You will review primary research studies focused on one type of clinical system that provides evidence that the system improved outcomes and/or efficiencies.
To Prepare:
Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.†(All four research studies would focus on the same system, in this case patient portals. You can focus on a specific patient population or studies from diverse patient populations).
Identify and select 4 peer-reviewed research articles from your research. The research articles need to be primary sources, articles that report on original research studies.
The Assignment: (4-5 pages)
In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:
Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.
Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
In your conclusion, synthesize the findings from the 4 peer-reviewed research articles. The Writing Center has resources on synthesizing https://academicguides.waldenu.edu/writingcenter/evidence/synthesis
This type of assignment is considered an \”Annotated Bibliography\”. The 4 articles need to be completed research studies on the same type of clinical system. These studies will provide evidence the clinical system improved outcomes or efficiencies. Please review the Week 8 assignment rubric. You may want to review the shell of the Week 8 assignment and the Writing Center\’s example of an Annotated Bibliography to help you complete this assignment. These documents are available in Doc Sharing.
Here is a link to research articles from Walden\’s Library https://academicguides.waldenu.edu/library/evaluating/researcharticles
Refer to the section of the course syllabus that talks about using primary and secondary resources in your posts and assignments. Research articles are primary sources, review articles that do not report on an original research study are secondary sources and do not meet the requirements of this assignment. For instance systemic reviews are secondary sources and should not be used for this assignment. Refer to the course announcement, \”Peer Review, Primary and Secondary Sources, and Research Articles\”. This course announcement has links that will help you complete this assignment.
Just a reminder that quality improvement studies are not research studies. Conner (2014) discusses the difference between research studies and quality improvement projects.
Conner, B. T. (2014). Differentiating research, evidence-based practice, and quality improvement. American Nurse Today, 9(6), 31. Here is a link to an article https://www.myamericannurse.com/differentiating-research-evidence-based-practice-and-quality-improvement/
Here are some links to resources on outcomes. “The Top Seven Healthcare Outcome Measures and Three Measurement Essentials†https://www.healthcatalyst.com/insights/top-7-healthcare-outcome-measures
Jones, T. (2016). Outcome measurement in nursing: Imperatives, ideals, history, and challenges. OJIN: The Online Journal of Issues in Nursing, 21(2), 1.Outcome Measurement in Nursing_ Imperatives, Ideals, History, and Challenges Article for assignments 8 and 4.pdf
Here is the file for the Week 8 Shell Module 4 Week 8 Assignment Shell.docx and the Writing Center\’s Annotated Bibliography example Sample_Annotated_Bibliography_APA_7.docx
I have attached the shell to use as a word document.
Title of the Paper in Full Goes Here
Student Name Here
College of Nursing, Walden University
Course Number, Section, and Title
(Example: NURS 0000 Section 01, Title of Course)
Instructor
Due Date (Month, Day, Year)
The Use of Clinical Systems to Improve Outcomes and Efficiencies
This type of assignment is considered an “Annotated Bibliography”. You should review the sample Annotated Bibliography from the writing center to help you complete this assignment. You do not need a reference page as you will cite each article before discussing it. If you cite additional sources in the introduction or conclusion (it is not necessary to cite additional sources), you would include a reference page which lists only the additional sources. In this assignment, you will review 4 research studies focused on the application of one type of clinical system of your choosing. Listed below are examples of clinical systems:
- Inpatient Electronic Health Records (EHR)
- Outpatient EHRs
- Computerized Provider Order Entry (CPOE)
- Specialty Systems:
- Emergency Department Information System
- ICU Information System
- Cardiology Information Systems
- Operating Room Information System
- Ancillary Information Systems
- Laboratory Information Systems
- Pharmacy Information Systems
- Radiology Information Systems
- Electronic Medication Administration Record (eMAR)
- Bar Code Medication Administration (BCMA) Systems,
- Smart Pumps
- Care Planning Systems
- Messaging Systems
- Alerts and Clinical Decision Support Systems
- Telehealth Systems
- Patient Portals
- Patient Tracking Systems
- Remote Monitoring Systems
- Artificial Intelligence Systems
- Patient Education Systems
After selecting one type of clinical system, you will conduct a search for recent (within the last 5 years) research studies that examined the improvement in outcomes and/or efficiencies. These studies need to report on the results of a research study and appear in a scholarly journal, you should not use studies reported in conference proceedings. The research studies should provide evidence to support the use of the clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.” For example, if you selected patient portals as the clinical system, you would use the following search terms: patient portals and outcomes. Searching on outcomes usually returns results on efficiencies as well.
The articles need to be primary sources, according to the syllabus “A research report is primary, and you can tell because it includes materials and methods demonstrating how the research was done”. Literature reviews, systematic reviews, narrative reviews and integrative reviews are secondary sources and are not appropriate for this assignment. Here are two links to help you find and identify research articles.
Research Articles https://academicguides.waldenu.edu/library/evaluating/researcharticles
How to Find Research Articles https://academicanswers.waldenu.edu/faq/73303
The Assignment: (4-5 pages)
In a 4- to 5-page paper, synthesize the peer-reviewed research studies you reviewed. Be sure to address the following:
- Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format. The articles should appear in alphabetical order in your paper. After the citation, you would discuss each article.
- For each study, you will briefly summarize the study, explain the improvement to outcomes and/or efficiencies, and discuss lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples. Each study should be discussed in approximately one page. In the conclusion you will synthesize the studies.
In summary, you need to select one type of clinical system and find 4 current research articles, published in scholarly journals, that examined outcomes and/or efficiencies related to the clinical system you chose. On the next page is the beginning of the shell of the paper. I purposely chose four articles on CPOE that were not current.
The Use of Clinical Systems to Improve Outcomes and Efficiencies
Annotated Bibliography
Fortescue, E. B., Kaushal, R., Landrigan, C. P., McKenna, K. J., Clapp, M. D., Federico, F., Goldmann, D. A. & Bates, D. W. (2003). Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics, 111(4), 722-729.
In the first paragraph you will summarize the study. Briefly describe the aim of the study, the sample and setting, and the methods.
In the second paragraph you will identify the outcomes and/or efficiencies examined in the study and explain the results related to improvements in the outcomes and/or efficiencies.
In the third paragraph, you will discuss lessons learned from the findings of the study and relate the lessons learned to the application of the clinical system.
Potts, A. L., Barr, F. E., Gregory, D. F., Wright, L., & Patel, N. R. (2004). Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics, 113(1), 59-63.
In the first paragraph you will summarize the study. Briefly describe the aim of the study, the sample and setting, and the methods.
In the second paragraph you will identify the outcomes and/or efficiencies examined in the study and explain the results related to improvements in the outcomes and/or efficiencies.
In the third paragraph, you will discuss lessons learned from the findings of the study and relate the lessons learned to the application of the clinical system.
Upperman, J. S., Staley, P., Friend, K., Neches, W., Kazimer, D., Benes, J., & Wiener, E. S. (2005). The impact of hospitalwide computerized physician order entry on medical errors in a pediatric hospital. Journal of Pediatric Surgery, 40(1), 57-59.
In the first paragraph you will summarize the study. Briefly describe the aim of the study, the sample and setting, and the methods.
In the second paragraph you will identify the outcomes and/or efficiencies examined in the study and explain the results related to improvements in the outcomes and/or efficiencies.
In the third paragraph, you will discuss lessons learned from the findings of the study and relate the lessons learned to the application of the clinical system.
Walsh, K. E., Landrigan, C. P., Adams, W. G., Vinci, R. J., Chessare, J. B., Cooper, M. R., Hebert, P. M, Schainker, E. G., McLaughlin, T. J., & Bauchner, H. (2008). Effect of computer order entry on prevention of serious medication errors in hospitalized children. Pediatrics, 121(3), e421-e427.
In the first paragraph you will summarize the study. Briefly describe the aim of the study, the sample and setting, and the methods.
In the second paragraph you will identify the outcomes and/or efficiencies examined in the study and explain the results related to improvements in the outcomes and/or efficiencies.
In the third paragraph, you will discuss lessons learned from the findings of the study and relate the lessons learned to the application of the clinical system.
Conclusion
The conclusion should synthesize the major results of all four research studies, examining and relating the findings of all studies to one another. Do not introduce new ideas in this paragraph; the conclusion should interpret what you have written and what it means in the bigger picture. Here is a link to Walden’s Writing Center on Synthesis https://academicguides.waldenu.edu/writingcenter/evidence/synthesis
The Use of Patient Portals to Improve Outcomes and Efficiencies in Patients with Diabetes
Student Name
College of Nursing, Walden University
Course Number, Section, and Title
(Example: NURS 0000 Section 01, Title of Course)
Instructor
Due Date (Month, Day, Year)
The Use of Patient Portals to Improve Outcomes and Efficiencies in Patients with Diabetes
Annotated Bibliography
Graetz, I., Huang, J., Muelly, E. R., Fireman, B., Hsu, J., & Reed, M. E. (2020). Association of mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes. JAMA Network Open, 3(2):e1921429. doi: 10.1001/jamanetworkopen.2019.21429. PMID: 32074289; PMCID: PMC7646995.
Medication adherence promotes well-being and improves the health outcomes of patients with diabetes. The aim of this study was to assess the impact of increased mobile patient portal access on medication compliance and glycemic control in patients with diabetes. The sample for the study was adult patients with diabetes treated at Kaiser Permanente in Northern California. The Kaiser Permanente healthcare delivery system was the setting for the study. The researchers used a retrospective cohort study design and a quantitative methodology in the study.
The two patient outcomes identified in the study are medication compliance and reduced glycemic levels. From the study findings, access to computer-based patient portals was associated with a 1.16% increase in medication compliance and a 0.06% reduction in HbA1c levels. Access to both mobile-based and computer-based portals resulted in a 1.67% increase in medication compliance and a 0.13% reduction in HbA1c levels.
An important lesson learned from the findings of this study is that healthcare systems should provide diabetes patients with access to both computer-based and mobile-based portals as part of their self-management kits. As discovered from the study, combining mobile patient portals with computer patient portals is associated with increased medication adherence and improved glycemic control. Continued support with the usability of these tools can improve the quality of life for patients with diabetes.
Lyles, C. R., Sarkar, U., Schillinger, D., Ralston, J. D., Allen, J. Y., Nguyen, R., & Karter, A. J. (2016). Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups. Journal of the American Medical Informatics Association: JAMIA, 23(e1), e28–e33. https://doi.org/10.1093/jamia/ocv126.
Diabetes is a chronic condition whose effective management highly depends on constant medication refill and medication compliance. The aim of this study was to examine whether the use of online patient portals influenced statin adherence and health outcomes in patients with diabetes. The setting for the study was the Kaiser Permanente healthcare delivery system. Adult diabetes patients were the study sample. The researchers used a retrospective cohort study design with a quantitative methodology.
The outcome measure that has been pointed out in the study is increased medication adherence. From the study findings, there was a significant improvement in statin adherence over time when patient portals were used compared to when they were not used. The improvement was observed among all racial groups.
An important insight gained from these findings is that patient portals allow patients with diabetes to refill medications online. Patients are able to refill medications even when they are at home. This significantly improves medication adherence as reported by the researchers.
Wakefield BJ, Turvey C, Hogan T, Shimada S, Nazi K, Cao L, Stroupe K, Martinez R, Smith B. (2020). Impact of patient portal use on duplicate laboratory tests in diabetes management. Telemedicine Journal and E-Health, 26(10):1211-1220. doi: 10.1089/tmj.2019.0237. Epub 2020 Feb 11. PMID: 32045320.
Laboratory tests are expensive and duplicate tests impact negatively on hospital costs. The aim of this study was to assess the effect of patient portals on duplicate laboratory tests among patients with diabetes. The setting for the study was the United States Veterans Health Administration and the sample was a group of Veterans with diabetes. A retrospective study design was used in the study.
The specific outcome evaluated by the investigators in this study was efficiency as defined by duplicate laboratory tests. The study revealed that the use of the Blue Button patient portals significantly reduced duplicate HbA1c laboratory tests. Portal users were less likely to have duplicate tests when compared to non-portal users, a factor that helps to improve efficiency.
An important lesson learned from the study findings is that healthcare systems should provide diabetes patients with patient portals for effective diabetes management. When patients are allowed to access these portals, they are able to influence laboratory test ordering, thereby preventing duplicate tests. Therefore, continued use of patient portals for diabetes patients can promote efficiency by minimizing healthcare costs.
Zocchi, M. S., Robinson, S. A., Ash, A. S., Vimalananda, V. G., Wolfe, H. L., Hogan, T. P., Connolly, S. L., Stewart, M. T., Am, L., Netherton, D., & Shimada, S. L. (2021). Patient portal engagement and diabetes management among new portal users in the Veterans Health Administration. Journal of the American Medical Informatics Association: JAMIA, 28(10), 2176–2183. https://doi.org/10.1093/jamia/ocab115
Diabetes patients are able to have improved physiological outcomes when they are allowed to engage with a team of healthcare providers involved in their care. The aim of this study was to examine the impacts of the Veterans Health Administration’s My HealtheVet (MHV) online patient portal on the physiological outcomes of patients with diabetes. The sample for the study was veterans with type 2 diabetes. Veterans Health Administration was the setting for the study. The researchers used a retrospective cohort study design and a quantitative methodology in the study.
A number of physiological outcomes related to diabetes were identified in the study. They include HbA1c, Low-density lipoprotein (LDL) cholesterol, systolic blood pressure, and diastolic blood pressure. Study findings indicate that the use of patient portals for a period of 12 months was associated with a significant decline in HbA1c and LDL levels and a minimal improvement in both diastolic and systolic blood pressures.
These findings generate great insights for health systems. Essentially, health systems should provide diabetes patients with access to patient portals as part of self-management. The researchers have discovered that the use of patient portals improves physiological outcomes in patients with diabetes.
Conclusion
Evidence documented in the reviewed studies indicates that patient portals improve health outcomes in patients with diabetes in a number of ways. For example, access to both mobile-based and computer-based portals is associated with a significant increase in medication compliance HbA1c levels in patients with diabetes. Increased adherence to statin medication was observed in patients who were allowed to use patient portals. Additional evidence indicates that the use of patient portals for a period of 12 months is associated with a significant decline in HbA1c and LDL levels and improvement in both diastolic and systolic blood pressures. Healthcare systems that use patient portals improve efficiencies by preventing duplicate laboratory tests that impact negatively on healthcare costs. Thereby, it is advisable that health systems integrate patient portals to help improve the health outcomes and efficiencies in patients newly diagnosed with diabetes.