Impact of Adequate Follow-Up after Hospitalization of Patients

Research Proposal

Follow-up care is the process whereby the doctor contacts patients after the treatment to check the condition of the disease. This exercise is mostly common among cancer patients. Statistics show that they have a 75% chance of managing the disease if they maintain a regular contact with the doctor (Pukkala et al., 2009). Furthermore, the same research indicates that patients who do not have follow-up have a 50% chance of dying within the first year of diagnosis. On the other hand, research by Trikalinos et al. (2011) indicates that other diseases apart from cancer also require a closer doctor’s attention, and a patient has a significantly higher chance of quicker recovering than people who do not contact their doctors after medication. Some of the diseases that require follow-up include chronic kidney diseases, diabetes mellitus, and cardiovascular diseases, among others. The follow-up can take two forms. First, a health practitioner can contact the patient through a phone and, second, the doctor can request a meeting with the patient. The primary purpose of constant follow-up is to help the physician to identify any possible changes in the health condition of the patient. Moreover, people tend to believe that follow-up exercise helps to reduce the possibility of recurrent hospitalization, as well as decrease future complications and severity of the symptoms. In addition, most health officials and medical researchers have indicated that follow-up assists patients in understanding the new medication that is given to them, helps to support the relatives and the patient in the rehabilitation process, and they may be helpful in reducing medical costs for patients, hospitals, and insurance companies. Most of the above factors have been adequately researched, apart from the recurrent hospitalization, the level of complications, the severity of the symptoms, and the impact on the future medical costs of the patients. Therefore, the purpose of this paper is to present a proposal for an evidence-based practice (EBP) project on the impact of adequate follow-up exercise on the readmission rate, the level of complications, the severity of symptoms, and the future medical costs of the patient.

Background

Follow-up exercise has not been common in most of the hospitals, and many patients are not aware of its advantages. Most patients, especially cancer victims, do not usually know whether to tell their doctor about the symptoms which they encounter or which health practitioner to contact after the treatment. Furthermore, the majority of patients is not aware of how regular they should visit their doctor or how long it would take for them to recover. Therefore, this section looks at the background information about follow-up, which includes what follow-up entails, whom it affects, the period it has been a problem, and the types of records a patient would need to keep, which might help during the follow-up exercise. Moreover, this section explains the nature of the problem, the progress, and the outstanding issues that are related to the problem.

First, an effective follow-up exercise should involve and affect both the patient and the doctor. This process is facilitated by a good relationship between the physician and the patient, and both parties should be willing to conduct the exercise. For instance, for cancer patients, follow-up should start after two weeks after diagnosis or at the moment they observe physical changes in their body (Calin & Croce, 2006). The follow-up in other diseases should be based on an agreement between the doctor and the patient, but at least one visit in every month is necessary. During a follow-up visit, doctors always review the medical history of the patient, and they may conduct some tests. Physicians also inform the patients about the possible long-term effects of the disease, possible warning signs, the current progress, and current condition of their disease. Lastly, some of the important documents that the patient requires during follow-up include the records on the disease the patient was treated for, the lab reports, the medication that was given, and any problems that have occurred since the medication. The problem of follow-up has been there since the medical practice started and no lasting solution has yet been found.

Problem Statement

Follow-up has not been a common exercise in most dispensaries and level I, II, and III hospitals. In addition, most health workers in level IV and V hospitals either do not conduct follow-up or do not meet all the required aspects of an adequate follow-up. The World Health Organization (2007) indicates that for a follow-up to be adequate, it should be conducted at least two times every month for cancer patients and once every month for other patients. A study by Pukkala et al. (2009) shows that 78% of cancer patients follow this requirement and less than 45% of the patients who have other diseases do no not conduct follow-up at all. Furthermore, the same article reveals that if adequate follow-up is done, the cancer death rate can be reduced by 70% and the deaths from the other disease can be reduced by 85%.

Moreover, I have been working at a local hospital, and I have noted in several instances that many patients and relatives go home with medication, but they are usually not sure how to take care of the patient after hospitalization. Some people are not always ready for the new transition and, in most cases, they end up mishandling the patient or even asking for a wrong advice from unqualified people. These problems can be solved when the patients and family members are educated on the importance of follow-up. On the other hand, some doctors are not aware of its significance. Therefore, this research aims at investigating the impact of follow-up on the readmission rate, the level of complications, the severity of symptoms, and the future medical costs of the patient. The results and conclusion of this investigation will enlighten both patients and doctors on the importance of adequate follow-up and, in the end, the current deaths from cancer and other diseases will significantly decrease.

Since the medical practice started, there has been no progress in addressing this problem. The researchers have long been ignoring it because not many people knew the impacts and effects of not conducting follow-up. There are several issues that are related to the problems of follow-up, which have not been yet addressed. Some of them include the training of health practitioners. Doctors and nurses should be trained on the right way of conducting follow-up when it is necessary. In addition, they should be taught on the different types of follow-up, which should be conducted on patients with different diseases. Therefore, this problem should be dealt with before severe side effects emerge.

Clinical Significance

The care of patients with most terminal diseases does not end with the treatment. Follow-up is necessary to ensure that the disease is well managed. This section discusses the clinical importance of conducting the appropriate follow-up exercise and the clinical significance of the results obtained in this study.

First, follow-up enables the health practitioner to monitor the recurrence of the disease. This monitoring helps to improve the patient care and the quality of the health care. Diseases like cancer have a greater probability of recurring because some cancer cells may remain in the body and multiply. During the follow-up exercise, doctors usually ask questions that can help determine if there are symptoms of the same disease. Further, they may conduct blood tests to identify if a virus or the disease cells are eliminated. If doctors notice some traces of the virus, they can take precautionary measures that would ensure that the disease does not recur. Also, physicians might advise the patient how to identify symptoms that signify the recurrence of the disease.

Second, constant follow-up helps to manage the long-term effects of the disease. Moreover, the effects that occur in the later stages of the disease are easily managed during the follow-up exercise. These are the effects that might recur after the treatment or even after the disease has completely healed. These are either the physical or psychological effects. Most people do not know how to manage this problem, and some of them do not know if they are long-term effects of the disease they had. Some long-term effects that might affect patients diagnosed with cancer include thyroid infections, lung infections, and a possibility of the patient developing depression. Therefore, the doctor can either prevent or treat these effects if they reappear, which helps to improve the quality and outcome of the health services.

Lastly, the results of this study will help to advise the patients on whether constant follow-up has an impact on the level of complications and symptoms of the disease. This information is important because the patients will be aware of the importance of follow-up, and they can visit the doctor when they observe any uncommon symptoms. Therefore, the long-term effect is that the incidence of diseases such as cancer among the population will decrease. The importance is that the patient’s comfort and the outcome of the services will be improved.

Purpose

The main purpose of this study is to investigate if follow-up has a significant effect on reducing the readmission rate, level of complications, severity of symptoms, and the medical costs that the patients incur. Below is the research question in PICOT format:

• Population – The target population comprises the patients who have experienced any illness before.
• Interest – the interest of this investigation is to study the effect of follow-up on the readmission rate, the level of complications, severity of symptoms, and the medical costs.
• Control – The control group could have comprised the people who have not been exposed to the treatment of interest. However, since this is a prospective quantitative research, the control group will not be necessary.
• Outcome – The expected outcome is that the follow-up exercise will have a significant effect on reducing the readmission rate, level of complications, severity of symptoms, and the medical costs.
• Timeline – The timeline is two months.

Research Questions

1. Does adequate follow-up significantly reduce the readmission rate of the patients?

2. Does adequate follow-up significantly reduce the number of complications of the patients?

3. Does adequate follow-up significantly reduce the severity of the symptoms of the disease?

4. Does adequate follow-up significantly reduce the medical costs incurred by the patient?

Research Hypotheses

1. Ho: Adequate follow-up does not have a significant effect on the readmission rate of the patients.

Ha: Adequate follow-up significantly reduces the readmission rate of the patients.

2. Ho: Adequate follow-up does not have a significant effect on the number of complications of the patients.

Ha: Adequate follow-up significantly reduces the number of complications of the patients.

3. Ho: Adequate follow-up does not have a significant effect on the severity of the symptoms of the disease.

Ha: Adequate follow-up significantly reduces the severity of the symptoms of the disease.

4. Ho: Adequate follow-up does not have a significant effect on the medical costs incurred by the patient.

Ha: Adequate follow-up significantly reduces the medical costs incurred by the patient.

Literature Review

The literature review is the search of the previous research works that are related to the current research topic. The importance of conducting a literature review in scientific research is to help the researcher to develop the theoretical framework and the methodology of the research. In this investigation, the literature was obtained from existing research papers that have studied the impact of follow-up exercise on the readmission of patients. In addition, the researcher conducted a thorough search of the articles that investigate the relationship between the follow-up exercise and some variables such as the level of complications, severity of symptoms, and medical costs. The literature was obtained from several databases, including the PubMed, PopLine, and Trip, among others. Lastly, the key words were “follow-up,” “readmission rate,” “recurrent hospitalization,” “complications,” “medical costs,” and “severe symptoms.”

The article by Laver, George, Thomas, Deutsch, and Crotty (2012) investigated the relationship between follow-up and the readmission rate while taking gender as the confounding variable. This research was quantitative in nature, and the researchers used random sampling. The target population was patients who were aged above 45 years and who suffer from a stroke. The study setting was the rural areas of South Africa where the author selected a sample of six public hospitals. In this research, the primary data analysis test was a regression analysis where the decisions were made at the 5% level of significance. The results revealed that the confounding variable was significant in the model where the impact of follow-up was less when gender is excluded. Also, the regression analysis showed that there was a significant positive relationship between follow-up and recovery from stroke. It meant that an increase in follow-up increased the likelihood of the recovery from stroke. Lastly, the author recommended that people with stroke should insist on follow-up because the severity of the disease increases with time when adequate follow-up is not available.

A study by Kenfield, Stampfer, Giovannucci, and Chan (2011) tried to investigate the impact of follow-up exercise on the recovery of prostate cancer patients. The researchers conducted a quantitative study that aimed at investigating if follow-up by the doctors yielded positive results. The research was conducted on a sample of 143 people who had prostate cancer. The researchers used stratified random sampling. The stratification criteria comprised gender and the age of patients. In this research, the male and female were categories, and then there was a further subgrouping of the male and female into their respective age groups. This strategy was used to make each subgroup as homogeneous as possible. After the stratification, the researchers selected simple random samples from each of the individual groups and combined the samples to form one complete sample of 143 subjects. The primary data collection tool in this study was a survey that contained close-ended questions. The study was conducted in different public and private hospitals in the United States. The data analysis was conducted using correlation and regression tests, and the results revealed that the relationship between follow-up and recovery was significant and positive. Furthermore, it was evident that the correlation between the follow-up and recovery in the older people was stronger than in the young people. This result indicated that the elderly people needed more extensive follow-up than the young people did. Lastly, the researchers concluded that follow-up was necessary for cancer patients to ensure that the disease is eliminated.

Further, Larsen, Auestad, Evensen, Haahr, and Rossberg (2012) in their research tried to investigate if the follow-up had a significant effect on the recurrence of the disease among people with kidney diseases. This research was quantitative in nature where the researchers used a survey tool in collecting data. The target population was people who had kidney disease and who were above 50 years old. The study was conducted in rural areas of some third world countries in Africa. The main sample selection procedure was simple random sampling where the researchers selected a sample of 58 people. The primary data analysis tool was the regression analysis, and the analysis was conducted using SPSS. It revealed that the follow-up was significant in reducing the recurrence rate at the 10% level of significance, but the results were not significant at the 5% level. Lastly, the paper recommended that more studies should be conducted on the same topic, but the future research works should include confounding variables to reduce the level of variability in the data.

In conclusion, it is evident that there are very few articles on this topic. The first article shows that adequate follow-up increases the likelihood of the recovery from stroke. The second article shows that the follow-up helps to facilitate the recovery of prostate cancer. Also, it shows that follow-up is needed more in the elderly people as compared to the young individuals. On the other hand, the last article reveals that at the 10% level of significance, the follow-up reduced the recurrence of kidney diseases. Therefore, it is clear that previous research works show that follow-up is necessary for almost all diseases. The only gap in the above articles is that no research considers the impact of follow-up on the level of complications severity of these symptoms and the medical costs. This EBP project will fill these gaps by incorporating the above variables in the research question and the analysis.

Theoretical Framework

According to Verma, Paterson, and Medves (2006), follow-up in a clinical setting is an exercise where the health officials conduct further observations or treatment for monitoring patients’ response to the given medication. This follow-up may be in the form of a telephone call or a physical visit. On the other hand, Fortinash and Holoday-Worret (2008) define readmission or recurrent hospitalization as a process whereby the patient is admitted for the same treatment or related illnesses after being treated. Also, Fortinash and Holoday-Worret (2008) explain that readmission can take place when the doctor does not meet the expectations of the patient or when new illnesses related to the first disease arise. Lastly, a complication is when the severity of the disease increases or when the disease worsens (Calin & Croce, 2006). It can be measured by an increase in pain, symptoms, or even pathological changes. These definitions will be used in this EBP research because they are clear and they match the purpose of the study.

From the above theory, it is evident that there is a direct link between the follow-up and the readmission rate. As Fortinash and Holoday-Worret (2008) explain, the level of satisfaction of the patient depends on the outcome of the services. It is also evident that the follow-up exercise directly influences the outcome and the level of recovery of the patient. Therefore, the principle outlined above is in line with the requirements of the EBP project and it portrays the importance of solving the problem at hand with immediate effect.

Methods – Research Design

A research design is a strategy which the researcher uses to ensure that the research question under study is answered. It should state the research type and give a clear justification. In addition, it should explain the data collection procedures the focus group under investigation. This investigation is based on a quantitative research design. According to Jackson (2015), a quantitative study is a study that uses quantitative or numerical data in answering the hypothesis. Also, the objective of the quantitative research design is to obtain data and compute sample statistics that aim at approximating the population characteristics. Therefore, it is evident that this research requires the quantitative design since the study questions and hypothesis are quantitative in nature and aim at approximating the nature of the relationship in the population.

Secondly, this study is descriptive since it aims at describing the characteristics of the target population in the most accurate way. Furthermore, it is non-experimental because the participants will not be assigned to different treatments. The researcher will try to obtain the prior information about the variables of interest using a survey tool. According to Jackson (2015), a survey is a piece of paper with questions that produce quantitative data. The researcher will design the survey with both open- and close-ended questions. The tool will have two main sections. The first part will be the demographic section that will capture the general information about the respondent. This information is important in any scientific investigation because it assists the researcher in accessing the accuracy of the sample selection procedure and determining if the sample is representative of the population. The second section of the survey will cover the questions that answer the research questions. This section will provide data that will be used in testing the research hypothesis. Both types of questions can be found in the Appendix at the end of the paper.

The survey will be given to a focus group of patients who have had previous treatment within a period of one year. Lastly, this is a retrospective study since it looks backward to obtain the data from the person in the focus group. The researcher will use this historical information in trying to solve the future problems.

Research Methods – Sample

The accuracy of data and the generalizability of the results of any scientific research depend on the representativeness of the sample (Beins & McCarthy, 2012). A representative sample should represent all the groups of the target population. Consequently, the representativeness depends on the sampling criteria applied. There are several sampling methods, but each situation demands a specific method.

The primary sampling method in this investigation is a stratified random sampling. According to Jackson (2015), the stratified random sampling is a sample selection criterion that is most appropriate when the target population is heterogeneous. In this study, the target population comprises patients suffering from different illnesses. The stratification criteria will be dependent on the illness of the person. It is evident that cancer patients require more attention and follow-up than people suffering from the other diseases do. Also, cancer patients are not as many as patients suffering from other diseases combined. It would be statistically incorrect to treat this population as homogeneous because cancer patients will be marginalized and will need more medical attention. Therefore, the researcher will separate the population into two groups. The first group will comprise people who have suffered from cancer while the second group will comprise persons with other illnesses. The researcher will then select a random sample from each of the groups where the sample size in each group will be proportional to the stratum size. The two sample sizes will then be combined to form one sample. This research aims at dealing with a combined sample size of 45 individuals. This sample size is appropriate because it is large enough to give accurate results. Further, there are time and financial constraints that cannot allow considering a larger sample.

Below are the factors that determine the inclusion of respondents:

1. Should have suffered an illness within the last year.

2. Should be between the age of 18 and 75 years.

Exclusion criteria:

1. Should not be a child (less than 18 years).

2. Should not be older than 75 years because aged people might not be able to remember some specific information.

Methods – Setting

The setting of research is critical because it determines the kind of people included in the sample. Inappropriate research setting can lead to obtaining incorrect data, and the results can thus be affected. As this is a health-related investigation, the setting will be public hospitals located in the urban areas. The researcher selected public hospitals because they have a larger number of both inpatient and outpatient clients than the private hospitals. In addition, public hospitals treat more illnesses than the private ones. It is thus evident that it is only possible to reach a wide variety of patients in the public hospitals. On the other hand, this research will consider urban areas because there are more equipped and advanced hospitals. Further, urban hospitals have more patients than the rural ones. Health care facilities in the rural areas only deal with specific illnesses, and it might not be possible to obtain a representative sample there. Therefore, it is evident that this setting is the most appropriate in this kind of study, and the sample obtained will be as representative as possible. Lastly, the researcher will obtain a letter from the selected hospitals. It is always ethical to inform the administration of the institution where one is conducting research prior to conducting the actual study. This letter will detail the purpose of the study, its positive impacts on the hospitals, and the duration of the investigation.

Methods – Research Protocol

The first step will be sending a letter to the selected hospitals and wait for their approval. Consent will also be sent to target respondents, and it will explain what they are expected to do and any side effects of the investigation. Secondly, the researcher will visit the hospitals that positively responded to the letter and conduct a pilot study. The main aim of the pilot study will be to test the applicability of the questions and identify any possible mistakes in the survey tool. The latter will help to estimate the time taken by each respondent to complete the survey and any possible difficulties during the data collection phase. After the pilot study, the researcher will visit the hospitals during the actual data collection process. The individuals will be selected at the reception, and those who qualify will be explained the purpose of the study. Every person will be given a chance to accept or reject to participate in the investigation. Moreover, the researcher will conduct tests that will confirm the reliability and validity of the questions. The test-pretest method will be the primary technique that will test these two properties. This technique will ensure that the survey tool is as valid and reliable as possible. Lastly, this research is designed to last for two months (8 weeks).

Methods – Data Analysis

The accuracy the results of any scientific investigation depends on the appropriateness of the data analysis tests used (Beins & McCarthy, 2012). There are several data analysis tests, but each condition demands that a specific test is used. This research has two sets of data. The first set will comprise the demographic data while the second set is the data answering the study questions. Consequently, the data analysis plan has two main sections: the descriptive and inferential statistics parts. The descriptive analysis will cover the analysis of the demographic variables while the inferential analysis will analyze the study variables. The demographic variables will be analyzed using measures of central tendency (for example, mean, median) and measures of dispersion (for instance, standard deviation). Furthermore, visual aids such as bar graphs and pie charts will be used in analyzing these demographic variables. On the other hand, the inferential analysis part will cover the analysis of the study variables using parametric tests. The primary data analysis test will be regression analysis, which is a mathematical technique that aims at finding the relationship between two or more quantitative variables. In this case, there will be four regression models, each model for each hypothesis. Lastly, the entire analysis will be done using IBM SPSS software, version 21.

Timeline

The whole research will take place in 8 weeks. Below is the breakdown of the activities:

Week1: Proposal writing

Week 2: Selecting the hospitals that will participate in the study

Week 2-3: Sending a consent letter to the selected hospitals and receiving replies

Designing the survey tool

Week 4: Conducting a pilot study

Week 5-6: Selecting the sample

Conducting the actual data collection exercise

Week 7-8: Data analysis and report writing

Report presentation

Conclusion

It is evident that many people do not know the importance of conducting follow-up after the treatment. Most patients do not realize that follow-up can have several positive impacts on their recovery process. The results of this research will provide appropriate advice and guidance to both health officials and patients regarding the impacts of appropriate follow-up. The methods section also reveals that the data and the results of this investigation will be as accurate as possible. The data collection procedures, research design, and the data analysis plan sections are all in agreement with the EBP project. Lastly, it is evident that the problem addressed by this investigation is urgent and demands an immediate solution.