Clinical Inquiry and Hypothesis Testing HLT 362
Complete an article analysis for each using the “Article Analysis: Part 2” template.
Refer to the “Patient Preference and Satisfaction in Hospital-at-Home and Usual Hospital Care for COPD Exacerbations: Results of a Randomised Controlled Trial,” in conjunction with the “Article Analysis Example 2,” for an example of an article analysis.
Article Analysis: Example Approach
| Article Citation and Permalink | Utens, C. M. A., Goossens, L. M. A., van Schayck, O. C. P., Rutten-van Mölken, M. P. M. H., van Litsenburg, W., Janssen, A., … Smeenk, F. W. J. M. (2013). Patient preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: Results of a randomised controlled trial. International Journal of Nursing Studies, 50, 1537–1549. doi.org/10.1016/j.ijnurstu.2013.03.006Link: https://www.ncbi.nlm.nih.gov/pubmed/23582671 (Include permalink for articles from GCU Library.)
|
| Point | Description |
| Broad Topic Area/Title | The differences in preference and satisfaction based upon hospital care location for COPD exacerbations. |
| Define Hypotheses | Hypothesis not stated. Below is an example from the study:H0: There is no difference in satisfaction levels based upon treatment location.H1: There is a difference in satisfaction levels based upon treatment locations. |
| Define Variables and Types of Data for Variables | Treatment Location – categorical – “home treatment” and “hospital treatment”Satisfaction – Ordinal Scale (1-5)Preference – categorical “home treatment” and “hospital treatment” |
| Population of Interest for the Study | COPD exacerbation patients from five hospitals and three home care organizations |
| Sample | 139 patients69 from the usual hospital care group70 from the early assisted discharge care group |
| Sampling Method | Mixed methods; quantitative was randomized sampling |
| How Were Data Collected? | A questionnaire with both open-ended questions and questions with a scale of 1-5 (p. 1539) |
Article Analysis 2 Template
| Article Citationand Permalink(APA format) | Article 1 | Article 2 |
| Point | Description | Description |
| Broad Topic Area/Title | ||
| Define Hypotheses | ||
| Define Independent and Dependent Variables and Types of Data for Variables | ||
| Population of Interest for the Study | ||
| Sample | ||
| Sampling Method | ||
| How Were Data Collected? |
Article Analysis and Evaluation of Research Ethics
| Article Citation and Permalink (APA format) | Article 1 Fritz, B. A., King, C. R., Mehta, D., Somerville, E., Kronzer, A., Ben Abdallah, A., Wildes, T., Avidan, M. S., Lenze, E. J., Stark, S., & ENGAGES Research Group. (2022). Association of a perioperative multicomponent fall prevention intervention with falls and quality of life after elective inpatient surgical procedures. JAMA Network Open, 5(3), e221938. https://doi.org/10.1001/jamanetworkopen.2022.1938 |
| Point | Description |
| Broad Topic Area/Title | Falls Among Hospitalized Patients |
| Problem Statement (What is the problem research is addressing?) | Up to 4 percent of patients during their inpatient stay, the experience falls after elective inpatient surgical procedures. Upon discharge, this percentage rises threefold among these patients in their first year after elective inpatient surgical procedures (Fritz et al., 2022). These falls have a significant impact on the patient’s life quality, finances, and safety and thus need to be addressed. |
| Purpose Statement (What is the purpose of the study?) | The authors of this study used a multicomponent intervention that included patient education, a home medication review by a specialist, and an assessment of home safety. This study aimed at assessing whether this multicomponent intervention was associated with patient fall incidence reduction in patients who had undergone elective inpatient surgical procedures |
| Research Questions (What questions does the research seek to answer?) | This study’s research questions sought to find answers to whether an intervention that incorporates patient education, specialist’s medication review at home, and identification of hazards in the patient’s home environment could be associated with reductions in patient falls during the first year after an elective inpatient surgical procedure. |
| Define Hypothesis (Or state the correct hypothesis based upon variables used) | Effects of falls among hospitalized patients are multifactorial, multifaceted and have physical, emotional, financial, and functional consequences on the quality of life of the affected patients. Elective inpatient surgical procedures add to these risks in the postoperative period. The preoperative and postoperative periods is an opportunity to offer multicomponent strategies to prevent fall and minimize fall risks. |
| Identify Dependent and Independent Variables and the Type of Data for the Variables | The dependent variable in this study was the incidence of patient falls in the first year after elective surgery reported by the patient. This study also had secondary dependent variables such as quality of life scores by the Veterans RAND tool. The application of the multicomponent fall prevention intervention was the independent variable. |
| The population of Interest for Study | The study population was a group of adult patients who had undergone general anesthesia before an elective inpatient surgical procedure and had at least 2-day hospital stays. |
| Sample | The study sampled a total of 1396 patients from two different studies assigned into intervention and control groups. The 698 patients were from the ENGAGES indicates Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes clinical trial study, while the other 698 patients in the control groups were from the d SATISFY-SOS, Systematic Assessment and Targeted Improvement of Services Following Yearly Surgical Outcomes Surveys cohort study and had met the inclusion criteria same as those in the intervention group. |
| Sampling Method | A non-random sampling, quota sampling, the method was used to select eligible participants from the intervention and control patient pools. |
| Identify Data Collection Identify how data were collected | Data on the primary outcome variable was collected through patient surveys that were administered for baseline assessment during the first postoperative month and also after the first postoperative year in both groups. These surveys were sent through email, and those who did not respond were followed by phone. The secondary variable, quality of life, was assessed using the Veterans RAND 12-item health survey tool. This tool had both mental and physical assessment items. |
| Summarize Data Collection Approach | The data collection approach was biphasic, with baseline data for primary outcomes assessed for compression purposes at the study end. The quality of life assessment was done a month before the procedure and one year after the surgical procedure. This data collection approach transformed quality types of data into objective quantitative data for analysis |
| Discuss Data Analysis Include what types of statistical tests were used for the variables. | Logistical regression analysis was used to analyze the propensity scores that were used to match the intervention and control group participant data. Pearson χ2 or Wilcoxon rank sum tests were used as appropriate to examine whether the matched cohorts had confounders. Comparative analyses were indicted for outcome variables for both cohorts. Null hypothesis significance testing (NHST) was used for these comparisons. |
| Summarize Results of the Study | Fall incidence in the intervention groups after one year was 32.7% (228 of 698) and the incidence in the control groups was 32.2% (225 of 698). Cooperative analysis and significance testing. These differences were statistically insignificant at a 95% confidence interval. However, quality of life scores in the intervention groups was higher than that in the control groups. |
| Summary of Assumptions and Limitations Identify the assumptions and limitations of the article. Report other potential assumptions and limitations of your review not listed by the author. | This study had a multidisciplinary approach in the implementation of the intervention that increased the likelihood of success of each intervention. The study sued a large sample size that increased the accuracy of results, reduced the margin of error, and enabled the identification of outlier values. Despite these strengths, this study had limitations because it was a single-center study, thus limiting the generalizability of the findings. Selection and recall bias are potential limitations due to the sampling method and periodical data collection methods applied in this study. |
Ethical Considerations
Evaluate the article and identify potential ethical considerations that may have occurred when sampling, collecting data, analyzing data, or publishing results. Summarize your findings below in 250-500 words. Provide rationale and support for your evaluation.
This study used an approach that did not involve true experiments making it ethically appropriate for vulnerable patients. The lack of intervention used in the control groups showed lower benefits in their life quality during the study period. A potential ethical consideration arises because withholding this intervention (that would be reasoned as clinically beneficial) for the control groups on a nonrandom basis was biased and unethical (Handley et al., 2018).
Therefore, the causal association is limited by the nonrandom assignment of patients, undermining the principle of fairness because the participants did not get an equal chance of selection. Another ethical consideration in this method was the potential harm from the intentional withholding of an intervention that was viewed as beneficial to the patient’s quality of life.
Other general considerations in this study would be patient data confidentiality, privacy, and security owing to the study approach used. Sharing of patient data from the two studies to this study would jeopardize confidentiality. Even if protected health information were encrypted, the authors of this study would require to follow them up. This would have required personal patient data, thus the need to disclose them to a third party. The patients thus would lack autonomy in the use of their data.
The study was limited in external validity partially due to being a single-center study. The presence of confounders such as exercise that would have improved the quality of life of the patients in the intervention groups would have led to inferential bias that limits the external validity of this study (Lewis, 2020). Nevertheless, the quality of evidence and the level of evidence in the hierarchy are higher making. Despite the aforementioned limitations, this study still has many methodological strengths
Clinical Inquiry and Hypothesis Testing HLT 362 References
Fritz, B. A., King, C. R., Mehta, D., Somerville, E., Kronzer, A., Ben Abdallah, A., Wildes, T., Avidan, M. S., Lenze, E. J., Stark, S., & ENGAGES Research Group. (2022). Association of a perioperative multicomponent fall prevention intervention with falls and quality of life after elective inpatient surgical procedures. JAMA Network Open, 5(3), e221938. https://doi.org/10.1001/jamanetworkopen.2022.1938
Handley, M. A., Lyles, C. R., McCulloch, C., & Cattamanchi, A. (2018). Selecting and improving quasi-experimental designs in effectiveness and implementation research. Annual Review of Public Health, 39(1), 5–25. https://doi.org/10.1146/annurev-publhealth-040617-014128
Lewis, J. (2020). Experimental design: Ethics, integrity, and the scientific method. In Handbook of Research Ethics and Scientific Integrity (pp. 459–474). Springer International Publishing. https://doi.org/10.1007/978-3-030-16759-2_19
Also Read: HLT 362 Week 1 Article Analysis 1 Example