Running head: PICOT EVIDENCE BASE 1
PICOT Evidence Base
NR701: Application of Analytic Methods
Karine Austin
Chamberlain University
,PICOT EVIDENCE BASE 2
PICOT Evidence Base
Congestive heart failure (CHF) affects roughly 2% of the American adult population, and
its prevalence will continue to grow in the foreseeable future (Garcia, 2017). CHF patients who
are hospitalized frequently are rehospitalized within six months of discharge, with 25%
readmitted in the first 30 days alone (Guirguis-Blake, 2016). Rehospitalization puts CHF patients
at risk for poorer, and even mortal, health outcomes, and readmission within 30 days prevents
hospitals from being reimbursed from public and private insurance providers for services
provided (Garcia, 2017). There is a need to change the way that hospitals provide care to patients
hospitalized for CHF both prior to and following discharge in order to reduce rapid readmissions
among this vulnerable patient population. The purpose of this assignment is to present
information on a Population, Intervention, Comparison, Outcome, and Time (PICOT) question
that would study a transitional care program for hospital in patients with CHF to reduce
readmissions, while also discussing the available evidence on the topic, with the ultimate
purpose of applying these elements of the assignment in the development of a Doctor of Nursing
Practice (DNP) project.
Problem Statement
CHF is the most common reason for hospital readmissions in the United States, and
causes many stakeholder problems from the standpoints of patient health outcomes, health care
provider resources, and economic factors. At the facility where the DNP project will be
conducted, readmission rates are similar to national statistics for CHF patients, which involve
34% of CHF patients being readmitted within 90 days, and roughly 45-50% being readmitted
within six months after discharge (Bayati et al., 2014; Garcia, 2017). Patient risks for
, PICOT EVIDENCE BASE 3
complications with CHF, as well as for premature mortality, significantly increase with
readmission to the hospital, because readmission can often serve as an indicator of issues such as
a failure to adhere to medication regimens or to make lifestyle and dietary changes that are
necessary with CHF (Bayati et al., 2014; Vedel & Khanassov, 2015). Generally, hospitals do not
sufficiently coordinate care with outpatient and home services patients require after
hospitalization for CHF, do not provide adequate patient and family education in regard to self-
care, lack standardized coordination for the patient discharge processes, and do not conduct
medication reconciliation, which are all factors that raise the risk of readmission (Hamar et al.,
2016). The Centers for Medicaid and Medicare Services no longer reimburses care providers for
CHF care provided in the context of readmissions, and many private insurers are following suit
(Guirguis-Blake, 2016; Verhaegh et al., 2014). The economic impact of CHF goes far beyond
this, however; direct health care costs alone exceed $32 billion annually in the United States
(Whitaker-Brown et al., 2017). Patients, their family members, clinicians, and hospitals share a
common interest in reducing readmissions from CHF.
PICOT Question
The PICOT question that will guide my potential DNP Project is: In adults with
congestive health failure regarding acute inpatient admission, how does use of a transitional care
intervention during and after discharge, compared to routine discharge care, affect the rate
patient readmissions within 30 days of discharge?
PICOT Evidence Base
NR701: Application of Analytic Methods
Karine Austin
Chamberlain University
,PICOT EVIDENCE BASE 2
PICOT Evidence Base
Congestive heart failure (CHF) affects roughly 2% of the American adult population, and
its prevalence will continue to grow in the foreseeable future (Garcia, 2017). CHF patients who
are hospitalized frequently are rehospitalized within six months of discharge, with 25%
readmitted in the first 30 days alone (Guirguis-Blake, 2016). Rehospitalization puts CHF patients
at risk for poorer, and even mortal, health outcomes, and readmission within 30 days prevents
hospitals from being reimbursed from public and private insurance providers for services
provided (Garcia, 2017). There is a need to change the way that hospitals provide care to patients
hospitalized for CHF both prior to and following discharge in order to reduce rapid readmissions
among this vulnerable patient population. The purpose of this assignment is to present
information on a Population, Intervention, Comparison, Outcome, and Time (PICOT) question
that would study a transitional care program for hospital in patients with CHF to reduce
readmissions, while also discussing the available evidence on the topic, with the ultimate
purpose of applying these elements of the assignment in the development of a Doctor of Nursing
Practice (DNP) project.
Problem Statement
CHF is the most common reason for hospital readmissions in the United States, and
causes many stakeholder problems from the standpoints of patient health outcomes, health care
provider resources, and economic factors. At the facility where the DNP project will be
conducted, readmission rates are similar to national statistics for CHF patients, which involve
34% of CHF patients being readmitted within 90 days, and roughly 45-50% being readmitted
within six months after discharge (Bayati et al., 2014; Garcia, 2017). Patient risks for
, PICOT EVIDENCE BASE 3
complications with CHF, as well as for premature mortality, significantly increase with
readmission to the hospital, because readmission can often serve as an indicator of issues such as
a failure to adhere to medication regimens or to make lifestyle and dietary changes that are
necessary with CHF (Bayati et al., 2014; Vedel & Khanassov, 2015). Generally, hospitals do not
sufficiently coordinate care with outpatient and home services patients require after
hospitalization for CHF, do not provide adequate patient and family education in regard to self-
care, lack standardized coordination for the patient discharge processes, and do not conduct
medication reconciliation, which are all factors that raise the risk of readmission (Hamar et al.,
2016). The Centers for Medicaid and Medicare Services no longer reimburses care providers for
CHF care provided in the context of readmissions, and many private insurers are following suit
(Guirguis-Blake, 2016; Verhaegh et al., 2014). The economic impact of CHF goes far beyond
this, however; direct health care costs alone exceed $32 billion annually in the United States
(Whitaker-Brown et al., 2017). Patients, their family members, clinicians, and hospitals share a
common interest in reducing readmissions from CHF.
PICOT Question
The PICOT question that will guide my potential DNP Project is: In adults with
congestive health failure regarding acute inpatient admission, how does use of a transitional care
intervention during and after discharge, compared to routine discharge care, affect the rate
patient readmissions within 30 days of discharge?
