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Other titles Outcomes management for nursing practice
ISSN 1093-1783
OCLC 36569178
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Throughout the literature on hospital readmission, little has been written about what is an optimal rate of rehospitalization and the definition of preventable hospitalization. Therefore, the research on hospital readmissions aids in the understanding of variation in the phenomenon but does not necessarily set goals or standards of practice. Using secondary data rather than primary data does not preclude careful thought regarding the operationalization of each variable under study. The optimal time to initiate that process is at the early conceptual phase of a project. As researchers and clinicians proceed with planning a readmission study, reviewing these six categories of methodological issues will assist in producing a carefully designed definition of readmission.
    Outcomes management for nursing practice 01/2001; 5(4):150-2.
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    ABSTRACT: As people age, their incidence of coronary heart disease increases. The majority of persons undergoing invasive procedures such as coronary artery bypass surgery are 65 and older. Because of population trends related to aging, it is projected that there will be exponential increases in the numbers of people requiring treatment for this health problem in the future. Changes in health care reimbursement have significantly decreased hospital length of stay, resulting in many patients completing their recovery either in a rehabilitation facility or at home. Patients with multiple preoperative comorbidities are at risk for postoperative complications. Older patients usually have more health problems after coronary artery bypass surgery because they have more risk factors prior to the procedure. It is not known whether there are differences in outcomes between comparatively older and younger patients when they are matched by risk classification. Information on the recovery of patients at home will enable nurses to meet their care needs prior to surgery and after discharge from the hospital.
    Outcomes management for nursing practice 01/2001; 5(3):127-33.

  • Outcomes management for nursing practice 01/2001; 5(2):52-6.
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    ABSTRACT: The purposes of this article are to present a case study that demonstrates the use of OASIS data in evaluating a cardiac disease management program and to identify the problems encountered and the knowledge gained. It was found that OASIS data can be useful in the description of patients in disease management program development. The analysis of patient end-result outcomes (comparing start of care and discharge information) proved to be the greatest challenge. Recommendations for future studies are included.
    Outcomes management for nursing practice 01/2001; 5(4):167-72.
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    ABSTRACT: Elderly patients (n = 121) with hip fracture were followed to determine if: (1) outcomes measured 12 months post-fracture differed significantly from pre-fracture measures, and (2) patient characteristics on hospital admission predicted three outcomes (site of residence, function, and walking status) 12 months later. At 12 months fewer patients resided at home. They had declined functionally. Baseline cognition, residence site, function, and walking individually predicted outcomes. However, outcomes were predicted best by multiple variables. These findings can be used to educate patients, their families, and the public on outcomes and their determinants after hip fracture.
    Outcomes management for nursing practice 01/2001; 5(3):121-6.
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    ABSTRACT: Studies in the field of outcomes research often use very large data sets. Before data collection, specific issues related to data storage, data collection, and data retrieval should receive careful consideration. New technologies have made the process more cost-effective, efficient, and under the direct control of the researcher.
    Outcomes management for nursing practice 01/2001; 5(1):6-10.
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    ABSTRACT: Measurement of the outcomes associated with implementation of evidence-based practice changes is becoming increasingly emphasized by multiple health care disciplines. A final step to the process of implementing and sustaining evidence-supported practice changes is that of outcomes evaluation and monitoring. The comparison of outcomes to internal and external measures is known as benchmarking. This article discusses evidence-based practice, provides an overview of outcomes evaluation, and describes the process of benchmarking to improve practice. A case study is used to illustrate this concept.
    Outcomes management for nursing practice 01/2001; 5(2):70-4.
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    ABSTRACT: Although unlicensed assistive personnel (UAP) have been a part of health care teams for decades, today's UAP are assisting in the care of more acutely ill clients who are being discharged after shorter hospital stays. This qualitative study examined nurses' narratives of patient outcomes after delegation of activities to UAP and identified the factors leading to the outcomes.
    Outcomes management for nursing practice 01/2001; 5(1):18-23.
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    ABSTRACT: The purpose of this comparative study was to evaluate patient outcomes for wound healing and home health care service use for patients whose care was paid for by the traditional Medicare program versus a Medicare managed care organization (MCO). Results showed that there were no differences between the groups in wound healing at discharge, functional ability at discharge, or the numbers of home visits. Changes in the Medicare reimbursement system for home health care may have provided an equalizing effect between Medicare MCO and traditional Medicare patients with wound/skin diagnoses in home health care agencies in the Midwest.
    Outcomes management for nursing practice 01/2001; 5(2):63-7; quiz 68-9.
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    ABSTRACT: This article describes actual reported uses for patient acuity data that go beyond historical uses in determining staffing allocations. These expanded uses include managing patient care outcomes and health care costs. The article offers the patient care executive examples of how objective, valid, and reliable data are used to drive approaches to effectively influence decision making in an increasingly competitive health care environment.
    Outcomes management for nursing practice 01/2001; 5(1):36-40.
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    ABSTRACT: In recent years, there has been an increased focus on end-of-life decisions and the use of medical technology. It is not well documented in the literature whether or not and to what extent patients' advance directives are used for directing resuscitative efforts. The purpose of this study was to determine how useful patients' advance directives were to members of the health care team in determining treatment and end-of-life decisions among patients who received cardiopulmonary resuscitation (CPR) efforts. Medical records of 135 adult patients who had undergone CPR efforts within the previous year were reviewed to determine if and to what extent advance directives were useful in directing end-of-life care and treatment decisions. Only 35 of these patients had advance directives. Three categories for advance directives emerged: those that were "independently directive," those that were "vague and required further clarification," and those that were "nondirective." Information from this study may be used to clarify treatment options for end-of-life care and to determine if and what further interventions are required to ensure that advance directives can be executed as meaningful documents.
    Outcomes management for nursing practice 01/2001; 5(2):87-92.
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    ABSTRACT: The purpose of this study was to determine if a research-based protocol for pressure ulcer treatment that had been successfully implemented in a long-term care facility was sustained over time. A secondary aim was to describe the attributes of the care environment that may have contributed to or impeded the maintenance of this protocol. A retrospective chart review was conducted of all patients who developed incident stage II, III, or IV pressure ulcers in the facility over a one-year period five years after initial implementation of a pressure ulcer treatment protocol. Data regarding ulcer characteristics and type, frequency, and duration of treatments were collected. Subjects were followed until the ulcer healed, the subject died or was discharged, or the 1-year study period ended. Care environment attributes, including patient care hours, turnover and stability rates, salaries, decision-making structures, and facility mission were obtained from the facility's Human Resource Department and existing databases in the Nursing Services Department. Outcomes of protocol implementation were defined as ulcer healing and costs associated with treatment. Costs were calculated from the provider perspective and included cost of supplies and labor consumed in providing direct pressure ulcer care. Of the 46 incident ulcers treated during the one-year study period, 40 (87%) healed and five (11%) were unhealed when the subject died. One ulcer remained unhealed at the end of the study. The total cost for treatment of these incident ulcers was $18,688, with nursing labor comprising 80% of the total expenditures. Adherence to the protocol, which contained predominantly inexpensive moist wound healing treatment options, resulted in complete healing of most pressure ulcers at a relatively low cost to the facility. The organizational environment of the facility, which maintains staffing levels and salaries at higher than national averages and promotes staff nurse accountability and decision making, may have provided the necessary climate to overcome barriers to clinical integration and sustain the desired care practices.
    Outcomes management for nursing practice 01/2001; 5(3).
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    ABSTRACT: In recent years, regulatory and governmental initiatives have focused increased scrutiny on the use and practices associated with mechanical restraints. Consequently, hospitals are increasingly measuring and comparing both internally and externally their restraint practices as they strive to optimize their use and assure the safe care of patients being restrained. This study analyzes 12,860 restraint episodes from 10 acute care hospitals in a single health care system. Overall findings support many previously identified trends related to the types of restraints used and reasons for application. However, findings from this study also suggest that there are differences among rural, community, and tertiary hospitals. This study also provides the first widespread documentation of rates and types of alternative methods attempted and common patient care practices carried out during restraint application. These results can serve as external comparisons for other acute care settings as they strive to minimize and assure safety in restraint application.
    Outcomes management for nursing practice 01/2001; 5(3):102-9; quiz 110-1.
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    ABSTRACT: The purpose of this study was to examine the effects of an individual performance feedback intervention on nurses' adherence to pain management practice guidelines. Thirty orthopedic staff nurses received individual performance feedback on their past performance of three recommended pain management practices. Nurses' performance of the three recommended practices significantly improved over the 15 weeks after the feedback intervention. Missed 4-hour pain assessments declined (t = 8.77, df = 239, P < 0.0001), reassessments after analgesics increased (t = -5.71, df = 239, P < 0.0001), and follow-up taken for unacceptable pain increased (t = -3.08, df = 178, P < 0.01). Results suggest that individual performance feedback may be an effective approach to improving nurses' pain management intervention activities.
    Outcomes management for nursing practice 01/2001; 5(2):57-62.
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    ABSTRACT: A continuous quality improvement in health care, combined with measurement of patient and organizational outcomes, is an international trend that promises improvement in meeting the needs of health care consumers in a cost-effective manner. A clinical improvement workshop was conducted in our institution to study the practical methods that can be used by clinical teams to improve the quality and value of health care. This workshop enabled the Epilepsy Team to identify change strategies that potentially could accelerate clinical improvement efforts in the epilepsy monitoring unit (EMU). The Team was able to develop, plan, and test improvements and link these improvements to patient outcomes.
    Outcomes management for nursing practice 01/2001; 5(1):11-6; quiz 16-7.
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    ABSTRACT: The devastating effects from cardiovascular disease are the largest contributors to employers' health care costs, insurance premiums, disability insurance, and worker's compensation. The purpose of this study was to establish baseline data regarding physiological outcomes comparing two participant groups in a corporate wellness program. Results suggest that a corporate wellness program can be beneficial in assisting employees to improve their health behaviors and outcomes.
    Outcomes management for nursing practice 01/2001; 5(2):82-6.
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    ABSTRACT: Pain sensation and distress in 38 intestinal surgical patients were moderate to severe on postoperative day 1, ranging from 34 to 49 mm and 33 to 45 mm, respectively, on 100-mm scales. During ambulation, both increased from baseline to post-ambulation, P < 0.01. Half of the patients reported severe pain not relieved by analgesics, and although 44% learned a relaxation technique in the past, only 8% used one for pain after this surgery. Pain disturbed the sleep of 34% of the patients, and pain was related to respiratory, intestinal, febrile, and other complications in 18 (47%) subjects. Attentive analgesic use and nonpharmacologic therapies are recommended.
    Outcomes management for nursing practice 01/2001; 5(1):41-6.
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    ABSTRACT: The Minimum Data Set (MDS) is a standardized assessment tool designed to provide a comprehensive biopsychosocial assessment of medical, behavioral, and cognitive status of nursing home residents. This pilot study examined the relationships of three MDS subscales--cognition, depressive symptoms, and behavioral disruptions--to other measures of the same domains (e.g., diagnosed dementia and depression and caregiver ratings on the Revised Memory and Behavior Problems Checklist [RMBPC]). The sample consisted of 135 nursing home residents with a mean age of 84 years. Based on the MDS, there was a high prevalence of cognition-related behaviors but a low prevalence of disruptive and depressed behaviors. The prevalence rates were substantially different according to the RMBPC. In addition, most of the MDS subscales failed to differentiate between residents with and without diagnosed dementia and depression, whereas caregiver ratings on the RMBPC did. The MDS and RMBPC subscales were modestly related but only in residents without dementia. These findings raise questions about the validity of the MDS in measuring nursing home residents' behavior, especially depressive and disruptive behaviors. Thus, caution should be employed in using the MDS as a sole outcome measure for these behaviors, and the use of multiple measures is suggested.
    Outcomes management for nursing practice 01/2001; 5(1):28-35.
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    ABSTRACT: There are several skills nurses can develop or expand to improve their ability to manage outcomes. This is an exciting area for nurses and one that is valued during times of cost reduction in healthcare. In addition to increasing skills in the health outcomes management arena, nurses will benefit from a continual increase in knowledge of case management, clinical pathways, and guidelines. The healthcare market-place is likely to reward nurses with these skills.
    Outcomes management for nursing practice 01/2001; 5(4):146-9.
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    ABSTRACT: The 12-item Short-Form Health Survey was developed to describe mental and physical health status of adults and to measure the outcomes of healthcare services. Based on testing of the original SF-12 with a group of older adults, a revised scoring system and measurement model of the SF-12 Health Survey was proposed. The purpose of this study was to test the reliability and validity of this revised measurement model and scoring system. Testing was done with a sample of 187 older adults in a continuing care retirement community and a sample of 211 older adults discharged from an acute care setting. There was sufficient evidence for the internal consistency of the revised SF-12 (Cronbach alpha coefficients of 0.72 to 0.89); test retest reliability (r = 0.73-0.86); reliability based on R2 values; and validity based on confirmatory factor analysis, contrasted groups, and hypothesis testing. The revised SF-12 is a valid and reliable measure that can be used with confidence to measure outcomes for older adults.
    Outcomes management for nursing practice 01/2001; 5(4):161-6.