NURS FPX 4025 Assignment 3 Applying the PICO(T) Process

NURS FPX 4025 Assignment 3 Applying the PICO(T) Process

Student Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name:

Date

Applying the PICO(T) Process

The progressive and incapacitating respiratory disease known as chronic obstructive pulmonary disease (COPD) presents serious health challenges, especially for marginalized and disadvantaged groups. This paper explores a clinical issue related to COPD by developing a focused PICO(T) question, followed by an evidence-based literature review to inform best practices. Emphasis is placed on outcomes, risks, and healthcare disparities affecting those with COPD. The analysis aims to guide clinical decision-making and improve patient-centered care by integrating credible and relevant research evidence.

Diagnosis Overview and Disparities

Long-term exposure to irritants such as cigarette smoke, air pollution, and workplace toxins is often the cause of chronic obstructive pulmonary disease (COPD), a lung disease characterized by persistent airflow limitation. The disorder encompasses emphysema and chronic bronchitis, and it leads to significant morbidity and mortality. Common outcomes include reduced lung function, increased dyspnea, exercise intolerance, frequent exacerbations, and a gradual decline in quality of life. Long-term complications may involve pulmonary hypertension, respiratory failure, and cardiac comorbidities, especially in individuals with advanced disease (Jo, 2022). 

Patients with COPD are at high risk for frequent hospital readmissions and acute exacerbations, which often require emergency care or intensive interventions. These risks are amplified among vulnerable populations, including older adults, those with low socioeconomic status, rural residents, and racial or ethnic minorities. They have higher rates of undiagnosed COPD due to limited access to pulmonology specialists and inadequate follow-up care, all of which contribute to poorer health outcomes (Gaffney et al., 2021).

Social determinants such as lack of health insurance, transportation barriers, or limited health literacy complicate disease management. These healthcare disparities deeply affect the course of COPD by delaying diagnosis, reducing adherence to treatment plans, and limiting access to preventive services like smoking cessation and pulmonary rehabilitation. Addressing such inequities is essential to improving COPD outcomes, particularly for underserved groups. Tailored interventions must consider the unique needs of these populations to close the gap in care and outcomes.

PICO(T) Question Development

To address the challenge of frequent exacerbations in COPD patients, a PICO(T) question was developed: 

“In adults with COPD, does taking part in a structured pulmonary rehabilitation (PR) program, compared to routine care without rehabilitation, lower the frequency of acute exacerbations and hospitalizations over six months?”

This question is aligned with the PICO(T) framework.

• Population (P) focuses on adults diagnosed with moderate to severe COPD. 
• Intervention (I) is implementing a structured PR program.
• Comparison (C) involves standard care that does not include rehabilitation. 
• Outcome (O) is the reduction in acute exacerbations and hospital admissions. 
• Timeframe (T) is six months. 

This research question targets a critical issue in COPD management and provides a clear foundation for evidence-based investigation to improve patient outcomes and inform clinical decisions.

Literature Search Strategy

A thorough literature search was undertaken to find high-quality research on the effect of PR on COPD exacerbations. The primary databases used included PubMed, CINAHL, and Cochrane Library, chosen for their focus on peer-reviewed, evidence-based clinical research. Initial search terms included: COPD, pulmonary rehabilitation, exacerbations, hospitalizations, outcomes, and standard care. The search results were filtered using Boolean operators like “AND” and “OR.” With an emphasis on Currency, Relevance, Authority, Accuracy, and Purpose, the CRAAP test assessed the reliability of sources (Muis et al., 2022).

Currency guarantees that the data is current. The content’s direct response to the research topic is validated by relevance. The authority examines the qualifications of authors and their affiliations. Accuracy checks the evidence and citations used. Purpose assesses whether the content is objective and free from bias, making CRAAP a reliable tool for identifying trustworthy, scholarly evidence. This refined strategy helped eliminate unrelated or low-quality studies and ensured the final selection was directly applicable to the research question. Sources were evaluated based on the reputation of the publishing journal, study design, and author expertise, ensuring high reliability and relevance for evidence-based practice.

Evidence Summary and Relevance

Four sources of evidence are evaluated to support the PICO(T) inquiry on COPD. Firstly, Toubes-Navarro et al. (2023) study evaluated PR’s clinical and economic impact in 200 COPD patients. The program significantly reduced emergency visits (−42.5%), hospital admissions (−48.2%), and inpatient days (−46.6%) within one year post-intervention. The study is credible due to its peer-reviewed publication in Annals of Thoracic Medicine, recent publication, authors’ reputation, and comprehensive outcome metrics.

Its relevance lies in demonstrating PR’s dual role in improving patient outcomes and reducing healthcare costs, aligning directly with the outcome measures in the PICO(T) question related to COPD exacerbation reduction. Secondly, the systematic review by Meneses-Echávez et al. (2023) assessed PR for acute exacerbations of COPD (AECOPD). Results showed that PR reduces hospital readmissions and improves cardiovascular submaximal capacity, thus reducing disease complications. This evidence source is credible as evidenced by its 2023 publication date, focus on AECOPD outcomes (relevance), peer-reviewed authority, and objective evidence synthesis. 

NURS FPX 4025 Assignment 3 Applying the PICO(T) Process

Initiating PR within 90 days after hospital discharge decreased all-cause readmissions, hospital stays, and nursing home days among older COPD patients, according to another article by Nici (2021). Despite high readmission rates, PR remains underutilized, highlighting a gap between guideline recommendations and real-world practice. The credibility of this source is strong as it is currently published (2021), relevant, and found in a reputable peer-reviewed journal. The author is an expert in pulmonary care. Limitations like selection bias and lack of randomization are transparently addressed, supporting cautious but valid conclusions.

Finally, Lee and Burge (2024) reinforce that PR improves COPD outcomes by reducing exacerbations, enhancing quality of life, and potentially lowering mortality. It emphasizes low global PR implementation due to limited access, cost barriers, and insurance gaps, despite evidence of cost-effectiveness and long-term health benefits. The source is quite reliable because it was written by respiratory care specialists and published in the peer-reviewed journal Chest. It cites robust evidence, including large-scale and systematic reviews. The information is current (2024) and relevant to clinical practice. 

Analysis of Evidence 

The four studies examined the effectiveness of pulmonary rehabilitation for individuals with COPD, focusing on outcomes such as reduced hospital readmissions, decreased exacerbations, and improved mortality rates. The evidence suggests that early initiation of PR enhances patient outcomes, including reduced readmissions, fewer exacerbations, and possibly lower mortality rates. The studies collectively support the efficacy of PR in reducing exacerbations and hospital readmissions, particularly when initiated early. According to Nici (2021), a structured PR program reduces COPD readmissions and improves health outcomes, focusing on timely initiation within 90 days post-hospitalization to lower readmission risks.

Moreover, Lee and Burge (2024) show that this intervention improved patient outcomes by reducing exacerbations and mortality. Meneses-Echávez et al. (2023) highlight its efficacy in reducing hospital readmissions and improving cardiovascular submaximal capacity, and Toubes-Navarro et al. (2023) found significant reductions in emergency visits, hospital admissions, and inpatient days. The analysis assumes that PR programs are implemented within the recommended time frames, particularly after acute exacerbations. The studies also believe that patients enrolled in PR programs have similar baseline characteristics and that their adherence to the program is sufficient to yield measurable results. Furthermore, it is assumed that the settings in which these studies took place represent broader clinical environments, with access to necessary resources and support.

Conclusion

In summary, COPD is a common and crippling illness linked to high rates of morbidity, death, and medical expenses. Whether pulmonary rehabilitation (PR) lowers hospital readmissions among patients with COPD was investigated by the PICO(T) question. Four studies supported PR’s effectiveness in improving patient outcomes, demonstrating reduced hospital admissions and emergency visits, improvements in cardiovascular capacity, and readmission rates. The studies collectively emphasize the benefits of early PR initiation, despite challenges in access and implementation, urging broader adoption of this intervention in COPD management.

References

Gaffney, A. W., Himmelstein, D. U., Christiani, D. C., & Woolhandler, S. (2021). Socioeconomic inequality in respiratory health in the US from 1959 to 2018. JAMA Internal Medicine, 181(7), 968. https://doi.org/10.1001/jamainternmed.2021.2441 

Jo, Y. S. (2022). Long-term outcome of chronic obstructive pulmonary disease: A review. Tuberculosis and Respiratory Diseases, 85(4). https://doi.org/10.4046/trd.2022.0074

NURS FPX 4025 Assignment 3 Applying the PICO(T) Process

Lee, A. L., & Burge, A. T. (2024). Adding up the value of pulmonary rehabilitation in COPD. Chest, 165(2), 231–232. https://doi.org/10.1016/j.chest.2023.10.029 

Meneses-Echávez, J. F., Chavez Guapo, N., Loaiza-Betancur, A. F., Machado, A., & Bidonde, J. (2023). Pulmonary rehabilitation for acute exacerbations of COPD: A systematic review. Respiratory Medicine, 219, 107425–107425. https://doi.org/10.1016/j.rmed.2023.107425 

Muis, K. R., Denton, C., & Dubé, A. (2022). Identifying CRAAP on the internet: A source evaluation intervention. Advances in Social Sciences Research Journal, 9(7), 239–265. https://journals.scholarpublishing.org/index.php/ASSRJ/article/view/12670

Nici, L. (2021). Pulmonary rehabilitation after a COPD exacerbation: Impact on readmission risk in a real-world setting. American Journal of Respiratory and Critical Care Medicine, 204(9). https://doi.org/10.1164/rccm.202107-1768ed 

NURS FPX 4025 Assignment 3 Applying the PICO(T) Process

Toubes-Navarro, M. E., Gude‐Sampedro, F., Álvarez-Dobaño, J. M., Reyes-Santías, F., Rábade, C., Rodríguez‐García, C., Lado-Baleato, Ó., Lago-Fidalgo, R., Sánchez-Martínez, N., Ricoy-Gabaldón, J., Casal-Mouriño, A., Abelleira-París, R., Riveiro-Blanco, V., Zamarrón-Sanz, C., Rodríguez-Núñez, N., Lama-López, A., Ferreiro, L., & Valdés-Cuadrado, L. (2023). A pulmonary rehabilitation program reduces hospitalizations in chronic obstructive pulmonary disease patients: A cost-effectiveness study. Annals of Thoracic Medicine, 18(4), 190–198. https://doi.org/10.4103/atm.atm_70_23