QUESTION

General Requirements: Use the following information to ensure successful completion of the assignment: Refer to the ″10 Strategic Points A Courses″ resource located in the DC Network to complete this assignment. Doctoral learners are required to use the current APA style for their essay writing assignments. Draft statements for each of the 10 strategic points for your intended project, incorporating feedback received on past submissions of the 10 Strategic Points document in previous courses. This assignment is not a paper and should be developed and submitted in a table format. The 15 literature articles to utilize are attached under Literature Eval Table. The empty table to fill out is attached under Outline of 10 strategic Points. Instruction on how to fill out the table is also attached. I am in Course 820A if you need that information.

ANSWER

10 Strategic Points Document for a Quality Improvement Project

Ten Strategic Points
The 10 Strategic Points

Title of Project 1) Title of Project

Telehealth Impacts on adult patients in rural care settings compared to
commute-for-care.

Background
Theoretical
Foundation
Literature
Synthesis
Practice Change
Recommendation

2) Background to Chosen Evidence-Based Intervention:
Study Background
In the current world, technology has been advancing in various
industries, including the medical and health industry. Telehealth
technology is one of the growing health care processes that involves
providing care services remotely through telecommunication
technology. Adult patients have gained benefits from Telehealth. This
research articulates on connecting the traditional commute-for-care
and Telehealth to evaluate the differences between the two processes.
Research has not been completely exposing Telehealth's differential
benefits over traditional health provisions (Koren et al., 2022). No
apparent differences are showing the exact benefits that people gain
from Telehealth. The use of the traditional ways in healthcare
provision has had some challenges, especially for older adults.
Patients received care through Telehealth in various global regions
during the Covid-19 pandemic, which influenced all services
provision by reaching health needy people (Zheng et al., 2020). Most
current health care facilities are more prone to using technology to
achieve the most crucial factors associated with technology. In that
case, due to the emerging technology issues, health care providers
consider Telehealth the most important emerging trend in the medical
field that reduces waste of resources and minimizes risks linked to
health vulnerabilities. Telemedicine is one of the healthcare services
beyond the patient-doctor relationship that serves care services to
most remote-based people (Leelaarporn et al., 2021). Therefore,
health care practices use Telehealth to provide care to remote-based
patients.
i) Significance of the practice problem/gap
On the other hand, the research was significant to healthcare providers
because it justifies the likely impacts of contributing the benefits to
adult patients in remote-based care services. The study justifies using
broad educational reasons based on the general contribution. Notably,
the study will estimate and determine the gap in benefits between the
study existing literature and the potential outcomes of the current
research (Zheng et al., 2020). The study will determine the potential
difference between the current traditional operation-providing
operations and Telehealth.
ii) Theoretical Foundations
Theoretical foundation in nursing expounds on the need for

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Telehealth and its links to human care at every level of health
practice. Diverse nursing care influence the development of evidence-
based medicine or practice to attain the best application of scientific
methods applicable to clinical decisions. Theoretical evidence of
practice influences the development of Telehealth and advanced
technology in nursing.
Pender’s Health Promotion Theory/ Model
Theorist Nola J. Pender developed a complementary counterpart to all
models of healthcare prevention. It elaborated health-positive
dynamics situations instead of the absence of illness. Through
Pender’s theory, telehealth practice can influence health promotion by
directly increasing the well-being of all patients. The concept will
influence the assessment of telecare effectiveness through the
multidimensional nature of humans as they interact in diverse
environments to pursue health issues. This theory focuses on
individuals’ experiences and characteristics (Zheng et al., 2020). It
also describes a specific behavior cognition and its effects based on
the behavioral outcomes. Using Telehealth, Pender's theory will
evaluate the unique personal features and experiences that impact the
subsequent functions. The set of behavior variables in the specific
knowledge will provide the evidence-based practice of ensuring that
important motivational significance in Telehealth takes modified
functionalities in adult patients. Evidence-based practice in Telehealth
is the function of timely health communication and practical patient
education. Through this concept, the outcomes of Telehealth can be
confirmed as affirmative through attaining the nursing goals in every
healthcare (Provost, 2011). Therefore, there is a surety of better
quality in care provision, enhanced action ability, and improved
health results in all stages of development.
Literature Synthesis
Chrusciel, J., Fontaine, X., Devillard, A., Cordonnier, A.,
Kanagaratnam, L., Laplanche, D., & Sanchez, S. (2019). Impact
of a fast-track implementation on emergency department
length of stay and quality of care indicators in the Champagne-
Ardenne region: a before-after study. BMJ Open, 9(6), e026200.
doi.org/10.1136/bmjopen-2018-026200
https://bmjopen.bmj.com/content/bmjopen/9/6/e026200.full.pdf
This study aimed to assess the effects of fast-track implementation
on care emergency departments. The impact of using this
technology is to impact the quality of care, as the study indicated.
The researchers adjusted the before-after evaluation set on the
Champagne-Ardenne region in France. The research investigated
patients hospitalized in the ED from the records between 13
January 2015 and 13 January 2017. The participants selected were
initiated to fast-track as a model of telehealth technology as an
emerging requirement for care implementation. This test's

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secondary and primary output after fast-track ere proportion of
patients with LOS ≥ 4 hours. The technology has been good for
follow-ups for the patients who could not access beds within
appropriate admission beds. The outcomes show a drop in stays
lasting ≥ 4 hours after the fast-track implementation. There is also a
need for future studies to create variability and connect quality
improvement to people.
Kuo, Y. H., Leung, J. M., Graham, C. A., Tsoi, K. K., & Meng, H.
M. (2018). Using simulation to assess the impacts of adopting a
fast-track system for hospital emergency services. Journal of
Advanced Mechanical Design, Systems, and
Manufacturing, 12(3), JAMDSM0073-JAMDSM0073.
https://www.jstage.jst.go.jp/article/jamdsm/12/3/12_2018jamds
m0073/_pdf/-char/ja
This study aimed to investigate the fast-track system’s effects as
part of healthcare technology. It reduced the patient time of waiting
in lines of service. The research used a simulation experiment as a
methodology. The computational experiment influenced the
estimation of fast-track simulation by applying the software
ARENA to achieve the expected results. The study exposed the
complexity and challenges associated with technology as part of
healthcare promotion. The investigation also focused on the fast
service track to determine the efficiency. The technology is more
appropriate for medical services, but the study showed it could also
increase the long-time waiting in line. According to the
computational experience, the research suggested that fast-track
adoption can become more beneficial to the healthcare systems to
reduce waiting time in the care process. As a current healthcare
trade, fast-track systems can help reduce the overall waiting time in
emergency departments and more patients in urgent need. It is an
implication of telehealth development based on the adoptable
policies implicated by the study outcomes.
Ding, X., Clifton, D., Ji, N., Lovell, N. H., Bonato, P., Chen, W., &
Zhang, Y. T. (2020). Wearable Sensing and Telehealth
Technology with Potential Applications in The Coronavirus
Pandemic. IEEE Reviews in Biomedical Engineering, 14, 48-70.
Doi: 10.1109/RBME.2020.2992838.
The study focused on investigating the use of Telehealth in care
provision services during the Covid-19 pandemic. The article
explored the application of technology in curbing different
challenges associated with the COVID-19 pandemic. Development
of pandemic issues led to a critical examination of the best
technologies that could improve the disease emergence tackling
systems. The article expresses that the study focused on the
specialty of wearable tools appropriate for population risk
monitoring systems and the patient in quarantine. The study

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evaluated the health status of caregivers that involves management
personnel through triage process facilitation for hospital admission.
The investigation involved unobtrusive sensing systems that detect
illness and understand the clinical situation that may worsen in any
improvised care facility. In that case, telehealth technologies for
the remote monitoring, intervention, and diagnosis of Covid-19
and other relative illnesses. It investigated the opportunities and
challenges that link to the direction of developing the highlighted
needs of the health care services.
Bonnevie, T., Smondack, P., Elkins, M., Gouel, B., Medrinal, C.,
Combret, Y., & Gravier, F. E. (2021). Advanced Telehealth
Technology Improves Home-Based Exercise Therapy for
People with Stable Chronic Obstructive Pulmonary Disease: A
Systematic Review. Journal of Physiotherapy, 67(1), 27-40.
https://Doi.org/10.1016/j.jphys.2020.12.006
The article exposed how telehealth technology is a tool that
improves home-based therapies for stable chronic obstructive
pulmonary illness patients. The study used a systematic review for
effective home-based exposure in exercise therapy delivered
through telehealth tech. The research examined inpatient and
outpatient exercise therapy with home-based ET. Meta-analysis
was used to examine the ET through a systematic review. 1,522
participants selected had stable COPD referred to ET that involved
the ATT-ET. The exercise capacity, cost-effectiveness, functional
dyspnoea, quality of life, m various secondary outcomes, and
exercise capacity were the measure that the researcher used to
achieve the effects of telehealth technologies on the ET. The
outcomes of this examination indicated improved exercise capacity
and a high probability of improved life quality. Functional
dyspnoea showed similar effects on inpatient and outpatient ATT-
ET concerning life quality. Conclusively, the ATT-ET improves
exercise capacity through telehealth practices.
Nagel, D. A., Pomerleau, S. G., & Penner, J. L. (2013). Knowing,
Caring, and Telehealth Technology: “Going the Distance” in
Nursing Practice. Journal of Holistic Nursing, 31(2), 104-112.
https://doi.org/10.1177/0898010112465357
The study investigated the benefits of telehealth providing o people
with complex health conditions. The telehealth modalities uptake
involves rapid technological dynamics and evolution that has
outpaced most generations based on the practical skills and
knowledge to support the practice in diverse emerging health fields.
It also focuses on understanding how practitioners learn the needs
of patients and engage in holistic services of care within a virtual.
According to the article, nursing and personal relationships face a
significant impact because of limited potentiated perceptions of
distance, physical observation, and the influence of the reductionist

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perspective in care service. The purpose of the investigation
extended to illuminate the evolving and dynamic nature of nursing
practice by using Telehealth and the associated gaps in health
knowledge in a virtual environment. The article involved the
generation of information to support Telehealth's ethical, safe, and
effective based on distance care to patients through Telehealth.
iii) Practice Change Recommendation
The practice change recommendations include evidence-based
intervention that supports the health practices. Telehealth should be
improved to enhance active regulation in terms of behavior.
Telehealth is important for adult patients with biopsychosocial
complexity that influence progressive transformation in care provision
and interaction from a distance between patients and practitioners. It
requires time to build a professional background for an interpersonal
environment. It should reduce constraints across the board. (Zheng et
al., 2020) The evidence-based practice should also consider an
increase in the likelihood of committing actions and actual behavior
performance. The telehealth technology applied in nursing of adult
patients should consider the anticipation of deriving personal valued
benefits. The health-promotion is a significant requirement in
Telehealth that should be based on the evidence-based model
(Leelaarporn et al., 2021). The validation shows that prior behavior is
required to build a suitable frequency of understanding of the impact
of Telehealth on adult patients.
iv) Summary of the Findings
The capacity of adequate health care providers through telehealth
technologies to attain the virtual environment. Most telehealth care
operates remotely by ensuring that patients with complex and
challenging conditions are treated or can get healthcare services
(Leelaarporn et al., 2021). Also, Telehealth reduces patients waiting
time, and the potential services are availed to patients who cannot
attend or acquire hospital beds.

Problem
Statement

3) Problem Statement:
Primary care services are Dependent Variables (DV) that depend
on Telehealth and traditional commute-for-care as Independent
Variables (IV). It is not well known if implementing telehealth
systems in healthcare facilities would impact the outcomes of care
among adult patients within rural care settings. Most healthcare
technologies are developed to influence effectiveness in the care
environment and outcomes (Provost, 2011). This study’s focus is to
attain the potential impacts that Telehealth provides on the care
environment. However there are diverse reasons for using telehealth
technologies, but most researchers have not exposed the need for
using Telehealth in rural settings. This aspect aims to reduce adult
patients' waiting for time and crowd hospital admission (Zheng et al.,
2020). Evidence-based practice can guide the potential exposure of

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the telehealthcare services’ impact on the entire phenomenon.

PICOT to
Evidence-Based
Question

4) PICOT Question Converts to Evidence-Based Question:
(P) Among adult patients in a rural care setting, (I) how does
the implementation of a telehealth program (C) compare to
traditional commute-for-care (O) impact the rate of follow-up
with the primary care provider (T) over four weeks?
Evidence-Based Question:
To what degree will the implementation of a fast-track program in
rural hospitals impact the treatment of complex and challenging
conditions of type 1 and 2 diabetes among adult patients in rural
settings in California.

Sample
Setting
Location
Inclusion and
Exclusion
Criteria

5) Sample, Setting, Location
A sample of twelve 300 adults will be selected to provide a sample
size of 60 participants. Through quality improvement study design
and random sampling method, there is a high chance of concentrating
on a specific section of population samples, which may offer single
features rather than distributed characteristics. To mitigate this aspect,
it would have a repetitive process to ensure the selection picks the
average sample size with the required characteristics (Provost, 2011).
The research will have a community center in the Palo Alto
neighborhood in California. The adults aged 48-56 years will
participate in various interventions through teleconference. The
conversation between nurse practitioners and patients with complex
conditions will be recorded for further evolutions. The adults with risk
conditions such as mental health problems cannot participate in this
study exercise. The hospital electronic recording system will be used
to exclude patients with such complex conditions.

Define Variables 6) Define Variables:

i) The traditional commute-for-care and teleconferencing
interventions in primary will be the Independent Variable
(IV)
ii) Adult primary care outcomes will be the Dependent
Variable (DV)
Project Design 7) Project Design:

The quality Improvement approach is a design in the study
process designed to advance activities and generate immediate
improvement in patient care services. Still, in research, the design
does not consider urgency as a factor in implementing the findings
across the practice. The reason for applying the quality improvement
concept in this study is to ensure that evidence-based practice
explores the impacts of Telehealth in various primary health care
provisions. It applies and seeks the best clinical evidence that focuses
on making patient-care decisions to develop research suitable for the
best outcomes (Provost, 2011). The quality improvement uses a
systematic procedure to advance the outcomes within the patients to

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acquire the potential impacts of primary practice under telehealth care
influence.
On the other hand, the research offers an essential start for
understanding workable concepts that can help practitioners
implement the improvements (Provost, 2011). The goal is to achieve
quality in every weight of study towards identifying ways of
implementing effective alterations in practice to improve the service
of patient care, but not assessing the efficacy within the changes
selected.
In conclusion, evidence-based practice in this study will integrate
the best available research evidence with patient values and health
care expertise toward improving care outcomes (Provost, 2011). The
process entails questioning relevant clinical quarries and supporting
the answers with the best evidence, applying the evidence in primary
practice, and evaluating the outcomes of the evidence applied in
practice.

Purpose
Statement

8) Purpose Statement:
This quality improvement research project aims to detect if the
implementation of primary care using the fast-track system as a
telehealth technology tool would impact clinical follow-ups and
reduce waiting time among adult patients (Patten & Newhart, 2017).
The project was set for pilot purpose over eight weeks in a Palo Alto,
California, primary care clinic.

Data Collection
Approach

9) Data Collection Approach:
The study will have 60 adults sample size of adult patients with
complex health conditions. To acquire equality sensitivity, 50% will
be female, and 50% will be male respondents. The sample selection
will consider 46-56 years of African-American ethnicity. The pre-
made Likert scale will be necessary for measuring the features of the
participants. The scale calibration will be rated from 5 to 1 showing
more effectiveness from 1 to 5. The study will use electronic health
records to obtain the patient outcomes and filter based on time to
ensure reliability and validity (Patten & Newhart, 2017). The
electronic health records will provide accuracy of measures in the data
set as a presentation of what was supposed to be measured. At the
same time, reliability depends on the consistency of measurements
and ensuring the data can be reproduced under similar conditions.
Also, the data collection will involve searching the files from the
EHR database using keywords such as adults, primary, healthcare,
Telehealth, care, intervention, and patients. The files obtained will be
included in the study after filtration of duplicated files and obsolete
records. The participants will be given informed consent to sign
against the process due to policies applicable to personal data and
information exposure (Patten & Newhart, 2017). The ethical issue
will be a consideration that involves the use of informed consent and
ensuring only responsible personnel accesses the participant’s data.

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Through human research protections, the publication of information
will be based on the outcomes but not identify any personal
information. The research process will define the procedural
guidelines to ensure only authorized experts will handle the data issue
and how (Koren et al., 2022). The beneficence will be an appropriate
consideration in sampling, designing, and developing the clinical
questionnaire, problem, and theoretical framework.

Data Analysis
Approach

10) Data Analysis Approach:
The research will use an excel spreadsheet to evaluate the participant's
data from the demographic information. SPSS will be an appropriate
method for statistical data analysis to obtain the results. Through the t-
Test, the project will analyze the patient outcomes (Patten & Newhart,
2017). The discussion of mitigation will focus on the opportunity of
universal sample selection, and applying repetitive procedures to
attain valid results will be the mitigative concept of eliminating the
data bias.

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