Annotated Bibliography RECENT
Annotated Bibliography RECENT
Interdisciplinary transition care coordination strategies are critical approaches that allow healthcare organizations and providers to reduce hospital readmission in medical surgical units in acute care. Using five articles from the “Literature Evaluation Table” this paper provides an annotated bibliography of five quantitative articles that address the issue of interdisciplinary transition care coordination. The annotation provides a concise description about the quality, accuracy and relevance of each article to the PICOT-D.
PICOT-D Question: In a medical-surgical unit at an urban acute care hospital setting serving the adult population, does implementing interdisciplinary transition care coordination strategies from hospital to home reduce 30-day readmissions within eight weeks?
Kripalani, S., Chen, G., Ciampa, P., Theobald, C., Cao, A., McBride, M., Dittus, R. S., & Speroff, T. (2019). A transition care coordinator model reduces hospital readmissions and costs. Contemporary Clinical Trials, 81, 55–61. https://doi-org.lopes.idm.oclc.org/10.1016/j.cct.2019.04.014

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In this article, Kripalani et al. (2019) provide a model based on transition care coordination to reduce readmissions and costs. Using a quasi-experimental design, the researchers compared transition care coordinator (TCC) model of care to the standard or normal care. Despite the controls that they had, the study shows a positive correlation as it concludes that TCCCs lowered 30-and90-day readmissions and related costs.
The article is of high quality though under control and provides an accurate description of the effects of TCCs in reducing readmissions. The study is a controlled randomized trial implying that it is at level one on the evidence pyramid. The accuracy of the article is high given its level of evidence and allows practitioners to integrate these interventions to reduce readmissions. The article is relevant to the PICOT-D question since it shows that evidence-base practice models are effective in addressing the issue of readmission.
Pugh, J., Penney, L. S., Noël, P. H., Neller, S., Mader, M., Finley, E. P., Lanham, H. J., &
Leykum, L. (2021). Evidence based processes to prevent readmissions: more is better, a ten-site observational study. BMC Health Services Research, 21(1), 1–11. https://doi-org.lopes.idm.oclc.org/10.1186/s12913-021-06193-x
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In this article, Pugh et al. (2021) conducted a mixed method, multi-stepped observational study to assess the association between of evidence-based transitional procedures deployed and possibility of readmission rates. The researchers observe that facilities that use recommended care transition processes have increased chances of reducing the risk for readmission based on the (RSRR) model. The study observes that implementation variability and hurdles highlighted by provider to perform these interventions require the use of novel strategies to facilitate increased uptake of the model. Consistent use can help facilities that underutilize the processes and entail patient involvement and engagement in discharge planning as well as enhanced leveraging on community support.
The article demonstrates high quality evidence based on its level on evidence pyramid as it is at level III which gives evidence from well-designed controlled trials that have no randomization or quasi experimental approach. The article is relevant to the PICOT-D question as it shows that transition care coordination reduces the risk of readmissions in care facilities. The article also shows that effective care coordination requires the involvement of patients in their care plans.
Snyder, M. E., Krekeler, C. E., Jaynes, H. A., Davis, H. B., Lantaff, W. M., Mu Shan,
Perkins, S. M., & Zillich, A. J. (2020). Evaluating the effects of a multidisciplinary
transition care management program on hospital readmissions. American Journal of Health-System Pharmacy, 77(12), 931–937. https://doi-org.lopes.idm.oclc.org/10.1093/ajhp/zxaa091
The article by Snyder et al. (2020) assesses the effects of a pharmacist-developed transition of care programs to reduce the rates of 30-day all-cause readmissions and follow-up. Using a retrospective cohort design, the study shows the effectiveness of a pharmacist-led TOC program to lower 30-day readmissions in the facility. The study demonstrates that having interventions that incorporate healthcare professionals like pharmacists is critical to attaining transition of care programs that address patient needs. The article is accurate since it is a cohort study where participants were followed for 90 days to see if the intervention is effective in addressing the issue of readmissions. The quality of the article is good since it falls under level IV on the evidence pyramid. Level IV contains articles that use well-designed case-control and cohort research. Further, the article supports the PICOT-D as it shows that health care professions can initiate programs that offer benefits not just to patients but also health care providers.
Provencher, V., Clemson, L., Wales, K., Cameron, I. D., Gitlin, L. N., Grenier, A., &
Lannin, N. A. (2020). Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial. BMC Geriatrics, 20(1). https://doi-org.lopes.idm.oclc.org/10.1186/s12877-020-1494-3
The article by Provencher et al. (2020) demonstrates for health care providers to support geriatric patients moving from hospital to home by using evidence-based patient-centric discharge planning strategies. Using randomized control approach, the study notes that hospitalized elderly suffering from moderate cognitive impairment can attain benefits from the home model. The approach entails preparation and after-charge support to mitigate and prevent possible unplanned readmissions. The authors record the need to have improved discharge outcomes among the at-risk subgroups after getting an expert-led interventions to enable best care services.
Finlayson, K., Chang, A. M., Courtney, M. D., Edwards, H. E., Parker, A. W., Hamilton, K., Pham, T. D. X., & O’Brien, J. (2018). Transitional care interventions reduce unplanned hospital readmissions in high-risk older adults. BMC Health ServicesResearch, 18(1). https://doi-org.lopes.idm.oclc.org/10.1186/s12913-018-3771-9
In their article Finlayson et al. (2018) assert that transitional care interventions are essential in reducing unplanned hospital readmissions at elevated risk older individuals. Using a randomized controlled model involving 222 subjects, the authors show that multifaceted transitional care strategies in different settings can lower readmissions within the first three months of implementation. Utilizing different interventions cohorts, the study demonstrates that transitional care interventions are a critical aspect of ensuring quality care and reducing the cost burden. The study is accurate based on the statistical aspects that it demonstrates and the outcome measures that it uses to evaluate the outcomes across the four cohorts that they use.
The quality of the article is good based on its level of evidence as depicted by the evidence level pyramid.  The article’s evidence level is II since it designed randomized control trials in different sites to evaluate the effects of different transitional care interventions on hospital readmissions. Imperatively, the article is relevant to the PICOT-D question as it demonstrates clear evidence that effective transitional care approaches can reduce hospital readmissions across care continuum and settings.
Conclusion
The annotated bibliography shows that effective transitional care interventions can reduce readmissions when adult patients are discharged from hospital to home within eight weeks. A host of the articles show that readmissions drastically decline when the transitional care involves an interdisciplinary team approach and patients. However, the articles are not explicit is such interventions also work effective in medical-surgical units.
Annotated Bibliography RECENT References
Finlayson, K., Chang, A. M., Courtney, M. D., Edwards, H. E., Parker, A. W., Hamilton, K.,
Pham, T. D. X., & O’Brien, J. (2018). Transitional care interventions reduce unplanned hospital readmissions in high-risk older adults. BMC Health Services Research, 18(1). https://doi-org.lopes.idm.oclc.org/10.1186/s12913-018-3771-9
Kripalani, S., Chen, G., Ciampa, P., Theobald, C., Cao, A., McBride, M., Dittus, R. S., &
Speroff, T. (2019). A transition care coordinator model reduces hospital readmissions and costs. Contemporary Clinical Trials, 81, 55–61. https://doi-org.lopes.idm.oclc.org/10.1016/j.cct.2019.04.014
Provencher, V., Clemson, L., Wales, K., Cameron, I. D., Gitlin, L. N., Grenier, A., & Lannin, N.

(2020). Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial. BMC Geriatrics, 20(1). https://doi-org.lopes.idm.oclc.org/10.1186/s12877-020-1494-3

Pugh, J., Penney, L. S., Noël, P. H., Neller, S., Mader, M., Finley, E. P., Lanham, H. J., &
Leykum, L. (2021). Evidence based processes to prevent readmissions: more is better, a ten-site observational study. BMC Health Services Research, 21(1), 1–11. https://doi-org.lopes.idm.oclc.org/10.1186/s12913-021-06193-x
Snyder, M. E., Krekeler, C. E., Jaynes, H. A., Davis, H. B., Lantaff, W. M., Mu Shan, Perkins, S.
M., & Zillich, A. J. (2020). Evaluating the effects of a multidisciplinary transition care management program on hospital readmissions. American Journal of Health-System Pharmacy, 77(12), 931–937. https://doi-org.lopes.idm.oclc.org/10.1093/ajhp/zxaa091
Description

For this assignment, you will need three scholarly journal articles, one for each of the Three Pillars (servant leadership, ethics, and entrepreneurism)  In addition, locate scholarly journal articles that provide support on the Three Pillars as they relate to your career in the health care industry. In your annotated bibliography, include the following:

A brief description of the article.
Main ideas from the article.
How this source is relevant to your research paper.
Why the article is considered scholarly.

Annotated Bibliography RECENT Grid View

 
Excellent
Good
Fair
Poor

Main Posting
45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3.

First Response
17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.

Second Response
16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.

Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.

Total Points: 100