 2.
RCT 3 study arms: no intervention, traditional health care QI; opinion leader (OL) plus QI (level 2). Outcomes = 6 evidence-based quality indicators for 1994 unstable angina guidelines (level 2).
Hospitals in Alabama. Patients admitted to an Alabama hospital during 1997–98 (baseline) and 1999–2000 (followup) with ICD-9 CM codes of unstable angina, angina pectoris, coronary artery disease, and chest pain unspecified. Mean age of patients was >70 years of age.
Peer nominated opinion leader added to a Centers for Medicare and Medicaid Services (CMS) QI intervention.
OL treatment effects (over QI group) found for antiplatelet medication within 24 hours and heparin use (2 of 5 indicators).
Bootsmiller 2004103
Assess the implementation methods for 4 clinical practice guidelines (CPGs) in the VA health care system.
Retrospective cohort study. Evidence level 5.
Survey methods with questionnaire sent to 416 quality managers, primary care administrators, or others involved with guideline implementation in primary care at 143 VA medical centers with primary care clinics (level 9). Modified Dillman method was used.
Outcomes: methods used to implement guidelines (level 4).
Primary care clinics of VA medical centers. Study population is individual responsible for guideline implementation. 242 surveys returned from 130 hospitals. CPGs were chronic obstructive pulmonary disease (COPD), diabetes, heart failure, and major depressive disorder.
Total number of interventions used were counted and type of interventions used to implement CPGs were categorized as consistently effective, variably effective, and minimally effective, based on Bero’s categories:
Consistently effective:
– Forms created/revised
– Computer interactive education
– Internet discussion groups
– Responsibilities of nonphysicians changed academic detailing

EBP Research Table Assignment

Variably effective:
– CPG workgroup
– Clinical meetings to discuss CPG

Minimally effective:
– Providers receive brief summary
– Providers receive CPG
– Providers receive pocket guide
– Storyboards
– Instructional tape of CPG
– Grand rounds

EBP Research Table Assignment
Commonly used approaches were clinical meetings to discuss guidelines (variably effective/Bero’s classification), provider receipt of brief summary (minimally effective classification), forms created or revised (consistently effective classification), responsibilities of nonphysicians revised (consistently effective classification). Most facilities used 4–7 approaches. Consistently and minimally effective approaches were used most frequently. Strategies used together almost always included one consistently effective approach.
Bradley 200460
Describe the implementation process for the Hospital Elder Life Program (HELP)—an evidence-based program for improving care of older patients.
Descriptive prospective study.
Qualitative analyses of implementation process at the beginning of implementation and every 6 months for up to 18 months.
8 hospitals implementing HELP. In-depth, open-ended interviews were conducted by telephone with physicians, nurses, volunteers, and administrative staff involved in the HELP implementation.

Major themes in implementing the HELP program were (1) gain internal support for the program, recognizing diverse requirements and goals; (2) ensure effective clinical leadership in multiple roles; (3) integrate with existing geriatric programs to foster coordination rather than competition; (4) balance program fidelity with hospital-specific circumstances; (5) document and publicize positive outcomes; (6) maintain momentum while changing practice and shifting organizational culture.
Bradley 2004177

EBP Research Table Assignment
Identify key themes about effective approaches for data feedback as well as pitfalls to avoid in using data feedback to support performance improvement efforts.
Retrospective cohort study. Evidence level 5.
Qualitative study with open-ended interviews of clinical and administrative staff at 8 hospitals representing a range of sizes, geographical regions, and beta-blocker use rate after AMI (level 9). Outcomes = key themes in use of data feedback.
8 hospitals. Interviewed physicians (n =14), nurses (n =15), quality management (n = 11), and administrative (n = 5) staff who were identified as key in improving care of patients with AMI.
Data feedback for improving performance of beta-blocker use after AMI.
7 major themes: Data must be perceived by physicians as valid to motivate change. It takes time to develop credibility of data within a hospital. The source and timeliness of the data are critical to perceived validity. Benchmarking improves the validity of the data feedback. Physician leaders can enhance the effectiveness of data feedback. Data feedback that profiles an individual physician’s practices can be effective but may be perceived as punitive. Data feedback must persist to sustain improved performance. Effectiveness of data feedback might be intertwined with the organizational context, including physician leadership and organizational culture.
Carter 200561

EBP Research Table Assignment
Evaluation of the relationship between physicians’ knowledge of hypertension guidelines and blood pressure (BP) control in their patients.
Cross-sectional study
Cross-sectional study of physicians’ knowledge about Joint National Committee (JNC) 7 hypertension guidelines (level 4).
Outcomes were BP values of patients each physician treated.
Study setting was two academic primary care clinics located in the same academic medical center. The sample was 32 primary care physicians and 613 patients they treated. Mean age of physicians was 41 years (Standard Deviation [SD]. = 10.9), majority were men (66%).
Association between physician knowledge and BP control. Covariates of presence of diabetes, patient age.
There was a strong inverse relationship between BP control rates and correct responses by physicians on the knowledge test (r = −0.524; p = .002). Strong correlation was also found between correct responses on the knowledge survey and a higher mean systolic BP (r = 0.453; p = .009). When the covariates of patient age and diabetes were added to the model, there was no longer a significant association between physician knowledge and BP control. However, the correlation (in the multivariate model) was still in the same direction; for every 5 points better on the knowledge test, there was a 16% decrease in the rate of BP control (p = .13), and for every 10 years increase in patient age, there was a 16% decrease in BP control (p = .04).
Chin 200462, 186
To determine the additive effect of additional support for organizational change techniques and chronic care management as they are added to the Health Disparities Collaborative initiatives to improve diabetes care in community health centers.
RCT
34 centers were randomized to a standardized intensity arm (Health Disparities Collaborative initiatives) or high intensity arm. (level 2).

EBP Research Table Assignment
Outcomes included process of care measures; laboratory values based on American Diabetes Association (ADA) recommendations; and patient surveys of satisfaction with provider’s communication style and overall care, attitudes about interacting with providers, knowledge of ADA recommendations, and provider performance of key processes of care (levels 1 and 2).
34 community health centers from the Midwest or West Central clusters that participated in the 1998–99 or 1999–2000 Diabetes Collaborative of the Bureau of Primary Health Care in Improving Diabetes Care Collaboratively in the Community. These centers care for the medically underserved. In the standard arm, there were 843 patients at baseline and 665 in the followup standard intensity group. 993 patients were in the high intensity arm at baseline and 818 postinterventions high intensity group. Mean age of subjects ranged from 56 to 58, a majority were female, and white.
All 34 centers were community health centers that are overseen by the Bureau of Primary Health Care and had participated in the Health Disparities Collaborative to improve diabetes care. Interventions included forming a QI team, adoption of the Plan-Do-Study-Act (PDSA) cycle for QI, learning sessions, data feedback, monthly teleconferences, and regional meetings over a year. The centers randomized to the standard intensity arm continued to receive quarterly data-feedback reports, conference calls with other centers, and a yearly in-person meeting with other health centers. The high intensity sites received the standard intensity interventions plus additional…