Final Research Report
View this project's final research report.
Article Highlight: The first phase of Project ACHIEVE, published in the Annals of Family Medicine, determined that patients and their caregivers facing a transition from a hospital to their home most want to feel prepared and capable of applying care plans, to receive unambiguous accountability from the healthcare system, and to feel that medical providers care for and about them.
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Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers asked for clarification on the types of care transitions addressed in the study stating that the study appears to address care transitions broadly, but some parts of the report seem to focus more narrowly on transitions from hospital to home, for example. The researchers responded that the project focused on transitions from hospital to home or other sites but commented that they believe their findings likely apply to many types of patient care transitions.
- The reviewers commented that the use of odds ratios to depict the association between care transitions and several outcomes of interest could be misinterpreted, suggesting instead that the researchers report relative risk to better convey the relationship between transition strategies and certain outcomes. The researchers agreed with the reviewers, saying that when a particular outcome is common, it would be easier to interpret the results if they indicated relative risk of the outcome instead of absolute risk or odds. Therefore, the researchers changed the results tables in the report to display relative risk and moved the tables with odds ratios to an appendix.
- The reviewers asked about the possibility that the prospective study described in the report could have detected some spurious associations because of a large number of comparisons. The researchers reported that they used a more stringent probability threshold of 0.01 to detect statistical significance rather than the more conventional 0.05 by adjusting for comparing across five groups.
- The reviewers commented that the hospitals chosen for the study might not be entirely representative of hospitals throughout the nation, noting that for-profit hospitals were largely excluded from the study and rural hospitals were overrepresented. The researchers agreed that for-profit hospitals were underrepresented in their study, but stated that when they visited the hospitals in the study, they found that barriers and facilitators of care transitions were similar among different healthcare organizations, regardless of ownership. The researchers added that they purposely oversampled rural hospitals because such hospitals usually have fewer resources and face more challenges in transitional care. Also, the researchers explained that they could only obtain a representative number of rural patients by oversampling rural hospitals because these institutions tend to be smaller. The researchers did acknowledge the possibility that their sampling strategy, which focused on hospitals already participating in transitional care programs, could be biased. However, the researchers said they found that the characteristics of hospitals in the study were generally comparable to hospitals nationwide.
- The reviewers asked the researchers to describe how they reached thematic saturation in the qualitative work that was part of this project. The researchers explained that data analysis was ongoing during data collection for patient and caregiver focus groups, so they continued recruiting until they reached theoretical saturation. For provider focus groups and hospital site visits, the researchers did not attempt to reach thematic saturation. They did this for the former because the variability among providers, sites, and procedures would make saturation unfeasible and for the latter because thematic saturation was not a goal for the hospital site visits since this work was a pilot phase to prepare for a larger effort. However, the researchers believed that they did reach thematic saturation in these site visits based on the repetition of barriers and facilitators to transitional care programs identified by the site visit participants. In addition, the researchers explained that they validated the themes brought up in the qualitative substudies by discussing their findings with people at the sites visited, with research team members, and with patient stakeholders in the study.
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