Great University
Background
In this study, we plan to conduct an audit of medical practices at London University Hospital to determine how well the quality and evidence-based practices are being followed at the hospital regarding the common flu or allergic rhinitis symptoms. In this observational study, we plan to randomly select patients who have been regular to the hospital in the past two years. Further, we plan to evaluate whether they had been provided with evidence based care. This we primarily plan to do by evaluating the health records of the randomly selected patients, and evaluating if they have been provided with evidence-based healthcare. The result we will determine by comparing the treatment being provided with the established clinical pathways.
Therefore, the location of the study would be the London University Hospital, in Ontario Canada. The location will allow us to conduct survey with the healthcare providers and also study their health record at the facility. Further, we will be able to take advantage of the hospital’s decision support department for analysis and reporting.
The impact of evidence-based practice (EBP) has been a buzz word across the spectrum of healthcare delivery. Further, the need for evidence-based quality improvement and transformation highlights the need for redesigning care, which is effective, safe, and efficient. The research points out that nurses responded positively to the launch of the initiative, which maximizes their value contribution. And they will they work towards maximizing the benefit of EBP.
In one such study on allergic rhinitis, the researcher realized that there were multiple guidelines for the treatment of this disease. They realized that these guidelines were not necessarily consistent with the systemic review of the literature, and, therefore, did not address treatment of some disease sub-group and certain category of patients. Like our study, the researchers in this study consulted a technical expert panel to identify comparison of the treatment that was most relevant to patients and providers. Here also, the subpopulations of interest were the individuals with other common concurrent diseases. However, their outcomes of interest will be patient symptom scores, quality of life, and adverse events.
In another such study, it was realized that evidence-based health-care practice was available for a variety of conditions such as asthma, diabetes, and heart failure. This study realized that these practices are not implemented in care delivery settings on a routine basis and also, there are a lot of variations in implementation. The report argues that most of the studies have concentrated on the data analysis to identify patient safety issues and have elaborated how new practice guidelines will result in improvement. However, we concur with the report that much less work has been done on how to implement practice guidelines.
Another research article cited that there are an increasing number of studies that have demonstrated patients often do not get necessary care or at times receive care that is not needed. The report highlighted the lack of ideas and approaches on how to improve the state of practice. The report argues that although many interesting models of improvement have come up in recent times, further information is needed on their cost-effectiveness. Therefore, the challenge lies in devising strategies that borrow best of all the models.
Finally, we would like to highlight the fact that evidence-based medicine and clinical quality improvements can learn from each other. These two approaches complement each other and in combination allows to ‘do the right things right’.
Statement of Objective
The main objective of the research is to study the link between the evidence-based medicine (EBM) and clinical quality outcome of patients suffering from allergic rhinitis at London University Hospital. To be specific, we will try to determine quantitatively as well qualitatively the percentage of patients belonging to this disease group, who received evidence-based care. Also, we will use qualitative measures to determine what facilitated and what hindered the delivery of evidence-based care. Further, to explore strategies and make recommendations to improve implementation of evidence-based practice.
Method
Target Population
We will use the medical records of both in-patient and out-patient clinics who were treated for allergic rhinitis. Particularly, we will include those practices that will have data on, evidence-based healthcare services and quality clinical outcomes. We will also try to short-list those practices that have at least 1 year of data. From those practices, we will use random sampling of patients of the number that are essential for the statistical significance and independence of the samples. For the sake of simplicity and to reduce the costs, we use cluster sampling, which involves dividing the practice into batches, which are randomly selected and assigned.
Next, we will be recruiting volunteers from nursing staff to parse through the health records for evidence of evidence-based practice and also note the clinical quality outcomes. Some of the nurses will be used to conduct surveys with the physicians and the patients themselves. Those patients, who do not happen to visit the hospital during the course of the study, will be contacted over the phone. Their consent will be taken prior to their enrollment into the study, and it will include their permission to be contacted via phone.
Also, we will be employing nurses as coaches to identify practices, which have staff members that had sufficient involvement to provide historical and in the current context of practices’ work with evidence-based practice, particularly in the case of flu and allergic rhinitis.
Ethical Considerations
We will use informed consent to ensure that the autonomy of the participants is maintained. The approach discussed so far involves balancing between over-informing and under-informing the participants. This also implies that they maintain their right as an independent and autonomous individual to voluntary accept or decline to participate in the research.
The next ethical principle which is applicable is beneficence that means doing good for others and avoiding any harm. Therefore, the research strategies that are used to collection data and the selection criteria also have ethical implications. So, patients who are not in a position to give informed consent in open-ended interviews should not be persuaded to participate in the study. So, if we are following the principle of beneficence, addressing the potential consequences related to disclosure of participants’ identity will be our moral obligation.
Lastly, we will also take into account the ethical principle of justice. One of the major critical and unique features is avoiding exploitation and abuse of subjects. So, researchers understand that the application of the principle of justice in research can be demonstrated by accepting the vulnerability of the participants and their status in the society.
Data Collection Method
Along the practices that are selected, we will be conducting in-person, on-site, key informant focus group interviews in the first two months of the research study. They key informants will include representatives from the practice leadership, which is physicians, nurse practitioners, physician assistants, practice managers and practice staff, such as registered nurses, registered practical nurses, medical assistants, front desk and billing clerks. So as to maximize the diversity of perspectives and minimize single-source bias, interview will be conducted in two groups – one with practice leadership and one with staff. Each interview will last around one hour and will be conducted by the member of the study team. All interviews will be recorded and transcribed verbatim. To standardize the interview process, we will use a semi-structured interview guide with probes to explore informant response. The questions will cover eight domains; understanding and perception of evidence-based practice; motivation and power balance; clinical information and challenges; extent of implementation; resources and support; physician, provider, and staff stress; spillover effects; and costs.
Analysis
The medical record and interview data will be analyzed using a combination of deductive and inductive methods. A code book will initially be developed from the interview domains. New codes will be added as the concepts emerged. Four members of the team will code two common transcripts and meet to reach a consensus on the final set of codes, code definition, and use. Remaining transcripts will be coded by two members of the study team. All coding will be supported by ATLAS.ti qualitative data analysis software. Throughout the process, the coding team will regularly meet to ensure coding is done consistently and to discuss emerging themes and subthemes.
Quantitative analysis will be done using SPSS software, and depending upon whether the variables are categorical, ordinal or numerical, various statistical analyses such as ANOVA, Chi-test, and regression analysis will be used.
Timeline
Preparation and Planning
The preparation and the planning stage will involve the formation of the research team. It will include the physicians, nurses, medical records staff, and management representatives who will be running the show. The team will also include those stakeholders, such as state health department which have a stake in the outcome of the study.
Study Phase
Once the preparation and planning phase is over. The actual research will be conducted, which includes conducting surveys and parsing information from the medical records. This will also include telephonic survey with those unable to make it to the facility. Further, focus groups will be conducted with the hospital staff about the need to improve evidence-based practices with the intention of making recommendations.
Analysis Phase
The analysis phase includes statistical analysis of the data and preparation of a report for all the stakeholders. The statistical analysis will be conducted in context of the questions that need to be answered. Care will be taken such that the tools being used are relevant. Further, these tools will also be explained in simple terms in the report because many won’t know what they do and what the results imply
Budget
C.V.
Education
Masters in Science, in progress
Skills
- Knowledge of Laboratory procedures
- Knowledge of the use and preparation of clinical guidelines
- Knowledge of medical terminology
- Verbal and written communication skills
- Supervisory Skills
- Interpersonal/human relation skills
- Ability to maintain records and inventory
Work Experience
- Sets-up and operates various scientific apparatus
- Performs various clerical duties including typing, answering phones, preparing correspondence
- Assist in research projects; performs independent research; plans, designs, and implements research projects
- Performs various editorial duties; writes, reviews and edits various materials for publication; prepares publication schedules.
References
Agency for Healthcare Research and Quality. (2013). Treatments for Seasonal Allergic Rhinitis. Rockville: Agency for Healthcare Research and Quality. Retrieved from http://www.effectivehealthcare.ahrq.gov/ehc/products/376/1588/allergy-seasonal-report-130711.pdf
Glasziou, P., Ogrinc, G., & Goodman, S. (2011). Can evidence-based medicine and clinical quality improvement learn from each other? BMJ Quality & Safety, 20, i13 - 117. Retrieved from http://qualitysafety.bmj.com/content/20/Suppl_1/i13.abstract
Grol, R. (2000). Between evidence-based practice and total quality managment the implementation of cost-effective care. International Journal for Quality in Health Care, 12(4), 297-304. Retrieved from http://intqhc.oxfordjournals.org/content/12/4/297.full.pdf
Stevens, K. R. (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. The Online Journal of Issues in Nursing, 18(2). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html
Tiler, M. G. (2008). Chapter 7: The Evidence for Evidence-Based Practice Implementation. In R. G. Hughes, Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2659/
