HLT540 full course

HLT 540 full course
All Discussions and all weeks Assignments
2015

week 1

Why do you think many healthcare practitioners are often
unwilling to change practice patterns, based on research findings? Some
practitioners criticize evidence-based practice as “cookbook care.”
Considering these perceptions, how would you utilize your education and
experiences in planning the implementation of a major change?

Consider the question: “Why do physicians and nurses
kill more people than airline pilots?” Apply your critical thinking skills
to this argument and critique the statement. First, do you think it’s true? If
it is, what do you think about their rationale? How would you address it if the
question were posed to you in a forum?

week 2

What kinds of extraneous variables (not cited in the
studies) do you think could have affected the relationships between the
independent variables and the dependent variables in both the Messina et al.
and Coyne et al. studies?

How effectively do you think the Coyne et al. study and the
Messina et al. study both used their review of literature to help the reader
understand why the research question was asked? How could they have done it
more effectively?

week 3

Given that there is a documented advantage to the use of an
experimental and control group design, discuss why other designs are frequently
used, and the situations that may prompt the use of one.

Discuss your understanding of the concept of internal
validity in a research study, and the impacts of several errors or biases that
can reduce the study’s validity.

week 4

Why do you think so many people have problems with using,
interpreting, or applying statistics in making business decisions?

As you have learned to evaluate different research studies,
what elements seem the most important to you for evaluation of the research’s
quality? Why?

week 5

Discuss the concept of the normal distribution, why it is
important, and what you think it means.

diss 2

When students talk about “grading on the curve,”
how does that apply to the normal distribution?

week 6

Discuss the differences between the concepts of correlation
and causality, and why it is critically important to make sure that the
differences are understood?

What are the indicators for using a t-test? Create a
research scenario in which it would be correct to use a t-test, including the
research question, sample size, and dependent and independent variables.

week

What are the indicators for using an ANOVA? Create a
research scenario in which it would be correct to use an ANOVA, including the
research question, sample size, and dependent and independent variables.

What are the indicators for using a regression analysis?
Create a research scenario in which it would be correct to use a regression
analysis, including the research question, sample size, and dependent and
independent variables?

week 8

Re-visit the roadmap that you began at the start of your
program of study. Complete information regarding this course. In the
discussion, reflect on how this course meets your career goals. What have you
gleaned from the course that will help you in your career path? Respond to at
least two other classmates.

Discuss your thoughts about the ethics of using informed
consent vs. blinding the subjects to the expected outcomes of the intervention.
Should they be told? How much should they be told? How would the placebo effect
be impacted if subjects are told which intervention is being applied to them?

assignments

Details:

Identify, analyze, and discuss the components that comprise
a valid evidence-based research study.

Based on the information compiled above, interview a health care leader
about his/her experiences related to using evidence-based research to drive
changes in practices in his/her facility.

Write a report (1,000-1,250 words) of your findings. Include
the following in your report:

1) The changes that the health care leader
has been involved in implementing.

2) How strong did the leader feel the research on the topic
was? Why?

3) Have they ever rejected research findings? Why or why
not?

4) Include any concerns they have had or resistance they
have experienced when implementing changes based on research.

5) Analyze your findings as they apply to the components of
evidence-based research.

Prepare this assignment according to the APA guidelines
found in the APA Style Guide, located in the Student Success Center. An
abstract is not required.

This assignment uses a grading rubric. Instructors will be
using the rubric to grade the assignment; therefore, students should review the
rubric prior to beginning the assignment to become familiar with the assignment
criteria and expectations for successful completion of the assignment.

week 3

Details:

1) In a paper (1,000-1,250 words), compare and contrast the
major elements of the reports by Coyne et al. and Messina et al., listed in the
Module 2 Readings.

2) Complete the “Coyne and Messina Articles
Analysis.” Study the information in the right-side column related to the
Coyne, et al. study, which identifies the required elements as found in the reading.
Complete the information for the Messina et al. article by
identifying the required elements from the article.

3) Prepare this assignment according to the APA guidelines
found in the APA Style Guide, located in the Student Success Center. An
abstract is not required.

4) This assignment uses a grading rubric. Instructors will
be using the rubric to grade the assignment; therefore, students should review
the rubric prior to beginning the assignment to become familiar with the
assignment criteria and expectations for successful completion of the assignment.

Coyne and Messina Articles Analysis

As an example guideline, review the study components in the
left-side column of the table below. Read the study by Messina et al., and
build the data in the right-side column with the key components in that study.

Research Question:

Coyne: Do size and ownership type make a
difference in the efficiency and cost results of hospitals in Washington
state? (Highlight p.164, second column, starting 15 lines from bottom to
seven lines from bottom.)

Messina:

How did the research question emerge from the review of
literature in the article?

Coyne: Built on an earlier study by Coyne on
performance differences between multi-facility systems and independent
hospitals using two cost measures. Cited studies that used a range of
variables to measure differences in hospital performance, and noted that
prior findings have been inconclusive in regard to hospital size, although
economies of scale were found.

Messina:

Independent Variables

Type:

Coyne: Hospital size and hospital ownership
structure.

Categorical

Messina:

Dependent Variables

Type:

Coyne: Efficiency measures – continuous
variables.

Cost measures – continuous variables.

Messina:

Design Elements

1. Quantitative vs. Qualitative

2. Sample Size

3. Method of sample selection

4. Experimental vs. control group?

5. Reliable and valid data instruments?

Coyne:

Quantitative

96

Picked all hospitals in state, except investor owned
hospitals.

No

Used data that are commonly used to measure hospital
efficiency and performance with high degrees of accuracy (reliable), and data
that are historically used and make sense to other hospital users (valid).

Messina:

Describe analysis.

What statistics were used?

Coyne: Two-way Analysis of Variance (ANOVA)

Messina:

Did the researchers’ conclusions make sense, did they
answer the research question, and did they appear to flow from the review of
the literature?

Did they explore control of extraneous variables?

Coyne: They concluded that size and ownership
type make a difference in reported levels of efficiency. Not for profits seem
to achieve higher performance levels, and medium and large not for profits
operate more efficiently than industry average. The same results were found
for cost levels, in that size and ownership type do make a difference, with
medium sized hospitals reporting lower costs than large or small hospitals.

Yes, when they called for national studies that controlled
for case mix, scope of services, and payer mix, all of which could have
affected the results in this study in an unmeasured way.

Messina:

Details:

1) Choose a research study article of
interest to you.

2) Refer to the study you choose and complete
“Assessing a Research Study.”

3) Identify an article that directly references your chosen
study and compare it to your findings. Does this article refute or confirm the
study’s findings?

4) Write a paper (750-1,000 words) that analyzes and
summarizes your findings.

5) Prepare this assignment according to the APA guidelines
found in the APA Style Guide, located in the Student Success Center. An
abstract is not required.

6) This assignment uses a grading rubric. Instructors will
be using the rubric to grade the assignment; therefore, students should review
the rubric prior to beginning the assignment to become familiar with the
assignment criteria and expectations for successful completion of the
assignment.

Assessing a Research Study

Review the study components in the left-side column of the
form below. Refer to the study you chose, and complete the data in the
right-side column with the key components in that study.

Research Question:

How did the research question emerge from the review of
literature in the article?

Independent Variables

Type:

Dependent Variables

Type:

Identify and Define the Study Design Elements:

1. Quantitative vs. Qualitative:

2. Sample Size

3. Method of sample selection: Explanation.

4. Identify and define the experimental and control
groups?

5. Reliable and valid data instruments? Explain.

Describe analysis.

What statistics were used?

Did the researchers’ conclusions make sense, did they
answer the research question, and did they appear to flow from the review of
the literature?

Did they explore control of extraneous variables?

week 4

Details:

1) Write a paper of 1,000-1,250 words regarding the
statistical significance of outcomes as presented in Messina’s, et al. article “The
Relationship between Patient Satisfaction and Inpatient Admissions Across
Teaching and Nonteaching Hospitals.”

2) Assess the appropriateness of the statistics used by
referring to the chart presented in the Module 4 lecture and the resource
“Statistical Assessment.”

3) Discuss the value of statistical significance vs.
pragmatic usefulness.

4) Prepare this assignment according to the APA guidelines
found in the APA Style Guide located in the Student Success Center. An abstract
is not required.

5) This assignment uses a grading rubric. Instructors will
be using the rubric to grade the assignment; therefore, students should review
the rubric prior to beginning the assignment to become familiar with the
assignment criteria and expectations for successful completion of the
assignment

week 5

Details:

Complete “Practice Exercise 1” (page 157) and
“Practice Exercise 11” (page 180) in the textbook. For the data set
listed, use Excel to extract the mean and standard deviation for the sample of
lengths of stay for cardiac patients. Use the following Excel steps:

1) Enter the data set into Excel.

2) Click on the Data tab at the top.

3) Highlight your data set with your mouse.

4) Click on the Data Analysis tab at the top right.

5) Click on Descriptive Statistics in the analysis tool
list.

6) Find the mean and standard deviation of the data sets.

7) Send the results to instructor via e-mail, along with
your analysis of the description of the data set.

APA format is not required, but solid academic writing is
expected.

This assignment uses a grading rubric. Instructors will be
using the rubric to grade the assignment; therefore, students should review the
rubric prior to beginning the assignment to become familiar with the assignment
criteria and expectations for successful completion of the assignment

Details:

1) Write a paper (750-1,000 words) regarding the use of the
Spearman rank correlation coefficient by Messina, et al. in “The
Relationship between Patient Satisfaction and Inpatient Admissions Across
Teaching and Nonteaching Hospitals,” listed in the module readings.

2) Comment on what variables were used; whether it answered
the research question; and whether the Spearman rank correlation coefficient is
appropriately used, given the requirements of the Spearman rank correlation
coefficient.

3) Prepare this assignment according to the APA guidelines
found in the APA Style Guide, located in the Student Success Center. An
abstract is not required.

4) This assignment uses a grading rubric. Instructors will
be using the rubric to grade the assignment; therefore, students should review
the rubric prior to beginning the assignment to become familiar with the
assignment criteria and expectations for successful completion of the
assignment.

week 6
Details:

A drug company is measuring levels of oxygenation in
patients after receiving a test medication. As the researcher, you are
interested in whether Group I, which received the medication, has the same
oxygenation levels as Group II, which did not.

1) Group 1: 2,3,3,4,4,7,8,9

2) Group 2: 1,2,2,3,4,4,5,5,6,8

Use Excel to run a t-test for two samples, assuming equal
variances, with an alpha value of 0.05. Run the t-test and note:

1) Are you doing a one-tailed test or a two-tailed test
(Excel will give you both)?

2) What is the probability that Group I is different from
Group 2, using the p value? Is it significant against the benchmark of p < .05? APA format is not required, but solid academic writing is expected. This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. Details: 1) Refer to “The Use of Electro-Acupuncture in Conjunction with Exercise for the Treatment of Chronic Low-Back Pain” by Yeung, Leung, and Chow. 2) Complete “Yeung Analysis Worksheet.” 3) Examine the question the researchers were trying to answer and write an essay (500-750 words) that explains why you feel the t-test was chosen. Choose one of the other tools studied so far in this course and explain why it would not provide relevant findings. 4) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 5) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. Yeung Analysis Worksheet Yeung, C., Leung, M., & Chow, D. H. K. (2003). The Use of Electro-Acupuncture in Conjunction with Exercise for the Treatment of Chronic Low-Back Pain. Journal of Alternative and Complementary Medicine, 9(4), 479-490. Retrieved fromhttp://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=10555113&site=ehost-live&scope=site What was the research question? What were the independent variables? What was the dependent variable? What was the sample size and how was it chosen? What was the experimental design and use of control group? Were the instruments of measurement shown to be reliable and valid? What data types were included? Describe the statistics used, what they were used for, and the results. What were the researchers’ conclusions? How did they answer the research question(s)? How was error controlled? Did you see any concerns with the research study? If so, what? Use Excel to do a correlation between the following variables: 1) X – 2,5,5,6,6,7,8,9 2) Y – 1,2,2,3,4,4,5,5 This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. week 7 Details: 1) Use Excel to complete “Exercise 7” on page 208 (ANOVA) in the textbook. 2) Answer the questions at the end of the exercise. 3) APA format is not required, but solid academic writing is expected. 4) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. Details: 1) Use Excel to complete “Exercise 1” on page 247 (Regression Analysis) in the textbook. 2) Answer the questions at the end of the exercise. 3) APA format is not required, but solid academic writing is expected. 4) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. 1) Use “Roddy and Ganz Worksheets” to complete an assessment of the research studies: “Evidence-Based Clinical Guidelines: A New System to Better Determine True Strength of Recommendation” by Roddy et al., and “ICU Nurses’ Oral-Care Practices and the Current Best Evidence” by Ganz et al. 2) In a paper (1,000-1,250 words), analyze and support whether you believe that the changes recommended are statistically valid and sound enough to make practice changes in a hospital. 3) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 4) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. Roddy Analysis Worksheet Using the worksheet below, complete an assessment of the following article. Roddy, E., Zhang, W., Doherty, M., Arden, N. K., Barlow, J., Birrell, F., et al. (2006). Evidence-based clinical guidelines: A new system to better determine true strength of recommendation. Journal of Evaluation in Clinical Practice, 12(3), 347-352. Retrieved fromhttp://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=20870724&site=ehost-live&scope=site What was the research question? What were the independent variables? What was the dependent variable? What was the sample size and how was it chosen? What was the experimental design and use of control group? Were the instruments of measurement shown to be reliable and valid? What data types were included? Describe the statistics used, what they were used for, and the results. What were the researchers’ conclusions? How did they answer the research question(s)? How was error controlled? Did you see any concerns with the research study? If so, what? Ganz Analysis Worksheet Using the worksheet below, complete an assessment of the following article. Ganz, F., Fink, N., Raanan, O., Asher, M., Bruttin, M., Nun, M., et al. (2009). ICU nurses’ oral-care practices and the current best evidence. Journal of Nursing Scholarship, 41(2), 132-138. Retrieved fromhttp://library.gcu.edu:2048/login?url=http://proquest.umi.com.library.gcu.edu:2048/pqdweb?did=1780947491&sid=1&Fmt=3&clientId=48377&RQT=309&VName=PQD What was the research question? What were the independent variables? What was the dependent variable? What was the sample size and how was it chosen? What was the experimental design and use of control group? Were the instruments of measurement shown to be reliable and valid? What data types were included? Describe the statistics used, what they were used for, and the results. What were the researchers’ conclusions? How did they answer the research question(s)? How was error controlled? Did you see any concerns with the research study? If so, what? week 8 Details: Write a proposal paper (1,250-1,500 words) for a major change project that you would like to lead. Identify a health care issue that interests you and explain why. Develop a rationale using evidence-based research, including: 1) The background. 2) Statistical findings. 3) Probable stakeholders. 4) Logical conclusions. Design an implementation plan for the project, including: 1) A communications plan. 2) Creation of a design and implementation team by roles. List the strategies you would use to lead the team to success and identify potential obstacles that may be faced, along with plans to deal with them. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. Details: 1) Read and complete “Stakeholder Scenario.” 2) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Stakeholder Scenario Goal: To convince a group of people to use a specific, new type of antibiotic for patients pre-operatively in order to decrease surgical wound infections. Scenario:You are a healthcare administrator that is trying to introduce a change in practice to a group of stakeholders. Your goal is to help them understand the rationale and need for the change, and to get a sense of the areas of resistance to the change. The change under discussion is to implement a new antibiotic to be given one hour before surgery starts as a way of reducing post-op wound infections. The Centers for Medicare and Medicaid Studies (CMS) have indicated that timely pre-op application of specific antibiotics is becoming a requirement and will be a publicly reported indicator on the CMS Web site for your hospital. Thus, institution of this new procedure is something you really need to pull off. As the administrator in this scenario, you will hear the initial responses of each of the stakeholders. You will then be presented with several options for your response. Select the option you think is most effective. Review the stakeholders’ responses to the option you selected. According to their own perspectives and prerogatives, the stakeholders will respond in different ways to each choice. Your goal is to achieve some level of buy-in to the change. Issues: · The antibiotic is new and people aren’t familiar with it. · Requires administration within one hour of the actual surgery start time. · Requires administration by IV. · Adds a step to the busy pre-op nurse’s work load. · Saves the hospital $28,000 per year. · Research shows wound infections down 47% with this new antibiotic if it is administered in a timely fashion. Players: · Pharmacist: He’s learned about the new antibiotic through his research studies, and is excited about using it. · Pre-op Nurse: She is worried about having one more thing added to the pre-op activities list she must complete before the patient goes to surgery, but she’s very interested in doing the right thing for her patients. · Surgeon: He hates government mandates, doesn’t like to be told what to do, generally has a pretty good track record for his patients’ outcomes after surgery, but has no idea what his actual rates of wound infection are. · Finance Analyst: It’s all about the money. Don’t make it harder by concentrating on anything other than the dollars. Stakeholders’ Background Thinking Pharmacist: I really like this idea, because this antibiotic is better and cheaper too. If we can standardize to this antibiotic, I can save money by stocking only one antibiotic for surgery. It will save my staff time in preparation also. This is a great idea for me and my department. Pre-op Nurse: I am just worn out trying to keep up with all the changes they keep hitting us with. It’s hard enough to do my job and remember to do things differently and use different items. Why can’t they give me a break? Now I’ll have to start an IV as well as give a drug, and they are already pressuring me to get the patient ready for the OR faster. Sometimes I just want to go home!! But I got into nursing to help people, and if this really makes a difference, I guess I can suck it up. Physician: The government makes me crazy! Those bureaucrats think they know how to practice medicine better than I do. The last thing I need is some ivory tower academic telling me what antibiotics to give! I’ve been doing this for 30 years, and I know what works and what doesn’t. The stupid hospital better shut up and let me do what I know is right and stop telling me how to be a doctor. My patients like me and that is what counts. I’m sure voting Libertarian in the next election! Financial Analyst: I have been tasked to save this hospital hundreds of thousands of dollars this year, and this one change will save us a bundle. Why are they all arguing? This change could save their jobs! Don’t they get that it’s all about the money? I wish they’d just shut up and approve the change so we could go get lunch. First Responses of Stakeholders · Pharmacist: “This is really important. All the research on this new antibiotic shows that it makes a big difference in reducing wound infections. We could get our rate from 13% presently down to 2%. We need to do this.” · Pre-op Nurse: “This is going to take much more time. We’ve always been able to give our patients pill antibiotics, and now you want me to have to start an IV and administer the drug that way? What happens if I give it and the surgery is delayed? There is already so much I have to do to get the patient to the OR.” · Surgeon: “What a bunch of horse hockey! I’ve been using the same antibiotic for 25 years and its fine. No need to make silly changes just to keep the government happy. What do they know about medicine anyway? All they want to do is make us follow some stupid ‘cookbook’ and it’s ridiculous. They should just leave all that up to the doctor.” · Finance Analyst: “It saves money. Just do it.” Administrator’s Response Options Select one: 1) “Well, we have to do this because it’s a government requirement.” 2) “You all raise valid points of concern. The evidence shows a significant benefit to our patient care.” 3) “What could be done in the implementation that would relieve some of your worries?” Responses to Option 1 Pharmacist: “We can make this switch as soon as you are ready.” Pre-Op Nurse: “We’ll have to tell the patient to come in four hours before the surgery to do this. What a pain.” Surgeon: “The heck with this. You can’t make me do it.” Finance Analyst: “It saves money. Just do it.” Responses to Option 2 Pharmacist: “There is a real benefit. Surgical site infections drop like crazy. It’s the right thing to do.” Pre-op Nurse: “I want to do the right thing. If Pharmacy can get the drugs up to the unit in the morning, maybe I can start the IVs faster.” Surgeon: “I’m all about patient care, but why can’t I use what I’ve always used?” Financial Analyst: “It saves money. Just do it.” Responses to Option 3 Pharmacist: “It would help me to know how many drug doses to stock in the OR each morning so I can make sure they have what they need on hand.” Pre-op Nurse: “That would sure help me. We can begin by having the IVs pre-prepared so we just have to put the needle in the patient.” Surgeon: “Can I see the data about wound infections? How do I stack up against other surgeons?” Financial Analyst: “Great, you all see it. It saves money. Let’s do it.” Assignment As is usually the case, it is possible to achieve some measures of acceptance of changes. The way you respond will affect your ability to do this. However, in real life, it rarely happens this quickly. When involved in negotiations, key elements to remember include: · Pay close attention to the reasons people give for their resistance. You will gain a better insight into their thought processes and can tailor your responses to their perspectives. · You may have to ask questions several times to dig into the real reasons why people may oppose something. The opposition sometimes can be driven by fears and anxieties, but those are not usually expressed initially. However, if you keep asking questions and listening carefully, they will begin to emerge. · Once you have a sense of the perspectives of the various stakeholders about the change, you can begin to address them and use them to overcome any objections to the change. · Sometimes the best you can get in the initial conversations is a willingness to move away from “I’m not gonna.” to “Let me see the data.” That’s a big step toward willingness. Based on this initial scenario, develop an implementation plan. It should include: · The administrator’s initial statement of what is being implemented and why. · (Review the stakeholder’s background thinking and first responses.) The administrator’s (your) response option choice. · How to communicate with the stakeholders (especially if they need further convincing). · What evaluation criteria are needed? · Time frames. · Other items you think would be valuable to include.