DNP Scholarly Project Evaluation Plan

Pneumococcal disease is an infection caused by the streptococcus pneumonia bacterium that can result in pneumonia, infection and bacterial meningitis. According to study, African Americans have higher rates pneumococcal morbidity and mortality (Churchwell & Schaffner, 2011), The overall project goal for this study is to raise awareness of prevention of the disease through vaccination to this specific demographic that has been the most prone to infection. The disease is preventable and therefore effective strategy should be implemented to reduce the rate of infection among the demographic. A contributing factor to the problem is the low rates of pneumococcal vaccinations in the African American population. The problem is addressed using an intervention that will be implemented using a screening tool asking the patient several questions to determine if they have obtained a vaccination. If not, the patient will be educated about the benefits of receiving the vaccination and offered the vaccination. The patients who obtained a vaccination will be compared to patients who were not given the screening tool to see if the screening tool increased the likelihood of the patient getting vaccinated. The process of the study meets all IOM Aims and uses a three-step evaluation process. The process involves identifying the needs for acquiring data, the sources for extracting the data and certain performance measures throughout the process. To conclude, existing benchmarks and anticipated project outcomes provide an estimation of the project results. To begin, it is important that all of the IOM Aims are met during the course of study.

The Institute of Medicine lists six aims that a health care system must fulfill to deliver quality care: Safety, Effectiveness, Efficiency, Timeliness, Patient-Centeredness, and Equitability (Crossing, 2003). This study meets each of these characteristics. First, safety is assured for both the patient and the practitioner through anonymity and complete willingness. As with any medicine, there is always the possibility of a serious problem. However, during administration of almost 60,000 vaccinations, the risk of serious harm or death is extremely small (CDC, 2013). The specific project involves questioning specific patients about their knowledge about pneumococcal disease and educating them about its prevention, so the aim of patient-centered care is met. The effectiveness in the study can be achieved by reducing the rate of pneumococcal disease contraction among the African American women population. Timeliness is reached in that the education and vaccination processes  take place during the patients existing visit, making it really efficient, the fifth aim, to increase the amount of vaccinations administered. Finally, equitability can be met in restoring the disproportionate distribution of pneumococcal disease among the African American population. Our country’s history of discrimination and segregation up until the Civil Rights Act of 1964placed African Americans at a disadvantage in society socioeconomically, resulting in phenomena such as the pneumococcal disease in African American women. Raising awareness of the vaccination as well as providing an immediate opportunity to get the vaccination over-with is likely to significantly increase vaccinations administered as well as reduce disease contractions.  

The disproportionate burden of pneumococcal disease raises a sense of urgency for response. The data needs for the experiment are simple, a sample of the demographic given the screening and a sample of the demographic not given the screening. The study is testing weather or not the screening informing the patient about pneumococcal disease, its prevention through vaccination, and the opportunity to receive it on the spot in effect raises the amount of vaccinations administrated thereby reducing the amount of disease contractions. Samples may be taken from local and regional health clinics in bunches of 25-50 to minimize sampling error. By sampling live potential vaccination patients, examiners can directly measure the impact of the screening on the patient. After a series of trials, it can be studied the impact of the screening and possible enhancement strategies. The final result tallied is whether or not the patient chose to receive vaccination. One group will have the vaccination presented and offered to them while the other will not. While unlikely, the group did not provide the screening can still inquire about and receive the vaccination. It is hypothesized that a clear offering of the vaccination will significantly increase the likelihood of the demographic receiving the vaccine. The study will utilize basic statistical hypothesis testing (Grahm, 2003). The data needs for the study are the demographic samples, the screening and the vaccination, as well as follow up reporting. Then a proper study of the screening effectiveness can take place.

Primary sources for data on the topic comes from literature on pneumococcal disease and the African American demographic. Several studies involving the screening tool all found that African Americans were less likely to seek preventative healthcare in the form of vaccination than their Caucasian counterparts (Ganesan, 2003). A contributing reason for this was found in another study that found individuals in the African American community to be distrusting of their health care system due to past cases of abuse such as the Tuskegee study (Randall, 2009). Literature and historical accounts on the topics of African Americans, sociology of the United States, and healthcare provide insight why there is an existing discrepancy. There are numerous organizations that conduct research on pneumococcal disease such as the Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases and individual state departments of health. There is an extensive record of prior study regarding the disease in various settings.

Performance measures will be used to evaluate the project effectiveness in structure, process and outcome. Statistics already collected indicate that African American women disproportionately bear the burden of pneumococcal disease than any other demographic. In addition, the contraction of diabetes also increases the risk of contracting pneumococcal disease. The structure of the study will be evaluated in accordance with the IOM Aim standards listed earlier. The screening process will be evaluated according to weather or not it significantly increases the amount of vaccinations administered. If the control group does not request vaccination any more than the independent group, the screening tool is ineffective. If the number of vaccinations significantly increases in the control group, it is probably that it is due to the screening tool. Based on how effective the screening tool is, it can be modified and enhanced. In outcome, the performance will be measured according to the benchmark CDC standard of increasing the administration of pneumococcal vaccination in the African American population over 45 years with diabetes to 60%. This is the medical community’s goal in this field in the coming years.

With the overall goal of reducing the contraction of pneumococcal disease specifically among the African American female demographic, the outcomes of the project will be interesting to see. It is predictable that the screening tool educating the patients on the disease and the benefits of vaccination will increase the amount of vaccinations administered. However, the screening tool could be less effective than it should be due to certain personal beliefs and distrust. This is why it is important for the screening process to be modifiable. With flexibility, changes can be made to the process based on observations in initial trials. After a comprehensive screening tool is developed, it can be seen whether or not it significantly affected the rate of vaccination among patients. With a significant increase in the proportion of the demographic vaccinated, a decrease in pneumococcal disease contraction rate can be expected. If the screening tool is successful in trial and implemented on a nationwide scale, the goals of the medical community regarding pneumococcal disease can be achieved. 

References

CDC - Pneumococcal Disease Fact Sheet for Parents - Vaccines. (n.d.). Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/pneumo/fs-parents.html.

Churchwell, A. L., & Schaffner, W. (2011). Facing down the triple threat of influenza and pneumococcal disease in African Americans: Focusing on prevention. J Natl Med Assoc, 103(3), 278-280. http://dx.doi.org/10.1016/j.amepre.2011.10.027.

Crossing the quality chasm (2003). Washington, D.C.: National Academies Press, 

Graham, A. (2003). Statistics. Blacklick, Ohio: McGraw-Hill.

Ganesan, K., Teklehaimanot, S., Akhtar, A. J., Wijegunaratne, J., Thadepalli, K., & Ganesan, N. (2003). Racial differences in preventive practices of African American and Hispanic women. Journal of the American Geriatrics Society, 51(4), 515-518. http://dx.doi.org/10.1046/j.1532-5415.2003.51160.x

Omer, S. B., Salmon, D. A., Orenstein, W. A., Dehart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981-1988. http://dx.doi.org/10.1056/NEJMsa0806477

Randall, V. R. (1995). Slavery, segregation and racism: Trusting the health care system ain’t always easy--an African American perspective on bioethics. Louis U. Pub. L. Rev., 15, 191). Retrieved from http://academic.udayton.edu/health/05bioethics/slavery.htm\