My Doctoral Journey – Part 6

It has been 31 months since my decision in August 2010 to begin a doctoral journey. I have now completed 80% of the academic coursework and have learned a lot from 20 courses — most of them 8 weeks in duration — and writing 75 papers. I am currently studying Population Health and Epidemiology.  After that concludes in May, there will be four more courses: Evaluation of Healthcare Programs, Contemporary Leadership Issues, and a Doctoral Seminar. The doctor of health administration program includes three “residencies”. These take place in one of several locations and involve an intensive week of study with faculty and students from your cohort. I chose Atlanta for my residencies and I have completed all three. The third residency, which ended in November, was 100% focused on the development of a research proposal that ultimately becomes the first three chapters of the doctoral dissertation. 
I have been an Internet advocate for 21 years. My basic tenet has been that the Internet provides “power to the people” and one of the many areas in which this is true is education. Whether it is computer assisted instruction, e-learning, distance learning, or the latest craze of massive open online courses (MOOCs), the concept is the same—to enable people anywhere in the world to learn what they want to learn, when they want to learn it, and use whatever device they want to learn it on. While evangelizing the power of the on-line environment, I also embrace the validity and need for meeting in person. There is no substitute for what occurred in the third doctoral seminar Atlanta. Webcams and various forms of virtual reality can enhance an on-line experience, but no virtual capability can replicate the emotion behind the learning shared by students in the class. We all shared a passion for the Scholar-Practitioner-Leader model, and we challenged each other’s proposals, which was a huge benefit to all of us.
The largest challenge standing between the doctoral students and graduation is the dissertation.  The goal that every learner shares is to develop a research proposal, get it approved, complete the research, and complete the doctoral dissertation. Some say that at least half of doctoral learners never complete their dissertation because of the incredible detail required to get a 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 completed all of his coursework and received an ABD degree – all but dissertation. A visit to Amazon can reveal many books on how to “survive” a dissertation. I still remember the meeting with the academic review committee when I had to defend my masters thesis forty years ago. It seemed challenging at the time, but I can now say that it was minor compared to what lies ahead for the doctoral dissertation.

I arrived at the Atlanta residency with a 145 page dissertation proposal with more than 140 bibliographic references that I had researched this past summer.  The final proposal was submitted in February and approved in March with some minor suggested revisions. The other hurdle that must be compltred before research can be conducted is the institutional review board (IRB) approval. The IRB application is complex, with 11 appendices and many details about the research protocol that will be followed. The purpose of the IRB is to ensure that the proposed study will be conducted in an ethical way and present no risks to the participants in the study. I received the IRB approval earlier this week.
The study I am planning relates to hospital readmissions of congestive heart failure (CHF) patients. My mother passed away from CHF four years ago, and I learned a lot about the disease and the attendant continuum of care during her final months. 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 that 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 research study will be to answer the question of whether home-based telemonitoring can provide an early warning of an impeding episode of acute decompensated heart failure and allow for an intervention that can reduce hospital readmissions. I will be using anonymized archival data with no personally identifiable healthcare information to perform an analysis of the impact of the telemonitoring. 
During the months ahead, hopefully more than 100 participants will be recruited to the study. Participants will be randomly assigned to a telemonitoring group or a control group.  My analysis will focus on whether there is a statistically significant difference between the readmissions from the two groups. After the analysis is complete, the reamaining steps will be to write the final two chapters of the dissertation, submit to the university for quality review, and finally to present an oral defense to the three-member dissertation committee. If all goes well, everything will be completed before the end of the year.