Guidelines for Population Specific Intervention:

                                      Guidelines for Population Specific Intervention:

                                                    Comparative Effectiveness Paper

Introduction

to prepare students with an understanding of evidence-based clinical decision-making. These assignments assist the student to develop strong clinical inquiry skills–to critically appraise, select and apply sound research evidence in clinical practice and outcome evaluation. The first assignment introduced the concept of a clinical search using the PICOT or PICO format to research a symptom-focused clinical question. The second assignment focused on developing critical appraisal skills that guide clinical decisions about screening and selection of diagnostic tests. The third assignment will consider the comparative efficacy of an intervention associated with a specific population.

The purpose of the third assignment is to apply evidence-based practice (EBP) concepts to the selection of a population-specific intervention by comparing its relative effectiveness against other intervention options. Outcomes are a major focus of this paper including measurement and evaluation within the population and type of primary care setting.

Following an initial search addressing background questions, you will further focus and develop a clinical question (PICOT or  PICO format) narrow enough to yield targeted research to appropriately answer your question. Findings from the best available research will be critically analyzed and synthesized to support a decision or action related to patient care. Evaluation of an identified outcome will be presented.

Examples

In Hispanic adults with impaired glucose metabolism/insulin resistance (P), are non-pharmacologic interventions (to promote improved diet and physical activity) (I) as effective (or more effective) than metformin (C) in delaying the onset of Type 2 Diabetes (O) over a 12-16 month period (T)?

In patients with non-seasonal (perennial) allergic rhinitis, is a combined model of  symptom management and multiple dust mite control measures (I) more effective than  a single method (C) in controlling symptom breakthrough (O)?

Among community dwelling elderly patients with hypertension (P), is a statin plus aspirin preventive regimen (I) more beneficial than a statin alone (C) to prevent primary or secondary cardiovascular events (stroke, MI) and mortality (O) over a one year period of time (T)?

In older adults diagnosed with osteoporosis (P), are weight bearing exercises (I), or calcium carbonate or placebo (C) more effective in increasing bone mass, measured with the bone densitometry (O), after 1 year (T)?

Guidelines

Part 1: Backgound Questions

Based on your clinical research interests, first select a relevant population and its link to a preventable or existing condition. The following background questions will help to focus an initial discussion:

• Define the condition requiring an intervention:
  • A) Health risk (preventable condition) OR
  • B) Existing medical condition or health problem
• For A, define the condition and thoroughly describe specific patient populations or subpopulations with a known risk for developing the preventable condition. Support your choice of population and preventable condition with clearly explained details adequate to present the condition.
• For B, describe the pathophysiology of the condition and socio-cultural-environmental context of the population. Support your choice of population and existing condition or health problem with clearly explained details adequate to demonstrate the linkage between the condition and its context within the identified population.
• What is the clinical significance of the condition? Consider:
• a) epidemiological characteristics (prevalence, morbidity and premature mortality, and
• variability related to specific demographic populations),
• b) impact on quality of life
• c) present evidence-based practice guidelines appropriate to the scope of NP practice
• d) address the potential impact of NPs and other health team members within the defined area of
• practice
• What are the most common interventions currently utilized and outcomes measured? Are outcomes long-term vs. short-term?
• Are there reported effectiveness differences in one population vs others?
• Present an overview of published, peer-reviewed evidence from qualitative and quantitative research in nursing and medical databases.
• Describe the current practice guidelines and recommendations and level of evidence currently available for the diagnosis/condition you selected.

Based on the above initial questions and searches, you will be prepared to refine your clinical inquiry in the following section. Keep an electronic record (or “paper trail”) of your work in files that are readily accessible. Although many of the references you read will not make it into your final set of critically appraised evidence, they will be important sources of support data.

Part 2: Foreground ( PICOT or PICO ) Question development and refinement

1. Verify your selected patient population–define the characteristics in the population, e.g. gender, age group, race/ethnicity, occupation, living situation/socioeconomic status. The pre-existing medical diagnosis or health conditions as well as preventable or risk factors for disease serve as contextual factors related to the population and, of course, to the intervention(s) you have chosen to examine.
2. Present your intervention-focused clinical question in PICOT or PICO format.
3. Provide a rationale for your PICOT or PICO question. Discuss and address the background questions listed above.
4. Conduct a literature search with about 3 terms representing population, condition of interest, comparison and outcome. One suggested strategy is to start with PubMed’s Clinical Query, in which specific filters are used to help target your search, resulting in more appropriate results. Cinahl Plus provides APRN perspectives possibly missed with other databases.
5. Present the methodology used to scan and identify useful and appropriate articles. Include all database sources and search terms, and the results. Describe the process of refining and/or expanding the search. Explain rationale as to how the last 5-6 relevant studies were chosen for discussion. “Free text” should not be included as one of the search filters.

The search procedures detailed in the above methodology table will be graded as part of the methodology .

6. Identify and select 5 relevant studies at the highest level of evidence available, excluding systematic reviews and meta-analyses. Summarize the findings from the selected studies in a Table of Evidence.

                                        TABLE OF EVIDENCE

Table should be Single Space.  Use bullet points, phrases, not complete sentences, be concise and succinct, be selective and be relevant to the research question and selected population.

7. Briefly describe each of your individual studies. Critically analyze each study for validity, reliability and clinical relevance for your selected population and interventions appropriate for nurse practitioner implementation and evaluation. Are outcomes valid and measured reliably and at the correct time interval?
8. Synthesize findings from the literature search. Discuss any common themes, gaps and/or conflicting evidence in the literature. Will the studies assist the nurse practitioner in selecting the most appropriate interventions for the designated population?
9. Include a complete reference list of at least 20 references (including the 5 selected articles) from peer-reviewed journals or publications that were helpful in writing this paper.
10. Paper will be 11-12 pages in length (excluding tables), double spaced, font size 12. Use APA style throughout.

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