Chapter 14

1. Chapter 14 Introduction to Outcomes Research

2. Outcomes Research and Nursing Practice How nurses make decisions Nurse case management Nurse practitioner interventions Community health Health promotion Nursing outcomes in hospitals

3. Outcomes Research Outcomes Clinical end points Functional status General well-being Satisfaction with care

4. Theoretical Basis of Outcomes Research Evaluation methods Epidemiology Economic theory

5. Examples of Outcomes Research Journals Clinical Effectiveness in Nursing Health Education Research Journal of Care Management Journal of Clinical Outcomes Management Journal of Nursing Care Quality Outcomes Management for Nursing Practice Quality in Health Care Quality in Primary Care

6. Concepts of Donabedian’s Theories Health Physical-physiological function Psychological function Social function Subjects of care Patient (individual and aggregate)

7. Concepts of Donabedian’s Theories (cont’d) Providers of care Individual practitioner Organization of providers

8. Level and Scope of Concern

9. Donabedian’s Objects of Evaluating Quality Health Care Evaluating Outcomes Process Structure

10. Outcomes Functional status Physical Mental Social Role Clinical end points Symptoms and signs Laboratory values Death

11. Outcomes (cont’d) Satisfaction with care Access Convenience Financial coverage Quality General General well-being Health perceptions Energy/fatigue Pain Life satisfaction

12. Process of Care Interpersonal style Interpersonal manner Patient participation Counseling Communication level Technical style Visits and medications Referrals Test ordering Hospitalizations Expenditures Continuity of care

13. Questions to Ask When Evaluating Process of Care What constitutes the “therapeutic agent”? Do practitioners actually do what they say they do? Do practitioners always know what they do? (Bergmark & Oscarsson, 1991, pp. 139-140)

14. Standards of Care Clinical guidelines Critical paths Care maps

15. Donabedian’s Management of a Dysfunctional State Identification or diagnosis of the dysfunction The decision whether to intervene The choice of intervention objectives The choice of methods and techniques to achieve the objectives The skillful execution of the selected techniques

16. Costs of Care Cost benefits include: Preventing illness Preventing complications Maintaining higher quality of life Prolonging a productive life Who bears the cost of care? Individual? Third-party provider?

17. Structure of Care System characteristics Organization Specialty mix Financial incentives Workload Access/convenience

18. Structure of Care (cont’d) Provider characteristics Age and gender Specialty training Economic incentives Beliefs/attitudes Preferences Job satisfaction

19. Structure of Care (cont’d) Patient characteristics Age and gender Diagnosis/condition Severity Comorbid conditions Health habits Beliefs/attitudes Preferences

20. Outcomes Research Elements Outcomes studies are based on theories of quality of care. Outcome variables must show clear link between process of care and identified outcome. Desirability of selected outcome must reflect preference of the patient, not the provider.

21. Outcomes Research Elements (cont’d) Process of care leading to outcome must be clearly defined. Process of care is driven by structure of care defined in the study. Practice style of providers is a major factor in the process of care and should be defined.

22. The ANA’s “Nursing’s Safety and Quality Initiative” Initiative to identify indicators of quality nursing practice and to collect data using these indicators across the United States Goal was to develop nursing-sensitive quality measures

23. Disseminating Outcomes Research Findings To the clinicians, public, health care institutions, health policy makers, researchers Presentations at meetings Publish in journals