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Chapter 14

Introduction to Outcomes Research

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Outcomes Research and Nursing Practice

How nurses make decisions Nurse case management Nurse practitioner interventions Community health Health promotion Nursing outcomes in hospitals

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Outcomes Research

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

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Theoretical Basis of Outcomes Research

Evaluation methods Epidemiology Economic theory

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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

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Concepts of Donabedian’s Theories

Health Physical-physiological function Psychological function Social function

Subjects of care Patient (individual and aggregate)

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Concepts of Donabedian’s Theories (cont’d)

Providers of care Individual practitioner Organization of providers

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Level and Scope of Concern

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Donabedian’s Objects of Evaluating Quality Health Care

Evaluating Outcomes Process Structure

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Outcomes

Functional status Physical Mental Social Role

Clinical end points Symptoms and signs Laboratory values Death

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Outcomes (cont’d)

Satisfaction with care Access Convenience Financial coverage Quality General

General well-being Health

perceptions Energy/fatigue Pain Life satisfaction

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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

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Questions to Ask When Evaluating Process of Care

1. What constitutes the “therapeutic agent”?2. Do practitioners actually do what they say

they do?3. Do practitioners always know what they do?

(Bergmark & Oscarsson, 1991, pp. 139-140)

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Standards of Care

Clinical guidelines Critical paths Care maps

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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

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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?

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Structure of Care

System characteristics Organization Specialty mix Financial incentives Workload Access/convenience

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Structure of Care (cont’d)

Provider characteristics Age and gender Specialty training Economic incentives Beliefs/attitudes Preferences Job satisfaction

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Structure of Care (cont’d)

Patient characteristics Age and gender Diagnosis/condition Severity Comorbid conditions Health habits Beliefs/attitudes Preferences

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Outcomes Research Elements

1. Outcomes studies are based on theories of quality of care.

2. Outcome variables must show clear link between process of care and identified outcome.

3. Desirability of selected outcome must reflect preference of the patient, not the provider.

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Outcomes Research Elements (cont’d)

4. Process of care leading to outcome must be clearly defined.

5. Process of care is driven by structure of care defined in the study.

6. Practice style of providers is a major factor in the process of care and should be defined.

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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

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Disseminating Outcomes Research Findings

To the clinicians, public, health care institutions, health policy makers, researchers

Presentations at meetings Publish in journals