Outcomes management最新文献

This study investigated the relationship between health care professionals' ratings of their discharge planning collaboration and other patient characteristics with rates of postdischarge outcomes experienced by a sample of elderly veterans. The significant influence of interdisciplinary collaboration levels and comorbidity was demonstrated on emergency room visits and postdischarge fall rates. The author discusses several complex methodological issues for future studies on the relationship between programmatic and patient characteristics and cross-sector patient outcomes.

In this article, we document how an interdisciplinary committee of health professionals led to an approximate 50% reduction in the incidence of postoperative atrial fibrillation (AF) following a cardiac surgery procedure by using preoperative loading and dosing of PO amiodarone and beta blockade. Patients in this report (n = 3397) included all coronary artery bypass surgery (CABG) and valve replacement/repair procedures from January 1, 2000 to June 30, 2002. The incidence of postoperative AF for a CABG or valve replacement/repair procedure was 19.0% for period A (preprotocol) and 13.5% for period B (postprotocol). This translates into an absolute risk reduction of 5.5% or 113 actual cases of postoperative AF reduced. The role of the clinical practice specialist, a master's prepared nurse, and participation in the national Society of Thoracic Surgeon's database allowed us to track our CABG outcomes, benchmark our outcomes against both national and regional institutions, and make changes in outcomes incidence through performance improvement.

This article describes outcomes of a new model of care for hospitalized elders and their families. Patient functional and cognitive status on admission and discharge were evaluated for changes as a result of an educational program for preparing family-centered geriatric resource nurses. Patients in the intervention group (n = 173) demonstrated significant improvements in outcome measures (functional and cognitive status) from admission to discharge. A subset (n = 50) was selected from the 173 subjects who comprised the intervention group; this subset was compared with control subjects (n = 44); no statistically significant differences were noted between the 2 groups. Suggestions for future research are presented.

The purpose of this pilot study was to test the impact of a symptom management intervention (using a device called the Health Buddy) on recovery outcomes (symptom evaluation and response and postoperative problems) of elderly coronary artery bypass graft patients at time of discharge, at 2, 4, and 6 weeks after surgery, and at 6 months after surgery. While there were no statistically significant differences found for many of the study variables, there were trends in the intervention group of more improvement for many of the outcome variables, supporting the need for a randomized clinical trial.

Concurrent utilization review (UR) is both a quality improvement tool and a cost containment strategy used by managed care organizations. The UR process requires that providers (hospital staff) communicate clinical information about hospitalized patients to payers who evaluate the appropriateness and medical necessity of the planned care. Payers then make a decision whether to certify the care for reimbursement. This study provides data to indicate that denials of certification have little impact on clinical and fiscal outcomes of patient care.

The purpose of this article is to provide initial insight from rational and phenomenologic theoretical perspectives into how nurses integrate baseline and follow-up outcomes assessment data into practice to inform their clinical decision-making. Preliminary findings from 29 nurse interviews indicate that some nurses use outcomes assessment data for evaluating their interventions and for decisions concerning initial and/or discharge planning. Nurses' perceived usefulness of outcomes data was based on task complexity and nurses' level of expertise.

Skin care and pressure ulcer prevention programs abound, although their content varies and their outcomes are often difficult to quantify. This article describes 2 complementary programs, their quality improvement processes, and a variety of ways of measuring their success. The first program was broad in scope, emphasizing system-wide changes in administration and coordination of resources, while the second focused on nursing education on high-risk units. These 2 approaches could be adapted for use in any health care setting.

An effective OM program offers the best in clinical care, efficiency, and use of organizational resources and results in overall satisfaction for health care consumers, payers, and providers. Although challenges abound in today's health care environment, a strong interdisciplinary team with the appropriate resources and supports and led by a skilled outcomes manager will succeed. Such a team will also develop as other needs and opportunities exist in the future.

A comprehensive evaluation plan was developed to assess the outcomes of a multiuniversity project to support the development of academic nurse-managed centers (ANMCs). The evaluation included measuring ANMC impact on the clients and communities served, on students, and on the sponsoring faculties and universities. This article includes a discussion of the processes used in evaluation plan development, the variables measured, the tools developed to measure selected variables, and a summary of evaluation findings. Recommendations for use of selected evaluation components across ANMCs are presented.

Patients with heart failure often become lost in the ambulatory healthcare maze on hospital discharge. This causes fragmentation of care due to a lack of a communication link with the ambulatory setting. This article discusses a quality improvement project and addresses the use of a communication tool that helps to transition the plan of care for the heart failure patient from acute care to the ambulatory care setting. The key points focus on the continuance of the plan of care that began during hospitalization and is then extended into the ambulatory setting through care management services.