Author of Article: DR. Gajanan Bhalerao (PT).
PhD Scholar, MPTH Neuro, Certified Adult NDT therapist, HOD Physiotherapy & Rehabilitation Dept in Sancheti Hospital Shivajinagar Pune. Associate Professor & HOD PT in Neuro Rehabilitation Dept at Sancheti Institute College of Physiotherapy, Shivajinagar Pune
We all want to do good research and publish a paper our paper in scientific journal. But very few of us know how to write a research article. Writing of research paper is called as Manuscript writing. M.U.H.S. Nashik had arranged a workshop in Manuscript writing they and invited editor of journal Donald Pathman, MD MP from US for training. Fortunately i got opportunity to attend the workshop. I am sharing with you what ever they trained us and given the guidelines for manuscript.
Format and Content of Manuscripts Reporting Evaluation/Demonstration Case Studies of Educational and Other Interventions
: Donald Pathman, MD MPH
| Sections within Manuscript | Example: Clinical Quality Improvement |
| Introduction | |
| Background to field | ACE inhibitors decrease mortality in patients with heart failure |
| Problem for field | Nationally, many eligible CHF patients are not placed on ACEIs |
| Purpose of the intervention/initiative undertaken | There is a need to develop effective models for increasing proportions of eligible CHF patients on ACEI, and show their effectiveness |
| Purpose of this evaluation | To assess the effectiveness of an intervention that uses chart audit data and feedback to clinicians to increase ACEI |
| The Program/Intervention | |
| Organizational setting | Three clinics affiliated with an academic center, each with different patient population SES profiles |
| Issue and initiative’s context (historical, cultural) | ACEI use in CHF in these clinics was previously documented to be low, no previous intervention on this issue, but this network’s doctors are notoriously resistant to feedback on their care |
| Rationale/Purpose/Goals of the initiative | To increase proportion of eligible CHF patients on ACEI; to increase physicians’ acceptance of QA data intended to improve their care |
| Theory/Rational for the intervention design selected | Evidence shows that repeated reminders through a variety of sources are most effective in helping clinicians change clinical practices |
| Programmatic components of the initiative | Educational lunch conferences, oversight committee of clinic staff and clinicians formed, monthly chart audits, reminder/alert stickers placed on charts, monthly progress graphs created, token incentives given for “most improved” |
| Internal programmatic evaluation components (formative and summative) | Monitoring ACEI use improvement over time; quarterly provider satisfaction survey |
| Program history | Program initiated October 2008, chart stickers added in February 2009, initiative terminated in May 2011 when funding lost |
| Evaluation Methods (of intervention) | |
| Evaluation design | Pretest/posttest and time-series analysis (no comparison group); identify the evaluator and his/her connection to program |
| Outcome measures | Proportion of eligible CHF patients whose medication lists include ACEI; proportion of providers indicating satisfaction with their autonomy, with clinic management, with the quality of care they can perform; qualitative data on provider acceptance of the CHF/ACEI initiative |
| Data collection methods | Augmented sample size of chart audit data already routinely collected as part of the program; added quarterly physician satisfaction survey items drawn from validated instruments, and informal focus groups of physicians and staff |
| Documentation of program fidelity | Retrospective assessment that the targeted number of charts were audited each month, that feedback reports to providers were generated, that chart stickers were used whenever appropriate and that token incentives were given |
| Ethical review and funding disclosure | Funded by Pfizer; approval by UNC School of Medicine IRB |
| Results (findings of the evaluation) | |
| Program fidelity indicators | >90% of targeted charts reviewed each month; only 60% of monthly provider feedback reports generated; token incentives stopped in third month due to provider backlash |
| Outcome data | 30% increase in ACEI use (from 40% to 70%), but increases found principally in non-physician providers; non-physician satisfaction rose on all indicators, physician autonomy indicators fell; focus group data revealed intense positive and negative reactions to program |
| Other and unexpected outcomes | QA coordinator required supportive counseling; total program costs averaged $35,000 per year |
| Discussion | |
| Review of key findings | As above in “Outcome data”; identified barriers and facilitators to implementation |
| National perspective/congruence with literature | Mirrors previous reports of effectiveness of chart audit and chart sticker approach to QI, and mirrors problem of physician resistance to external scrutiny and “forced” change |
| Inferences | Use of data and longitudinal approach with continuous feedback were helpful; perceived encroachment on physician autonomy by non-physician-initiated program fueled backlash |
| Limitations | Program terminated earlier than planned; not all desired satisfaction survey items could be used; reasons for physician resistance not fully identified |
| Conclusions | This QA approach is effective in increasing ACEI use but can cause backlash in some physicians; more effective in non-physicians |
