PICOT FORM

To be completed by students and submitted during the HSA5923 Health Services Administration Master Degree Capstone class Week 1. The PICOT question must be approved by Dr. Gisela Llamas. Fill the form and send it to gllamas@fnu.edu to be reviewed, once the form is approved, the student must submit on Blackboard First Week assignment Folder using Turitin.

These forms are fillable.

 

Student information

 

Student Name:
FNU Email:

 

Address:

 

Student ID:

 

Phone:

 

 

 

1. What is the practice issue (foreground?)

 

2. What is the practice area?

 

Administration: Yes ___ No___

 

Clinical: Yes ___ No___

 

Educational administration: Yes ___ No _____

 

Informatics: Yes ___ No ___

 

Policy: Yes ___ No ___

 

Organization philosophy or mission and vision statement of the institution:

 

 

 

 

 

 

 

3. How was the practice issue identified? (check all that apply)

 

Quality and safety/risk management: Yes ___ No ____

 

Significant financial concerns: Yes ____ No _____

 

Procedural or process issue: Yes ____ No ____

 

Unsatisfactory patient outcomes: Yes ____ No ______

 

Different between hospital and community practice: Yes _____ No _____

 

Other (define in space below): Yes ____ No _____

 

Wide variation in practice: Yes _____ No _____

 

Clinical practice issue: Yes ____ No _____

 

 

 

 

4. How will the project align (Support) with institution mission?

5. How will the project help improve the organization performance? Does your project align with the site business models?

 

6. What is the scope of the problem?

 

 

 

Family: Yes ___ No ___

 

Individual: Yes ___ No ___

 

Institution/system: Yes ___ No ___

 

Population: Yes ___ No ___

 

Other (define in space below):

 

 

 

 

 

7. What are the PICOT elements?

 

Quantitative/ Qualitative (PICOT)

 

Population:

 

Intervention:

 

Comparison:

 

Outcome:

 

Timeframe:

Eight-week period ( One semester)

 

 

8. What evidence must be gathered? (check all that apply)

 

Integrative Literature review: Yes ____ No ___

 

Guidelines: Yes ___ No ___

 

Clinical Expertise: Yes ___ No ___

 

Systematic Literature review: Yes ____ No ____

 

Expert opinion: Yes ____ No ____

 

Financial analysis: Yes ___ No ___

 

Standards (regulatory, professional, community): Yes ___ No ___

 

Patient preferences: Yes ___ No ___

 

Other (define in space below): Yes ___ No ___

 

 

The topic description, definition and literature review:

 

9. State the PICOT question in narrow manageable terms.

 

Student’s Name:

 

PICOT Question Approved Yes _____ No _____

____________________________________________________

Dr. Gisela Llamas

 

References

At least 7 references for the past 5 years older only.