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Although healthcare systems could reduce their spending by 30% if patients receive evidence-based health care, the cost of healthcare delivery continues to increase in many countries across the globe (PricewaterhouseCoopers’ Health Research Institute, 2009). Poor-quality health care and wasteful healthcare spending are continued challenges. Further, medical errors that result in death, many of which could have been prevented with evidence-based practice (EBP), continue to be a global problem in healthcare systems. Fragmentation of care in healthcare systems is another huge problem (Carter, 2010). For example, in the United States, it is now not unusual for a typical Medicare patient to see two primary care providers and five specialists working in four medical practices (Thorpe, Ogden, & Galactionova, 2010). Our healthcare systems cannot sustain these rising healthcare costs, wasteful spending, and lack of EBPs without a collapse of the entire system.

Although evidence-based guidelines and recommendations on various topics have long been published throughout the globe, their uptake by clinicians in real-world practice settings is often less than desirable. It often takes decades to translate evidence-based interventions into real-world practice settings to improve healthcare quality and outcomes as well as lower costs.

The current critical condition of healthcare systems across the globe is calling for innovative studies and programs of research that will lead to evidence-based intervention strategies as well as new models of transdisciplinary care that enhance patient outcomes and, at the same time, decrease healthcare costs. This is no small feat, but it can be accomplished with a common vision, rigorous research, acceleration of EBP, and funding directed to high-priority areas that will make a difference in the most prevalent conditions negatively impacting health outcomes across the globe.

THE “SO WHAT” FACTOR IN RESEARCH AND EBP

  1. Top of page
  2. THE “SO WHAT” FACTOR IN RESEARCH AND EBP
  3. BUILDING AN IMPACTFUL PROGRAM OF RESEARCH THAT MAKES A DIFFERENCE IN “SO WHAT” OUTCOMES
  4. FUTURE TACTICS FOR IMPROVED HEALTH CARE AND BETTER PATIENT OUTCOMES
  5. References

Over the years, I have mentored many new investigators and students through their PhD and DNP programs. Because of the pressures associated with achieving tenure, it is common for tenure track faculty in research-intensive universities to place emphasis on obtaining peer-reviewed funding and publishing data-based articles in journals with high impact factors. Although dissemination of our work is critical, research is not complete until the findings from our studies are translated into clinical care and communities to positively impact outcomes (i.e., the quality of healthcare delivery and health of people). I have always said that I do not want to get to the end of my research career, having invested decades into conducting a program of intervention research with terrific outcomes for children and families, and have no one implementing my evidence-based intervention programs.

From the very beginning of a doctoral program or as we work with nurses and other transdisciplinary colleagues in healthcare systems, we need to start talking with them about the “so what” outcome factor, which is the term I use for conducting research with high impact potential to positively change healthcare systems, reduce costs, and improve outcomes for patients and their families (Melnyk & Morrison-Beedy, 2012). For example, key questions that every professional needs to be reflecting upon as they begin to design a new study or project are:

  • “So what” is the prevalence of the problem?
  • “So what” will be the end outcome of the study or EBP project once it is completed?
  • “So what” difference will the study or project make in improving healthcare quality, costs, and, most important, patient outcomes?
  • Who will care about the study's outcomes (e.g., healthcare providers, healthcare systems)?
  • Once you have the outcomes from the study or project, what are you going to do with them in addition to presenting or publishing the findings?
  • If it is an intervention that is being developed or tested, will it be feasible and cost-effective for providers, hospitals, or healthcare agencies to adopt and implement it?
  • How exactly will you go about getting your research findings translated into clinical practice to improve care and patient outcomes?

We must help our students and colleagues to focus more on the “so what” factors as they begin their programs of research, especially our PhD students who will be experts at generating evidence and our DNP students who will be experts at generating internal evidence and translating external evidence into practice in their own clinical settings (Melnyk & Morrison-Beedy, 2012). Planting these seeds in individuals as they enter our academic programs and mentoring them to engage in high-impact work that makes a difference in outcomes is necessary to make a positive difference in our healthcare systems, our patients, and the communities in which we live. Without this approach, we risk continuing to generate a large number of research findings that are disseminated through publications and presentations, but to a large extent do not make it into the real world to positively impact healthcare quality, patient outcomes, and costs.

BUILDING AN IMPACTFUL PROGRAM OF RESEARCH THAT MAKES A DIFFERENCE IN “SO WHAT” OUTCOMES

  1. Top of page
  2. THE “SO WHAT” FACTOR IN RESEARCH AND EBP
  3. BUILDING AN IMPACTFUL PROGRAM OF RESEARCH THAT MAKES A DIFFERENCE IN “SO WHAT” OUTCOMES
  4. FUTURE TACTICS FOR IMPROVED HEALTH CARE AND BETTER PATIENT OUTCOMES
  5. References

Throughout my career, one of my greatest passions has been improving the health outcomes of highly vulnerable children, adolescents, and their families. Specifically, my sustained research trajectory over the past 25 years has focused on the development and testing of theory-based interventions to improve coping and mental health outcomes in hospitalized or critically ill children, premature infants, and their parents, and translating those interventions into clinical care to improve healthcare quality and patient outcomes through EBP.

Over a period of two decades, I conducted a total of six experimental studies (three of which were funded by the National Institutes of Health/National Institute of Nursing Research) testing my Creating Opportunities for Parent Empowerment (COPE) program for parents of hospitalized young children, critically ill children, and premature babies. The COPE program is a manualized educational-behavioral skills building intervention that can be delivered by nurses or other health professionals at the bedside. It teaches parents about: (a) what to expect in the behaviors, emotional, and physical characteristics of their children, and (b) how best to parent their children while hospitalized along with strategies to enhance their children's developmental and psychological outcomes. Skills-building activities are incorporated into the program through a parent workbook so that parents can put into practice the content they are learning from the educational CD-ROMs and written information, which are part of the program.

Overall, findings from this series of six intervention studies indicated that parents who received COPE, in comparison to those who received an attention control program, reported: less stress, anxiety, depressive symptoms, and post-traumatic stress during and following hospitalization; and provided greater support to their children as well as had more positive parent–child interactions during hospitalization (Melnyk, 1994; Melnyk, Alpert-Gillis, Hensel, Cable-Beiling, & Rubenstein, 1997; Melnyk et al., 2001, 2004, 2006; Vulcan [Melnyk] & Nikulich-Barrett, 1988). In addition, children whose parents received COPE had less negative behaviors, up to a year following discharge, and better developmental outcomes, up to 3 years following discharge from the neonatal intensive care unit. Along with studying the effects of COPE on child and parent outcomes, our team studied the process through which COPE worked by empirically identifying parental cognitive beliefs as the key mediator of the effects of the intervention on parent mental health outcomes and participation in their children's care (Melnyk, 1995; Melnyk, Crean, Feinstein, & Alpert-Gillis, 2007). Structural equation modeling also supported that parental emotional outcomes mediated the effects of COPE on child outcomes (Melnyk, Crean, Feinstein, & Fairbanks, 2008). These findings filled a gap in the science of understanding the processes through which the COPE psychosocial intervention exerted its positive effects.

Although the findings from these studies were important and I received numerous inquiries about the program from across the United States and globe from both researchers and clinicians, the programs were not being implemented in hospitals and, as such, families were not benefiting from the COPE programs. The breakthrough for the COPE program's implementation in hospitals was not realized until we published the findings from our full-scale clinical trial with 260 premature infants and their parents, which indicated that the preemies of parents who received COPE were discharged by a mean of 4 days sooner than preemies of attention control parents. This earlier discharge rate resulted in a cost saving of nearly $5,000 per COPE infant (Melnyk & Feinstein, 2009). Further, COPE preterm infants less than 32 weeks' gestational age were discharged an average of 8 days sooner than attention control preterms. As a result, routinely delivering the COPE neonatal intensive care unit (NICU) program to parents of the over 500,000 preterm infants that are born in the United States every year could save our healthcare system at least $2.5 billion dollars every year. The “so what” outcome factor here is that not only does COPE improve important parent and infant outcomes, but it also shortens length of hospital stay and saves substantial costs for the hospitals who implement it. Once the cost-effectiveness analysis on COPE for parents of preterm infants was published, hospitals throughout the globe became interested in implementing COPE. It is now standard practice in several NICUs throughout the United States and Europe. Without demonstrating the “so what” outcome factors of reducing length of hospital stay and costs, I am certain that the uptake of COPE in real-world practice settings would not have become a reality.

FUTURE TACTICS FOR IMPROVED HEALTH CARE AND BETTER PATIENT OUTCOMES

  1. Top of page
  2. THE “SO WHAT” FACTOR IN RESEARCH AND EBP
  3. BUILDING AN IMPACTFUL PROGRAM OF RESEARCH THAT MAKES A DIFFERENCE IN “SO WHAT” OUTCOMES
  4. FUTURE TACTICS FOR IMPROVED HEALTH CARE AND BETTER PATIENT OUTCOMES
  5. References

A collective vision for improved health care and better patient outcomes is desperately needed among researchers, clinicians, leaders, educators, healthcare systems, and policy makers. That vision needs to focus on the “so what” outcomes: specifically improving healthcare quality, costs, and patient outcomes. However, vision without execution will not become a reality. Therefore, the following strategies are recommended as being key to success:

  • Conducting studies with impact, which include the measurement of outcomes that tap healthcare quality, costs, and patient outcomes (the “so what” factors important to healthcare systems and the health of our world);
  • Conducting comparative-effectiveness trials in order to support the most efficacious interventions to improve health outcomes;
  • Preparing the next generation of researchers and doctorally prepared clinicians to address the “so what” factor in their research and evidence-based or quality improvement projects;
  • Teaching these key concepts, including cost analysis and strategies that rapidly translate research-based findings into clinical practice, in the early phase of educational programs;
  • Encouraging PhD students to tackle intervention studies when there is sufficient qualitative and descriptive research about the problem;
  • Growing more innovators who are not steeped in “this is the way we do it here”;
  • Forming transdisciplinary teams to tackle the “so what” outcome factors and speeding the translation of evidence-based interventions into clinical practice;
  • Accelerating the use of technology in research and EBP;
  • Addressing key gaps in research where evidence is poor or lacking; and
  • Building cultures and environments of EBP within healthcare systems and academic institutions.

Nursing and the other health sciences professions have long suggested solutions for how to improve health care and the health of our nation. With the addition of cost analyses and the measurement of key “so what” outcomes that healthcare systems currently value, our research and quality improvement and EBP change projects will be more potent to drive needed effective solutions to the world's most pressing problems.

References

  1. Top of page
  2. THE “SO WHAT” FACTOR IN RESEARCH AND EBP
  3. BUILDING AN IMPACTFUL PROGRAM OF RESEARCH THAT MAKES A DIFFERENCE IN “SO WHAT” OUTCOMES
  4. FUTURE TACTICS FOR IMPROVED HEALTH CARE AND BETTER PATIENT OUTCOMES
  5. References
  • Carter, A. (2010). Innovation and experimentation in chronic care management will drive enduring healthcare reform. Home Healthcare Nurse, 28(8), 508-509. doi: 10.1097/NHH.0b013e3181ed759d
  • Melnyk, B. M. (1994). Coping with unplanned childhood hospitalization: Effects of informational interventions on mothers and children. Nursing Research, 43(1), 50-55.
  • Melnyk, B. M. (1995). Coping with unplanned childhood hospitalization: The mediating functions of parental beliefs. Journal of Pediatric Psychology, 20(3), 299-312.
  • Melnyk, B. M., Alpert-Gillis, L., Feinstein, N. F., Crean, H., Johnson, J., Fairbanks, E., … Corbo-Richert, B. (2004). Creating opportunities for parent empowerment (COPE): Program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics, 113(6). Retrieved from http://www.pediatrics.org/cgi/content/full/113/6/e597-e607
  • Melnyk, B. M., Alpert-Gillis, L., Feinstein, N. F., Fairbanks, E., Schultz-Czarniak, J., Hust, D., … Sinkin, R. A. (2001). Improving cognitive development of LBW premature infants with the COPE program: A pilot study of the benefit of early NICU intervention with mothers. Research in Nursing and Health, 24, 373-389.
  • Melnyk, B. M., Alpert-Gillis, L. J., Hensel, P. B., Cable-Beiling, R. C., & Rubenstein, J. (1997). Helping mothers cope with a critically ill child: A pilot test of the COPE intervention. Research in Nursing and Health, 20, 3-14.
  • Melnyk, B. M., Crean, H. F., Feinstein, N. F., & Alpert-Gillis, L. (2007). Testing the theoretical framework of the COPE program for mothers of critically ill children: An integrative model of young children's post-hospital adjustment behaviors. Journal of Pediatric Psychology, 32(4), 463-474. doi:10.1093/jpepsy/jsl033
  • Melnyk, B. M., Crean, H. F., Feinstein, N. F., & Fairbanks, E. (2008). Maternal anxiety and depression following a premature infants’ discharge from the NICU: Explanatory effects of the COPE program. Nursing Research, 57(6), 383-394. doi: 10.1097/NNR.0b013e3181906f59
  • Melnyk, B. M., & Feinstein, N. (2009). Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parents and premature infants: An analysis of direct healthcare neonatal intensive care unit costs and savings. Nursing Administration Quarterly, 33(1), 32-27. doi: 10.1097/01.NAQ.0000343346.47795.13
  • Melnyk, B. M., Feinstein, N. F., Alpert-Gillis, L., Fairbanks, E., Crean, H. F., Sinkin, R., … Gross, S. J. (2006). Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the COPE NICU program: A randomized clinical trial. Pediatrics, 118(5), 1414-1427. doi:10.1542/peds.2005-2580
  • Melnyk, B. M., & Morrison-Beedy, D. (2012). Setting the stage for intervention research: The “so what,” “what exists” and “what's next” factors. In B. M. Melnyk & D. Morrison-Beedy (Eds.), Designing, conducting, analyzing and funding intervention research. A practical guide for success (pp. 1-9). New York, NY: Springer Publishing.
  • PricewaterhouseCoopers’ Health Research Institute. (2009). The price of excess: Identifying waste in healthcare spending. Retrieved from http://www.pwc.com/us/en/healthcare/ publications/the-price-of-excess.jhtml
  • Thorpe, K. E., Ogden, L. L., & Galactionova, K. (2010). Chronic conditions account for rise in Medicare spending from 1987 to 2006. Health Affairs, 29(4), 718-724.
  • Vulcan [Melnyk], B. M., & Nikulich-Barrett, M. (1988). The effects of selected information on mothers' anxiety levels during their children's hospitalization. Journal of Pediatric Nursing, 3(2), 97-102.