Methodological challenges to prospective study of an innovation: interregional nursing care management of cardiovascular patients.
This paper discusses the methodological challenges of conducting an interregional intersystem study in a highly competitive health care environment. Nurses from a three-hospital rural health consortium and an urban tertiary medical centre collaborated in a two-phase study (a) to describe current interregional cardiovascular health care process (phase I) and (b) to test an interregional nurse-coordinated cardiovascular health care model (phase II). Phase I was a 1-year exploratory descriptive retrospective study involving patient interviews and chart reviews. Findings from the phase I study suggested a pattern of patient health problems occurring weeks and months following successful tertiary centre interventions. Phase II was a quasi-experimental prospective study with 90 intervention subjects and 64 comparison group subjects who completed pencil and paper survey tools over a 12-month period following discharge from the tertiary centre. Nurse and doctor providers completed a satisfaction survey twice, at an interval of 1 year. Concurrent data collection via telephone calls (comparison group) and a retrospective record review (intervention group) provided data on cost, resource use and system efficiency. Initial results of phase II are presented, together with tests of significance for hypotheses related to interregional nurse care management and patient outcomes, patient satisfaction, cost/system efficiency, and provider satisfaction. Methodological considerations and recommendations related to phases I and II of this interregional collaborative cardiovascular project are presented and discussed.