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Doctoral Journey – Part 3

Written: September 2011
Edited: December 2022

I really appreciate the support from my friends and family for my decision a year ago to begin the doctoral journey. I promised periodic updates, the purpose of this posting. I have now completed 19 credits of coursework out of the required 62 — approximately 30%. After the first four courses, I attended the first residency in Atlanta this past December. The second residency is coming up in November. It will be an important step as it is the launching point from which I will be able to submit a proposal for my research study and dissertation. The last two courses have been preparatory for the residency — Fundamental Principles of Sound Research, and Research Design. These have been intensive courses focusing on both quantitative and qualitative research.

The goal every doctoral learner shares is to successfully complete a dissertation as the final step in earning their degree. Some say at least half of doctoral learners never complete their dissertation because of the incredible detail required to get a research topic developed and approved for research. A typical dissertation is 200-300 pages in length. Some consider the process more than challenging. A friend of mine told me he had an ABD degree, all but dissertation. A visit to Amazon and you can find a lot of books on how to “survive” a dissertation. I still remember the meeting with the academic review committee when I had to defend my master’s thesis forty years ago. It seemed challenging at the time, but I can now see it was nothing compared to what lies ahead for the doctoral dissertation.

I have just completed a concept paper, which is the precursor to a proposal for a quantitative research study I have in mind relating to the cost of care and lives lost due to congestive heart failure (CHF). My mother passed away from CHF a few years ago and I learned a lot about the disease during her final months. As a member of the board at Western Connecticut Health Network, I can also see the impact from a hospital point of view. The concept paper is eleven pages long. Following are a few excerpts from the paper to display a few of the things I am considering.

Chronic heart failure (CHF) is the leading cause of hospitalizations and readmissions for the elderly, and accounts for a large share of developed countries’ healthcare expenditures. Although CHF is a condition for which hospitalization is often avoidable, nearly 20% of Medicare patients discharged from hospitals are readmitted within 30 days at a cost to Medicare of $15 billion annually. The problem is the frequent readmission of CHF patients to the hospital has a negative impact on the patient and the hospital. For the patient, it results in a reduced quality of life and a negative impact to their psychosocial and financial condition. For the hospital, it means using extra capacity for care while facing the risk of not receiving reimbursement for the associated cost.

The purpose of my proposed quantitative research study will be is to answer the question of whether home-based telemonitoring with coordinated care could improve mortality and reduce hospital readmissions for patients with CHF. Experimental research attempts to identify cause-and-effect relationships between variables by conducting a controlled experiment has not been successful. The proposed research method I am considering would use a randomized controlled experiment in which patients are randomly allocated into two groups; one which receives pharmacological treatment with coordinated care (control group) and the other, which receives pharmacological treatment with telemonitoring and coordinated care (enhanced care group).

Telemonitoring makes it possible to gather daily data from patients in a consistent and automated manner. A wireless gateway device similar in size to a cellular telephone can automatically capture data from other wireless devices such as a weight scale, a blood pressure cuff, and a pulse oximeter to measure pulse and the level of oxygen in the blood (oxygenation). Around-the-clock access to a patient portal could display patient data and enable caregivers to care proactively for the patient. For example, if the data from telemonitoring shows a sudden increase in the patient’s weight, a nurse might make a dietary suggestion or obtain authorization to make a change in medications.

There have been a number of similar studies, but none have shown a significant benefit from telemonitoring. The research I have in mind would be focused on whether the right combination of healthcare delivery and technology can improve outcomes. The result could be improved quality of life for patients and, if the care plans are implemented in a cost-effective way, reduced financial risk for hospitals and the ability to invest more in their community healthcare mission.

I will have a further report on the proposal after the residency in November. In the meantime, I will be continuing with more course work. Since the program began one year ago, I have written 34 papers. Many more to come and then the big one! If everything goes right, I could be just a little more than two years from completion of the doctoral journey.