Introduction
This research aims at providing workable strategies to reduce readmission rates for Medicare cardiac heart failure (CHF) patients. Qualitative research designs will be employed to determine the causes for CHF patient’s readmission in hospitals, which vary across culture, gender, and even socio-economic status. Qualitative research is the appropriate method in this case, because, the complex aspects and characteristics of the patient experiences to be studied (Woods, 2006). Qualitative research will be the best research design to be used because it will help in studying the aspects of the patients that cannot be quantified (Polit and Beck, 2008). Patients and participants will have the freedom of expressing themselves in their own way and words. In order to reduce and curb the rate of hospital readmission for these patients, there is the need to discover the actual causes of readmission. This qualitative research will take a period of six months.
This qualitative research will majorly aim at coming up with workable strategies, to decrease readmission rates for Medicare CHF patients. Qualitative research involves various designs, which include; observation, interviews, sampling, written materials, questionnaires, validity, ethics and qualitative research assessment (Woods, 2006).
The aim of the research will be divided based on what the research seeks to achieve. The aims include:
- To discover the possible roles that can be played by CHF Medicare patients in order to reduce the prevalence in disease reoccurrence.
- To determine how socio- environmental factors are associated with the increasing readmission rate among Medicare patients suffering from CHF.
In order to achieve each aim, various qualitative research designs will be employed depending on what each aim seeks to achieve.
To discover the possible roles that can be played by the CHF Medicare patients in order to reduce prevalence to disease reoccurrence
Since this qualitative research aims at achieving results and reducing the rate of readmission of Cardiac Heart Failure (CHF) Medicare patients, the patients themselves, who are at the centre stage of this research, will be involved, and the medical practitioners who care for these patients, and the family members of the patients. Qualitative research will help in understanding the CHF Medicare patient’s behavior, their understanding and perspectives on readmission (Flick, 2009). This research will involve a minimum of 27(3 initial strata variables x 9 independent strata variables) participants drawn from quota sampling. This sample will be based on the independent strata, variables, age (20-40, 41-60, 61- 90), and the dependent strata dependent variables, gender (male and female), education (AD, BS, RN-BS, Accelerated Entry into Nursing, Diploma) and relationship (old, new). This knowledge will help in learning the role that is played by the Medicare CHF patients, during readmission and hospitalization. To achieve this aim, the following research designs will be used:
Observation
Observation will be done on the CHF patients both at home after discharge, and those readmitted. Observation will ensure that the researcher is unobtrusive, as it will explore on the natural scene (Gillham, 2000). This method will not, in any way, interrupt the situation. It is one of the favorable strategies used. During observation, a researcher becomes part of the group and in this case, the CHF Medicare patients. The researcher will only observe the patients and their behavior, and in the process, determine the actions which lead to readmission. Observation is preferred when there is a language barrier or, in various settings such as hospitals, where interviews cannot be conducted. Observation is also applicable in situations where, a researcher does not want to be seen as being ethnocentric (Woodside, 2010).
Interviews
Interviews will bring in a considerable amount of qualitative materials and data. This will be done by talking to patients, their family members and the medical team dealing with the CHF patients, either through casual conversations or through formal interviews (Woods, 2006). There will be 30 interview questions that will cover the medical information of the patients, the age, gender and even the education of patients. Open ended questions will be used as they will give the participants the freedom of expressing themselves. Interviewing the CHF Medicare patients will assist the researcher in having a deep analysis of the real situation, and discover the understanding of the patients regarding a relapse or readmission. Interviews will be most applicable among illiterate patients.
To determine how social- environmental factors are associated with the increasing readmission rate among Medicare patients suffering from CHF
This qualitative research will employ various strategies to determine the relationship between social- environmental factors, and the increasing rates of readmission among CHF Medicare patients. The participants will be the CHF Medicare patients, who will be readmitted between the research period, and their family members. Participants will be drawn from three social level; low class, the middle class and the rich. The research will aim at redressing the political, cultural, environmental, and social aspects that affect Medicare patients suffering from CHF, and how these aspects contribute to readmission. To achieve this aim, the following research designs will be employed.
Participant observation
Participant observation will require the researcher to assume the role of the researcher and observe the study group in that capacity, as well as be part of the group (Polit and Beck, 2008). This design will allow the researcher to experience what CHF Medical patient experiences, and observe their behavior at the same time. This will help in ensuring that the researcher’s findings are free from bias, as the researcher will have both the insiders and the outsiders view (Gillham, 2008). This method will also help the researcher gain an insight on the cultural activities of the patients, their social interactions, as well as how their environment affects them. The researcher will act as a patient during the time of research, or live with the patient families in order to gain an insight of the situation. The research will take place in hospitals where the patients will be readmitted and at the homes of the patients. Participant observation will take a period of six months so as to give the researcher ample time to study the patients.
Sampling
Sampling as a method of acquiring data from samples of the case study, seeks generalized information about general issues, covering time, places and persons (Woodside, 2010). In this case, the researcher will use samples varying in terms of culture, literacy, language and the setting, to determine what kind of environment causes more readmission of CHF Medicare patients for a period of six months. Random patients will be studied from different cultures, age, gender and even social-economical backgrounds. The researcher will determine what factors need to be changed in a setting, in order to reduce the rate of CHF Medicare patients’ readmission. The researcher will get the sample from;
- Patients readmitted 3 months before the time of research.
- Patients readmitted for the first time, during the research period, in order to discover the general cause of CHF Medicare readmission over time.
- Patients aged between 20-90 years.
The research sample will not include:
- Patients readmitted 4 months and above prior to the research period.
- CHF patients readmitted more than once.
- Patients aged below 20, and above 90.
Data analysis
This descriptive qualitative research will use descriptive content analysis and, in particular, coding to analyze data. Qualitative data analysis requires dividing and reassembling data in line with the problem statement (Boeije, 2010). Segmenting and assembling the data again is done in order to process the data into information. Empirical data interpretation is also required, to arrive at the research findings. In data analysis, the researcher will dissemble information to examine the relationship to ideas derived from existing theories, cultural factors and even literature emerging during fieldwork, or suspicions. Coding will help the researcher to determine the connection between the CHF Medicare patient’s habits, and their environment in relation to readmission. Coding will be highly appropriate in interviewing, observation, sampling and even in participant observation. Through coding, the researcher will categorize data segments with short names that will, at the same time, account and summarize each and every piece of data.
The researcher will categorize and distinguish themes and research data, by giving it a code. Codes will represent analytical and theoretical concepts (Boeije, 2010). Open coding will be used at the beginning of the research, when no selection is done in relation to the relevance of the material researched (Woods, 2006). The researcher will gather all the information, group it into categories and finally give it a code to help in the analysis of the data. Axial coding, on the other hand, is what the researcher will use to determine the non dominant and less essential elements in the research (Boeije, 2010). In determining the most prevailing factors affecting the rate of CHF Medicare patients’ readmission, axial coding will be crucial for the researcher. Selective coding, which involves searching for connections and relationships between categories, will help the researcher better understand the activities being done in the field. Selective coding will assist the researcher in integrating the available segment as a way of ensuring the attainment of convincing findings. When researching on how the Patients behavior affects the rate of admission, selective coding will aid the researcher to determine the possible roles the patients can play, in order to reduce readmission. The researcher will also be able to determine the social- environmental factors associated with the increasing rate of readmission, among the Medicare patients suffering from CHF.
The Institutional Review Board (IRB)
After the data analysis, this study will be submitted to the institutional review Boards of Covenant health care system in Texas Tech University, Health sciences centre in Lubbock. The submission will be done for approval, before initiation of research. Contact with the participant will be done through the hospital management and the family members of the patients before questions are asked. The family members and the hospital staff will seek permission from the patients, for the researcher to interview them. All the participants will be briefed about the research by the research team after the permission is granted, and after the explanation, informed consent will be obtained from the participants (Polit and Beck, 2008).
The vital benefit of this research is that patient- centered information will be collected in order to discover the areas through which interventions for patients with CHF problems can be done. The study will be done at covenant medical centre, which is the largest Medicare centre in west Texas, and it has a cardiac centre. In this hospital different cases of readmission of patients will be assessed, hence providing a reliable base for collecting data and looking for interventions for the readmission of CHF Medicare patients.
The recruitment process will involve informed consent given by the participants. All the participants are free to decline the interview by failing to give informed consent, and can withdraw from the study as participants. For the participants who will give consent, they will be interviewed. The family members, who have also given consent, will be allowed to be present as well as contribute to the interview. The researcher will lead and conduct all the interviews and complete all the forms, apart from the informed consent forms, for the participants.
The risks and special populations are considered, and mitigation factors for the risks provided. The risks of relapse are likely to occur because the special population includes patients in the hospital whose conditions might be critical, and those patients at home who have ever been readmitted in the hospital due to CHF Medicare condition. The research process will be done discreetly to ensure that it does not provide any risk factors to the participants, and no disturbance will be caused to the normal activities of the patients and the hospital. Participants will be granted the freedom of quitting the study, in case their health conditions are very critical to avoid a relapse. The privacy and confidentiality of the participants and the information given will be reviewed by the board, to ensure that the privacy of the participants is looked onto and protected.
Conceptual Map
This research will adopt a qualitative approach with both dependent variable and independent variables. The dependent variable is the rate of readmission among patients suffering from CHF in the United States. The independent variables include quality of medical services provisions, the living condition of the patients, awareness and the rate of follow up programs, and the discharge regulations compliance rate, the government policy, and the literacy level of the patients and their families. Data in this research relies on information contained in the New York readmission rate data and primary sources like interviews, participant observation, pure observation and sampling. The rate of CHF Medicare patients is determined by the patients themselves in terms of the aftercare, and the medical practitioners in terms of the services and treatment given to patients.
References
Boeije, H. (2010). Analysis in Qualitative research. London: Sage publications limited.
Flick, U. (2009). An introduction to qualitative research. 4th ed. London: Sage Publications.
Gillham, B. O. (2000). Case study research methods. London: Continuum.
Polit, D.H. and Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. 8th ed. Philadelphia: Lippincott Williams & Wilkins.
Woods, P. (2006). Qualitative research. Buckingham: The Open University press.
Woodside, A. G. (2010). Case study research: Theory, methods, practice. Bingley: Emerald Group Publishing Company.