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Transition to Practice Study: Outcomes Data

Transition to Practice Study: Outcomes Data. Mary Blegen, PhD, RN, FAAN Mary Lynn, PhD, RN Phase II Site Coordinator Meeting February 1, 2012. Why do outcomes matter?. When outcomes are used something is the “cause” and something is the “effect” even if the study is not “causal” in nature

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Transition to Practice Study: Outcomes Data

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  1. Transition to Practice Study:Outcomes Data Mary Blegen, PhD, RN, FAAN Mary Lynn, PhD, RN Phase II Site Coordinator Meeting February 1, 2012

  2. Why do outcomes matter? • When outcomes are used something is the “cause” and something is the “effect” even if the study is not “causal” in nature • In other words “A” leads to “B” (or “B” is a consequence of “A”)

  3. If A leads to B …

  4. And B isn’t available…

  5. You are left with “A” A Which does not allow you to examine the possible impact of “A” on what you think it might effect.

  6. The “causes” are a bit easier A • In this study - Randomly assigned organizations to intervention and control groups • Surveys can easily be identical for all participants • Fairly easy to prompt for them to be completed at or about the same time (or the appropriate time) • Some of the “A”s are demographics (personal or institutional) and can be obtained whenever

  7. “Outcomes” are not as easy B • The same variable will differ in its definition across institutions, even if the same type (e.g., differ hospital to hospital) • In this Phase we have a mix of institutional types (e.g., home care, long term care, etc.) that leads to many different definitions • Outcomes “over time” require more motivation (and nudging) to obtain

  8. What is important about outcome data? B • That the data collected are: • The same across all institutions (to the extent possible) • What is measured • How they are measured (circumstance, method, timing) • As complete as possible • Each set of items or variables • The “over time” component

  9. Baseline Baseline Baseline 6 months 6 months 6 months 9 months 12 months 9 months 12 months 12 months Baseline The “over time” part is important Ideal 9 months Each problematic

  10. For this research study Aim is to determine the effects of the TTP intervention, and the feasibility of this intervention in non-hospital setting • Must have valid data for comparison • Across facilities – intervention and control • Across time – before and after the study (Valid means accurate, measuring what we intend to measure, and comparable across agencies and time) • Measures should be similar in all organizations • Surveys will be the same • Outcomes data will be appropriate for each type of organization • Data collected using the same definitions and care

  11. Obtaining Comparable Data is a major challenge Particularly with different types of organizations • 39 long term care • 4 public health • 3 home health • 2 ambulatory care

  12. Collecting Data TTP project Outcomes and Context • Nurse Participants • Organizations • Patient/Client/Resident

  13. Nurse Participants • New Nurse Survey • Job satisfaction • Knowledge • Perception of competence • Stress • Report of Errors • Preceptor Survey • Effectiveness • Knowledge • Perception of new nurse

  14. Organization Data • Size • Number of Beds, Days of Care, Visits, Clients, Services provided • Nursing Staff Size and Composition • Numbers of RNs, LPNs, unlicensed nursing assistants • Budgeted, Actual, New hires, Contract/Per diem • Nursing Retention (turnover) • Voluntary – organization could control • Voluntary – organization could not control • Terminations – organization decides

  15. Outcomes of Nursing Care Provided (patient, resident, client outcomes) Site Coordinator reporting • Patient/client satisfaction • With data available at each organization • Use existing data for each type of site

  16. Quality Outcomes Assessment • Site Coordinators will complete this survey • Survey was adapted to provide a comparable measure across our four types of sites from Nursing Intervention subscale of the Community Health Nursing Outcomes Inventory • Nurse considers patients’ prior functioning • Nurse identified goals/areas to jointly work with patient • Patients are in control of their health outcomes • Nurse ensures that services/resources are available • Nurse makes appropriate healthcare referrals

  17. Service Outcomes: examples • Nursing Home – Nursing Home Compare • Pressure ulcers -- Weight Loss • Depression / anxiety -- Restraints • Flu/pneumonia vaccine • Home Health – Home Health Compare • Pain decreased • Improvements in breathing, wound healing • Medication accuracy and knowledge • Flu/pneumonia vaccine

  18. Service Outcomes: examples • Ambulatory - Agency Healthcare Research Quality • Falls and fall risk assessment • Medication reconciliation • Flu/pneumonia vaccine • ER visits within 28 days • Public health – • Immunizations for children • Rate of Chlamydia • Prenatal care in first trimester

  19. Summary • The planned data collection will evaluate theNurse Participants, Preceptors, Organization, Outcomes • It will be similar across all organizations(outcomes appropriate to site type) • Collected at both Intervention and Control sites • What is measured is nearly the same • How they are measured is nearly the same • As complete as possible at each point in time • And, collected at two or more points in time to allow comparison over time within each organization, in types of organizations and for the entire sample.

  20. Questions?

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