My Doctoral Journey – Part 4

I really appreciate the support from my friends and family for my decision 17 months ago to begin the doctoral journey. I promised periodic updates and that is the purpose of this posting. I have now completed 27 credits of coursework out of the rquired 62 — approxmiately 43%. I completed a course in health care marketing in January and am now taking a course in health care economics. In December, I attended a second residency in Atlanta. The third residency will be in October. 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 goal that every doctoral student shares is to successfully complete a dissertation as the final step in earning their degree. Some say that 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 masters thesis forty years ago. It seemed challenging at the time, but I can now see that it was nothing compared to what lies ahead for the doctoral dissertation.

I have completed a concept paper, which is the precursor to a proposal for a quantitative research study that I have in mind. The study relates 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 share 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 that 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. The proposed research method I am considering would use a randomized controlled experiment in which patients are randomly allocated into two groups; one that 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 devises 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). Since my last update, I have discovered several companies that have interesting technology for monitoring. These include cardionet.com and corventis.com. Around-the-clock access to a patient portal could display patient data and enable caregivers to respond proactively to 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 in a few months. In the meantime, I will be continuing with more course work. Since the program began one year ago, I have written 47 papers. Many more to come and then the big one! If everything goes right, I could be just a little less than two years from completion.

Index of stories about My Doctoral Journey

Tags: chf, dissertation, doctorate, e-learning, hospital, scholar, telemonitoring

My Doctoral Journey – Part 3

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 and that is the purpose of this posting. I have now completed 19 credits of coursework out of the rquired 62 — approxmiately 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 that every doctoral learner shares is to successfully complete a dissertation as the final step in earning their degree. Some say that 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 masters thesis forty years ago. It seemed challenging at the time, but I can now see that 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 that relates 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 that 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. The proposed research method I am considering would use a randomized controlled experiment in which patients are randomly allocated into two groups; one that 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 devises 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.

Index of stories about My Doctoral Journey

Tags: doctorate, e-learning, scholar

My Doctoral Journey – Part 2

I really appreciate the support from my friends and family for my decision this past August to begin the doctoral journey. After the first four courses it was time to attend the first residency in Atlanta this past week.

I have been an Internet advocate for almost twenty 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 you call it computer assisted instruction, e-learning, or distance learning, 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 what 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 PHL700 (CREATIVE AND CRITICAL THINKING) this past week in Atlanta. Webcams and various forms of virtual reality can enhance an on-line experience, but no virtual capability can replicate the emotion behind the stories shared by learners in the class. I learned a lot about diversity, teams, dissertations, the Scholar-Practitioner-Leader model, doctoral degrees, and information technology.

Appreciation for diversity

I worked at IBM Corporation for 38 years and am proud that the company took diversity very seriously in thought, word, and deed. I have also been active in various non-profit organizations such as the Opportunities Industrialization Corporation and Habitat for Humanity, both of which featured diversity as a model. The University of Phoenix has brought my awareness and appreciation of diversity to a new level. Diversity is not simply black and white or male and female. Diversity includes cultural background, work experience, education, family, upbringing, experiences, and philosophy, to name a few areas that I observed in the classroom. I was particularly impressed with the drive to achieve exhibited by learners who at the same time have childcare, eldercare, and job responsibilities. It was also impressive to hear of the goals the learners expressed. Nearly all of them contained an altruistic element that motivates them. The diverse backgrounds provide diverse perspectives and these in turn provide a broader and deeper insight into the subject matters being learned. I feel fortunate to have learned a lot in my life, but relative to the breadth and depth of my fellow learners, I humbly realize that I have a lot to learn.

Value of Team

I must confess that I was skeptical about the team assignments in the first couple of classes. The on-line tools are not as advanced as they could be and some learners are not adept at using them. On the surface, the team assignments looked like they would take more time, but not produce better results. For team assignments this past week, that was definitely not the case. In part because it was in person and in part due to the strength of my team members, I feel this was one of the best team experiences I have had in many years. Even in areas where I have considerably more experience than my team members, they found oversights in some of my thinking and added some thinking of their own that enhanced what I was thinking. The bottom line is that although there may have been a small premium in the time spent, the collaborative efforts of the team produced a higher quality and more scholarly paper than I could have produced on my own.

Dissertation Planning

The goal that every learner shares is to successfully complete a doctoral dissertation. The checklist and blueprint are helpful, but what was really helpful was to hear the first hand experiences of Dr. Witchel and Dr. Bridgewater, our faculty for the class. I came to the residency with a dissertation focus area in mind. After discussing it with Dr. Witchel, Dr. Davidson, and two health administration doctoral learners, I feel that my initial idea is now enhanced by at least an order of magnitude.

Deeper insight to the SPL model

At first I did not see a deep or special relationship between scholar, practitioner, and leader. After each class, I see the relationship more clearly, and I am confident that my insight on the subject will continue to improve. The SPL model exercises gave me a clear example of how scholarship and practicing work together. The problem intervention the team developed was supported by scholarly work. That provided two legs to the stool. No stool can stand on two legs, and it is leadership that makes the stool stable and useful. It is leadership that allows the practitioner to take the intervention to the next situation and apply the model they have developed to solve a problem or to inspire others to solve a problem.

The Role of the Degree

Both instructors gave the class excellent insight about the role of the degree. They shared their personal experiences and provided useful guidelines for how to leverage the knowledge gained while avoiding the appearance or reality of arrogance. I was also impressed with the advice to think of the doctorate as a way to help others, whether it is solving a problem or helping someone to learn. In the long term it is the network of doctoral learners–and later doctors—that will provide leverage to all the members of the network.

Information Technology Tips

Information technology plays a key role in e-learning; without IT there would be no learning. All the learners are busy people and, although IT can be a productivity booster, it can also be a productivity detractor if systems and procedures do not work efficiently and effectively. I have many tools that I find helpful and I make it a point to learn of some new ones at every conference or class that I attend. I have been seeking a method to be able to read e-books on the iPad and this week I learned a solution. I will now be able to read course assignments on the treadmill each day. Many educators are not known for their embrace of technology. The PHL700 faculty and visiting instructor all were technology advocates. This was refreshing.

Summary

Supplementing the e-learning program with periodic residencies provides an excellent way to enhance the learning process, leverage the learning, and extend the network of fellow learners and faculty. I gained increased respect for the value of diversity and the power of teams. I increased my knowledge of the scholar, practitioner, and leader model and how it works, and learned about the pathway to my dissertation and the role of the doctorate. I picked up a few IT techniques that I will immediately deploy for increased productivity. The instructors were wise, selfless, and caring. They shared personal perspectives that I will remember. The first year residency was an important milestone and I feel that it has added clarity and momentum to help me achieve my goals.

Index of stories about My Doctoral Journey

Tags: doctorate, e-learning, scholar