Outcomes management最新文献

The purpose of this study was to identify provider documentation practices related to osteoporosis prevention and screening for women aged 40 to 65 years and to determine whether documentation practices differ by type of provider. The setting was an obstetric/gynecologic clinic of a large metropolitan health maintenance organization in Minnesota. One hundred fifty medical records were reviewed for documentation addressing calcium intake, vitamin D intake, exercise, hormone replacement therapy (HRT), and bone mineral densitometry. A statistically significant difference was found between physicians and advanced practice nurses in the documentation of vitamin D and HRT as osteoporosis prevention strategies. The results of this study suggest a need for increased awareness on the part of providers about the importance of their comprehensive documentation of counseling and education interventions as one strategy to promote positive outcomes such as osteoporosis prevention.

In this article we describe the process used to introduce and structure a nursing perspective as part of a balanced scorecard framework within a provincial hospital performance report. Results of a critical literature review and consultative process with key informants are outlined. Nurse-sensitive indicators emerged in the areas of system integration and change, clinical utilization and outcomes, patient satisfaction, and financial performance.

Patients (n = 3301) undergoing first-time elective coronary artery bypass surgery, between 1994 and 2000, with or without hypertension were compared for the incidence of postoperative complications. Fifty-five leg infections were documented (overall incidence 1.7%). Hypertension patients had a significantly increased risk of leg infections (2.45% versus 0.46%). A 10-year increase in age was associated with a 44% increased risk of leg infections (odds ratio = 1.44; 95% confidence interval = 1.09, 1.91). Hypertension patients also had a greater risk of stroke and prolonged ventilation time but not of postoperative mortality.

Patient satisfaction remains one of the critical benchmarks of primary care delivery. Although much of the research reporting outcomes related to nurse-managed centers (NMC) has included patient satisfaction, most of the reports have been limited to individual clinical settings. This study collected satisfaction data from 7 NMCs operated by 4 different academic institutions. Results demonstrated 3 components of patient satisfaction: patient perceptions of care, phone contact, and the patient's willingness to return to or recommend the clinic. Consistent with previous research, professional responsiveness and respect and courtesy from nurse practitioners were rated high on the composite satisfaction levels from a heterogeneous sample of consumers.

Transitional care programs are one method of providing care to elderly high-risk patients. The aims of this study were to determine if patient characteristics (including number of comorbidities, functional status, and length of stay during initial hospitalization) and social factors (including presence of a caregiver in the home and place of discharge disposition) were associated with increased hospital readmission and mortality for patients discharged from specialized transitional care.

Symptom occurrence, symptom characteristics (frequency, severity, interference with activities and enjoyment of life), and quality of life were examined in heart failure patients after release from the hospital and 2 months after enrollment in a home-based disease management program. The results provide information on the most common and distressing symptoms in a community-based heart failure population. This information may be useful in guiding assessments and designing specific nursing interventions to include in a home-based disease management program.

Several of AHRQ's priority areas including disease prevention, health promotion, primary care, quality of care, service delivery, and patient safety are particularly relevant to nurse researchers. With much national attention focused on nursing-related issues such as staff shortages, training, mandatory overtime, working conditions, and autonomy, it is mandatory that nursing research be conducted to inform healthcare delivery and policy. Nurses also need to contribute to the health services literature so that an even balance of discipline perspective is represented. AHRQ's mandate is represented by the slogan "quality research for quality health care." Although our understanding has expanded of contributors to and determinants of evidence-based practice and the relationship between clinical care and improved outcomes, we have much to learn. Appreciating how and which components of nursing care influence patient outcomes represents an essential area of research in need of development. While clarifying nursing contributions to improved outcomes is not the sole purview of nurse researchers, it is plausible to assume that a clinical background in nursing combined with strong methodological skills can help policy makers and health system leaders understand how nurses can most effectively contribute to outcomes and quality improvement. AHRQ is clearly interested in capacity building of researchers from all relevant disciplines. Nurses, the largest provider of healthcare, need to build capacity and develop a much stronger presence in the health services research community of scholars.

In efforts to quantify the quality of care delivered to patients within their systems, nursing administrators are being called on to both privately and publicly report nursing-sensitive outcomes for their institutions. Accurate reporting with appropriate patient population or risk adjustment is essential if the reported outcomes are to provide meaningful data to consumers and providers. At present there are no effective mechanisms available that can sufficiently adjust nursing-sensitive outcomes to assure reliable reporting. This study suggests that specialty unit classification may be one method by which nursing-sensitive outcomes can be accurately reported.

The debate surrounding mortality as a measure of healthcare quality is not a new one. In this article, the authors review the origin of mortality indices within the healthcare industry, explore the challenges and limitations to generating and risk adjusting mortality data, and discuss the relationship between institutional mortality and quality of care. The article ends with a summary of current sources of mortality data with which healthcare professionals need to be familiar.