HCAD 9000 Week 9 Revision Log Example

Revision Log, Versions 5 Through 8: Every Change to the Manuscript With Its Origin, the Changes Declined and the Pattern the Entries Reveal

Student Name

Walden University

HCAD 9000: Healthcare Administration Dissertation

Instructor Name

Month Day, Year

Revision Log, Versions 5 Through 8: Every Change to the Manuscript With Its Origin, the Changes Declined and the Pattern the Entries Reveal

About This Log

This log records changes to the dissertation manuscript between version 5, submitted to the committee on August 30, 2026, and version 8, dated November 9, 2026. The dissertation concerns referrals to specialists at a composite system, Cedar Basin Health, from primary care practices it bought and from practices it did not. Each entry names the version in which the change was made, the section altered, what changed and what prompted it. Changes requested and declined appear in the same table, marked as declined, with the reason. Locations are given by chapter, section and paragraph so they can be found in version 8 without page numbers.

Entries

Table 1

Revision Log, Versions 5-8

Rows are in date order within each version; "Writer" origins refer to items from the September status memo or the writer's own reading.

Notes on Declined Changes

Three changes were declined, and each decline was explained to the person who asked. The committee member's request to restructure Chapter 2 by type of integration reflected a reasonable preference, and many reviews are organized that way. It was declined because the review's purpose is to establish which claims the study tests and where the gap lies. Organizing by type of integration would scatter the referral communication sources, among them O'Malley and Reschovsky (2011), across sections where they would no longer sit next to the gap statement. The member accepted this reasoning on October 10.

The peer reader's request to move item-level results to an appendix was declined because Chapter 5 relies on them. Chapter 5's reading, that a shared record let specialists see information already on file, depends on seeing that the medication list and laboratory results changed while the specific clinical question did not. Moving the table would force readers of Chapter 5 to search for its evidence. The reader's underlying concern, that the table interrupted the RQ1 section, was partly met by retitling it to name the question.

The chair's request for recommendations to health system leaders was the most consequential decline. A recommendation, for example that systems convert acquired practices to the shared record quickly, would be a statement about what leaders should do, and the study does not show that faster conversion produces better care or lower cost. The decline was discussed with the chair on November 6 and the chair agreed that the implications should remain limited to further research.

Notes on Selected Accepted Changes

Two accepted changes need more explanation than a table row allows. The first is the re-run in version 6. During the September status review, the conversion date recorded for one acquired practice turned out to be the date its contract with the record vendor was signed, not the date it began using the system. The correct date was seven months later. Because the third research question divides each practice's post-acquisition months at conversion, the correction moved seven months of that practice's referrals from the after-conversion period to the before-conversion period. The re-run changed the RQ3 estimates slightly and the RQ1 estimate by a tenth of an item. Both values in the manuscript were replaced, and the analysis file used for the re-run is named in Appendix D so that the committee can match the tables to it.

The second is the narrowing of the gap statement in version 8. The audit found that Chapter 2 claimed no study had examined referral information after acquisition, while another paragraph of the same chapter described a 2019 study of referral letters in integrated systems. On rereading, the 2019 study described the content of letters at a single point in time and did not compare practices before and after acquisition. As revised, the gap statement limits itself to what the search turned up: no before-and-after study of referral information that also used a comparison group. This is narrower than the original sentence, and it is the claim the literature supports. Gandhi et al. (2000) remains the earliest cited source on referral information gaps, and the narrowing did not affect how it is used.

The accepted request from the chair in version 8 also deserves mention, because it changed the order of the limitations. The comparison group limitation had been third; the chair argued that it was the limitation a reader would raise first, and it now leads the section.

Patterns Across the Entries

The RQ1 section of Chapter 4 was touched four times in versions 6 through 8: a re-run that changed Table 1, a declined request that led to retitling Table 2 and two audit corrections to paragraph 2. A section revised this often usually holds an unsettled description, and in this case the description of the item-level results has changed with each pass. The consistency audit produced nine of the 23 entries, more than any other origin, and most of them corrected values or terms that had been changed in one place and not another during versions 6 and 7. The literature update produced four entries, all in Chapter 2. No entry originated from the abstract, which has not yet been drafted.

References

Beaulieu, N. D., Dafny, L. S., Landon, B. E., Dalton, J. B., Kuye, I., & McWilliams, J. M. (2020). Changes in quality of care after hospital mergers and acquisitions. New England Journal of Medicine, 382(1), 51-59. https://doi.org/10.1056/NEJMsa1901383

Carlin, C. S., Feldman, R., & Dowd, B. (2016). The impact of hospital acquisition of physician practices on referral patterns. Health Economics, 25(4), 439-454. https://doi.org/10.1002/hec.3160

Cooper, Z., Craig, S. V., Gaynor, M., & Van Reenen, J. (2019). The price ain't right? Hospital prices and health spending on the privately insured. The Quarterly Journal of Economics, 134(1), 51-107. https://doi.org/10.1093/qje/qjy020

Gandhi, T. K., Sittig, D. F., Franklin, M., Sussman, A. J., Fairchild, D. G., & Bates, D. W. (2000). Communication breakdown in the outpatient referral process. Journal of General Internal Medicine, 15(9), 626-631. https://doi.org/10.1046/j.1525-1497.2000.91119.x

Machta, R. M., Maurer, K. A., Jones, D. J., Furukawa, M. F., & Rich, E. C. (2019). A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes. Health Care Management Review, 44(2), 159-173. https://doi.org/10.1097/HMR.0000000000000197

O'Malley, A. S., & Reschovsky, J. D. (2011). Referral and consultation communication between primary care and specialist physicians: Finding common ground. Archives of Internal Medicine, 171(1), 56-65. https://doi.org/10.1001/archinternmed.2010.480