HCAD 9000 Week 5 Peer Read Example

A Cold Read of a Classmate's Literature Chapter on Rural Telehealth: Twelve Marks Placed Where Comprehension Broke, the Chapter Restated in the Reader's Words and Two Repairs Ranked

Student Name

Walden University

HCAD 9000: Healthcare Administration Dissertation

Instructor Name

Month Day, Year

A Cold Read of a Classmate's Literature Chapter on Rural Telehealth: Twelve Marks Placed Where Comprehension Broke, the Chapter Restated in the Reader's Words and Two Repairs Ranked

About This Read

This is a peer read of Chapter 2 of a classmate's dissertation, a 34-page review of research on telehealth use by rural primary care clinics. The chapter quoted here was written for illustration; no candidate's actual manuscript is reproduced. I read it once, front to back, without first reading the classmate's Chapter 1, so I came to it as a reader from outside the project would. Marks are numbered and run in page order. Each gives the location, what I expected at that moment and what the text delivered instead. I have not proposed wording anywhere; the sentences belong to the writer.

Marks in Reading Order

Mark 1, page 1, paragraph 2, second sentence. The chapter says its purpose is "to review the literature on telehealth." I expected a narrower statement here, because the title page names rural primary care clinics and a specific outcome, follow-up visit completion. What arrived was the broad version, and for the next three pages I did not know which parts of the telehealth literature would matter. I only learned the focus on page 4.

Mark 2, page 3, paragraph 1. A paragraph summarizes Dorsey and Topol (2016) on the growth of telehealth and its promise. I expected the next paragraph to say which of their claims the chapter would test or rely on. Instead, the following paragraph begins a new topic, reimbursement rules, and the review of Dorsey and Topol is never connected to anything later. I could not tell why it was there.

Mark 3, page 4, first full paragraph. Here the chapter states its focus for the first time: whether telehealth visits help rural clinics keep patients on schedule for follow-up care after a hospital discharge or a new diagnosis. This is a clear statement, and from here my reading improved. It is the passage I would most like to see moved to the opening page.

Mark 4, page 6, paragraph 3. The chapter reports that rural Medicare beneficiaries used telemedicine at very low rates in the years before 2014 (Mehrotra et al., 2016). I expected the chapter to say whether that pattern still holds, since the study period runs through 2025. The text moved on without saying whether the finding is a historical baseline or a current description. I read the next two pages assuming rural use was still rare, then found on page 9 that the chapter believes it has grown sharply since 2020.

Mark 5, page 8, the table of studies. The table lists 19 studies with columns for setting, design, sample and outcome. I expected the outcome column to use the chapter's own term, follow-up visit completion. It uses six different terms: "adherence," "attendance," "kept appointments," "no-show rate," "continuity" and "retention." I could not tell whether these measure the same thing. If they do, the table should say so; if they do not, I need to know which ones count as evidence for the chapter's question.

Mark 6, page 10, paragraph 2. The chapter cites Kruse et al. (2017) as evidence that patients are satisfied with telehealth. I expected a sentence explaining why satisfaction bears on follow-up completion. The chapter may intend the argument that satisfied patients keep their appointments, but the text does not make it, and I was left to supply the link myself.

Mark 7, page 12, start of the section headed "Barriers." The heading led me to expect barriers to follow-up completion. The section discusses barriers to clinics adopting telehealth: equipment, broadband and staff training. These are reasonable topics, but they are about the clinic's decision to offer telehealth, not about whether patients complete follow-up once it is offered. I lost the thread here for about four pages.

Mark 8, page 15, paragraph 1. The synthesis section begins: "Taken together, the evidence suggests telehealth improves follow-up." I expected this sentence to count the studies or at least name which ones support it. Having read the table, I recalled that at least five studies found no difference, and two of them were in rural settings. The sentence seems stronger than the table.

Mark 9, page 17, paragraph 3. A strong passage. The chapter explains clearly why studies done in urban academic centers may not transfer to rural clinics, naming travel distance, broadband access and smaller staff. I understood every step and could have explained it to someone else. I would leave this passage alone.

Mark 10, page 20, paragraph 2. The chapter introduces "digital readiness" as a factor. I expected a definition. None appears, and the term is used four more times with what seem to be different meanings: once for patients' comfort with devices, once for the clinic's equipment and twice for broadband availability in a county.

Mark 11, page 24, the section headed "Gap." I expected the gap to follow from the synthesis, since page 15 said the evidence was favorable. The gap section says the evidence is "inconclusive." Both cannot be the chapter's position. I suspect the gap section reflects the writer's real view, and page 15 was written earlier.

Mark 12, pages 30 to 34, the theoretical framework. The framework section arrives at the end. I expected to have met the framework earlier, because several earlier sections use its terms, "perceived usefulness" and "facilitating conditions," without explaining them. Reading in order, I met the terms before their source.

What the Chapter Seemed to Argue

Here is the chapter's argument as I understood it after one reading, in my words. Telehealth has grown quickly and patients generally like it. Rural clinics face specific obstacles to offering it, and studies from cities may not apply to them. Research on whether telehealth helps patients complete follow-up visits is mixed and uses many different measures, and almost none of it comes from rural primary care. Therefore a study of rural clinics with a clear follow-up measure is needed.

I am not sure this matches what the writer intends. If the intended argument is that telehealth improves follow-up and the study will confirm it, the chapter currently conveys something more cautious. If the intended argument is the cautious one, then page 15 and page 24 disagree, and the reader has to decide which to believe.

Two Repairs, Ranked

First, the one edit that would recover the most understanding is stating the focus, follow-up visit completion in rural primary care clinics, on page 1. Marks 1, 2, 6 and 7 all came from not knowing what the chapter was reviewing for, and each would likely disappear with that change.

Second, settling one term for the outcome and showing how each study's measure relates to it, in the table on page 8. Marks 5, 8 and 11 trace back to that inconsistency: once the measures are aligned, the synthesis and the gap can say the same thing.

Mark 12, the position of the framework, is real but less costly, and I would leave it to the writer's judgment.

References

Dorsey, E. R., & Topol, E. J. (2016). State of telehealth. New England Journal of Medicine, 375(2), 154-161. https://doi.org/10.1056/NEJMra1601705

Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2017). Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open, 7(8), Article e016242. https://doi.org/10.1136/bmjopen-2017-016242

Mehrotra, A., Jena, A. B., Busch, A. B., Souza, J., Uscher-Pines, L., & Landon, B. E. (2016). Utilization of telemedicine among rural Medicare beneficiaries. JAMA, 315(18), 2015-2016. https://doi.org/10.1001/jama.2016.2186