Developing and evaluating interventions that are applicable and relevant to inpatients and those who care for them; a multiphase, pragmatic action research approach

BMC Medical Research Methodology

Sandra Capra¹  Judith D Bauer¹  Tony Rossi²  Jack J Bell¹ 

[1]Centre for Dietetics Research, School of Human Movement Studies, The University of Queensland, St Lucia, Brisbane 4072, Australia

[2]Australian Centre of Sport, Physical and Health Education Research, School of Human Movement Studies, The University of Queensland Brisbane, Brisbane 4072, Australia

关键词: Qualitative research;    Hip fracture;    Aged;    Malnutrition;    Action research;    Pragmatic;   

Others  :  1091224
DOI  :  10.1186/1471-2288-14-98

 received in 2014-05-21, accepted in 2014-08-12,  发布年份 2014

【 摘 要 】

Background

Randomised controlled trials may be of limited use to evaluate the multidisciplinary and multimodal interventions required to effectively treat complex patients in routine clinical practice; pragmatic action research approaches may provide a suitable alternative.

Methods

A multiphase, pragmatic, action research based approach was developed to identify and overcome barriers to nutritional care in patients admitted to a metropolitan hospital hip-fracture unit.

Results

Four sequential action research cycles built upon baseline data including 614 acute hip-fracture inpatients and 30 purposefully sampled clinicians. Reports from Phase I identified barriers to nutrition screening and assessment. Phase II reported post-fracture protein-energy intakes and intake barriers. Phase III built on earlier results; an explanatory mixed-methods study expanded and explored additional barriers and facilitators to nutritional care. Subsequent changes to routine clinical practice were developed and implemented by the treating team between Phase III and IV. These were implemented as a new multidisciplinary, multimodal nutritional model of care. A quasi-experimental controlled, ‘before-and-after’ study was then used to compare the new model of care with an individualised nutritional care model. Engagement of the multidisciplinary team in a multiphase, pragmatic action research intervention doubled energy and protein intakes, tripled return home discharge rates, and effected a 75% reduction in nutritional deterioration during admission in a reflective cohort of hip-fracture inpatients.

Conclusions

This approach allowed research to be conducted as part of routine clinical practice, captured a more representative patient cohort than previously reported studies, and facilitated exploration of barriers and engagement of the multidisciplinary healthcare workers to identify and implement practical solutions. This study demonstrates substantially different findings to those previously reported, and is the first to demonstrate that multidisciplinary, multimodal nutrition care reduces intake barriers, delivers a higher proportional increase in protein and energy intake compared with baseline than other published intervention studies, and improves patient outcomes when compared with individualised nutrition care. The findings are considered highly relevant to clinical practice and have high translation validity. The authors strongly encourage the development of similar study designs to investigate complex health problems in elderly, multi-morbid patient populations as a way to evaluate and change clinical practice.

【 授权许可】

   
2014 Bell et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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