Presentation on theme: "Transition to Practice Study: Outcomes Data Mary Blegen, PhD, RN, FAAN Mary Lynn, PhD, RN Phase II Site Coordinator Meeting February 1, 2012."— Presentation transcript:
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 In other words “A” leads to “B” (or “B” is a consequence of “A”)
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.
The “causes” are a bit easier 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 A
“Outcomes” are not as easy 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 B
What is important about outcome data? 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 B
The “over time” part is important Baseline 6 months 9 months12 months 9 months 12 months Ideal Each problematic
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
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
Collecting Data TTP project Outcomes and Context Nurse Participants Organizations Patient/Client/Resident
Nurse Participants New Nurse Survey Job satisfaction Knowledge Perception of competence Stress Report of Errors Preceptor Survey Effectiveness Knowledge Perception of new nurse
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
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
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
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
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
Summary The planned data collection will evaluate the Nurse 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.
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