Case management for patients with heart fialure: a quality improvement intervention

At-home case management is one strategy for improving quality of care for elderly patients with heart failure. Essential components of an effective heart failure case management intervention include frequent patient contact with the case manager and vigilant at-home monitoring of symptoms with responsive modifications to the treatment plan. It is just as important that the health care system (e.g., the acute care institution) is committed to assuring administrative support, financial backing, and dedicating clinical expert resources to achieve clinical quality improvements. In this article, the design, implementation, and outcomes of an at-home heart failure case management program are described, and challenges faced in implementing and sustaining the program are outlined.     

Quality and the nursing workforce: APNs, patient outcomes and health care costs

Quality in health care requires access, appropriate and acceptable treatment plans, responsible patient follow through, a workforce of sufficient numbers and qualification and agreement on health care quality indicators. The purpose of this article is to describe APN workforce and dose effects on quality, reflected in patient outcomes and health care costs with current quality indicators. Stakeholders measure “quality indicators” differently. Nursing practices are often absent in databases and systems of reimbursement. Research overwhelmingly indicates equal outcomes for physician and APN care plus value-added APN effects on use of preventive services, adjustment to illness, stress management, treatment compliance, satisfaction, and reduced emergency room visits and rehospitalizations. APN dose has an important positive effect on patient outcomes and healthcare costs. Research is needed on the level of APN dose, staff mix and use of APNs, and balance of physician and APN dose in different stages of patient health, illness, and recovery to achieve quality outcomes.     

Use of an acute spinal cord injury clinical pathway

Phased outcome clinical pathways can be useful in the management of neurotrauma patients in the acute care setting. By developing multidisciplinary plans of care that focus on patient and family outcomes and not arbitrary points in time, hospitals can provide quality care to trauma patients that is both appropriate and cost effective. In fact, this type of plan for SCIs can be expanded on and used across the health care continuum from prehospital to community reintegration. Providing collaborative quality care will result in improved outcomes for both patients and health care institutions.     

The consequences of job stress for nurses' health: time for a check-up

The processes and outcomes of nurses' work are described extensively in studies about patient care, nursing education and training, job satisfaction, health care quality and management, and organizational behavior. These studies evaluate the relationship between nurses' behavior and organizational health (ie, productivity) or between nurses' behavior and patient health (ie, medical error). Fewer studies probe the association between the nature of nursing work and the status of nurses' health despite the logical connection between how well nurses feel and how well they perform, or even, whether they discontinue working altogether for health reasons. Yet, for many nurses working in today's health care environment, work is a stressful part of their lives. This article explores the connections between stressful work and nurses' health, especially given the restructuring of their work in the current health care system. The working conditions that give rise to stress and the potential health consequences from it are well described in the general stress literature and summarized herein. Moreover, studies about nurses' work and nurses' health are discussed in light of the limitations for connecting job stress to job changes or health outcomes over time. Current approaches for dealing with nurses' stress, such as the attraction to "Magnetism", may inadvertently impede progress in this area. Recommendations for the future are included.     

Case management and technology: a necessary fit for the future

We now reside in a data-driven health care environment and methods for gathering, presenting, and evaluating relevant data about health care systems are paramount. This article expands on the importance of evaluating the outcomes of case management and how collecting relevant clinical and cost data can provide an infrastructure on which to base future decisions. Data-based decision making in case management is crucial for ensuring quality of care and the appropriate management of patient outcomes, and it underpins the viability of this delivery model of care.     

Engaging Radiology Nurses in Quality Improvement Projects in a Women's Specialty Hospital

Measuring outcomes in health care have become mandatory as regulatory agencies, institutional guidelines, employers, and consumer groups advocate for quality health care focusing on improving patient outcomes. System-level quality departments often provide a framework for performance improvement (PI) that supports the organizational PI plan. However, nurses must learn to lead and be actively involved in projects in the radiology department to ensure key performance indicators are developed with on-the-ground quality management to improve patient outcomes, system performance, and professional development. This article explores such efforts at a large women’s specialty hospital in the Southern United States.     

The effect of the clinical nurse specialist on patient outcomes

The review of the literature shows a beginning body of evidence to support the positive effects of CNSs on patient outcomes. The most commonly examined patient outcomes were length of stay, complications, use of health care services, cost, and mortality rates. The study done by the author shows that patients with TKR operations on units with CNSs had better patient outcomes than patients on units without CNSs. Patients on units with CNSs had an overall shorter TLOS and fewer complications than did patients on units without CNSs, which is consistent with the literature. Health care providers are making continuing efforts to decrease operating costs. Because of economic pressures on health care administrators, a need to examine various job positions exists. Decisions regarding which positions are retained or eliminated should be based on well-designed research data. The effect of CNSs on patient outcomes can mean improved quality of care and cost reduction. As more research is conducted to show the effectiveness of CNSs on patient outcomes, health care administrators and consumers may become more convinced that such a person is a valuable member to have on the health care team.     

Workload and patient safety among critical care nurses

Several dimensions of workload experienced by nurses working in ICUs are described in this article, including the physical workload related to patient handling. The effects of workload on various outcomes, such as the health, safety, and quality of working life of nurses, and the safety of care provided by ICU nurses are discussed. A systemic approach to the assessment of workload is proposed that is aimed at identifying the work system factors that contribute to the different facets of workload and the interdependencies among the various dimensions of workload.     

The Iowa Model of Evidence-Based Practice to Promote Quality Care.

The UIHC Department of Nursing is nationally known for its work on use of research to improve patient care. This reputation is attributable to staff members who continue to question "how can we improve practice?" or "what does the latest evidence tell us about this patient problem?" and to administrators who support, value, and reward EBP. The revisions made in the original Iowa Model are based on suggestions from staff at UIHC and other practitioners across the country who have implemented the model. We value their feedback and have set forth this revised model for evaluation and adoption by others.     

The Vascular Project: using data to improve processes and outcomes.

Fiscal accountability by health care providers has become a theme in health care delivery systems; however, evaluation of outcomes on the basis of cost alone may minimize the importance of patient needs and the quality of the care delivered. Mechanisms related to resource identification and allocation has to be driven by internal data and information systems that consider clinical, financial, administrative, and patient satisfaction data. This article will define processes, outcomes and outcomes measurement, and management. Various nursing-sensitive outcomes will be presented and their establishment, tracking, interpretation, and effect on the delivery of patient care in a newly opened vascular unit will be highlighted.     

Product line management

The application of Product Line Management to the health care industry in the United States is an effort to use a management approach from the business world that aims at implementing, maintaining, and enhancing productivity without compromising quality patient care. Product Line Management is an opportunity for the nurse in management to develop a business acumen that will directly influence patient outcomes. Under this concept the product, is defined, priced, marketed and sold. The result is the ability to secure a competitive edge in the health care marketplace that not only allows us to survive, but to thrive.     

Team and patient orientation in nursing as a part of quality management--status and needs for research

The paper introduces a holistic concept of quality management in hospitals--the approach of employee and patient orientation ("MPO-Mitarbeiter- und Patientenorientierung"). It is shown that quality in health care does not primarily depend on the regulation of quantitative input and output of the health care system but is largely determined by improvements of processes within the system. TQM models like the European Quality Award are showing the way towards improving processes by focusing on employee and client orientation and satisfaction. Patient satisfaction has become a more and more popular indicator for quality in health care. However, reviews of the vast amount of literature on patient satisfaction reveal that present research suffers from the same problems and shortcomings that have already been criticised about 20 years ago. Only few studies choose innovative approaches by integrating the perspectives of patients and employees and by refraining from the insufficient measurement of satisfaction. Three of these studies are presented and compared. Against this background the MPO-approach is described; the approach integrates results from work psychology as well as from nursing research within the concept of complete activity. In contrast to other models of quality management the MPO-approach provides suitable methods for analysis and assessment of employee and patient orientation. These methods are described and are finally discussed with respect to strategies of total quality management in hospitals.     

Effects of registered nurse staffing on quality of care and resident outcomes in nursing homes

Few studies focus on Registered Nurse (RN) staffing and resident health outcomes in Korean nursing homes. This study aimed to investigate the effects of RN staffing on quality of care and resident outcomes in South Korean nursing homes. The study was a secondary data analysis of 5679 participants from the National Health Insurance Service. A mixed-effect linear model and multinomial logistic regression model assessed resident outcomes and quality of care, respectively. The number of RNs significantly affected patient mortality. The overall evaluation rating for quality of care in nursing homes increased as the number of RNs increased. Level of RN staffing in nursing homes influenced health management and quality of care for residents. A variety of efforts are needed to strengthen the workforce of RNs in nursing homes, including enacting a law for safe RN staffing and converting the evaluation of nursing home quality into health outcomes.     

Systematic review of the effectiveness of primary care nursing

This paper reports on a systematic review that sought to answer the research question: What is the impact of the primary and community care nurse on patient health outcomes compared with usual doctor‐led care in primary care settings? A range of pertinent text‐words with medical subject headings were combined and electronic databases were searched. Because of the volume of published articles, the search was restricted to studies with high‐level evidence. Overall, 31 relevant studies were identified and included in the review. We found modest international evidence that nurses in primary care settings can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors. Nurses are effective in care management and achieve good patient compliance. Nurses are also effective in a more diverse range of roles including chronic disease management, illness prevention and health promotion. Nevertheless, there is insufficient evidence about primary care nurses' roles and impact on patient health outcomes.     

Outcomes management in neonatal nursing clinical practice

One approach for evaluating the quality and cost of patient care is through outcomes management Outcomes management in a neonatal environment will be described within a structure-process-outcome framework Outcomes will be presented from three perspectives administrative, economic and clinical The relevance and implications of outcomes management will be discussed     

Advanced practice nursing for congestive heart failure

Congestive heart failure (CHF) is an enormous burden on society and the health care system. The role of the advanced practice nurse (APN) in CHF is multifaceted and combines inpatient, outpatient, and community patient care skills. Case management and quality management have been traditional focuses, with a high level of practice impact on patient care. Outcomes management in the APN role for CHF care is the future for measurable outcomes and maximum impact on organizational values. Because outcomes management is an evolving field for the APN, focus on a chronic disease such as CHF is a very valuable tool for implementation.     

Quality Health Outcomes Model

Purpose: Donabedian's 1966 framework of structure, process, and outcome has guided three decades of study in the United States of the elements needed to evaluate and compare medical care quality. Donabedian's perspective was essentially linear, assuming that structures affect processes, which in turn affect outcomes. Patient characteristics are sometimes considered as mediating outcomes and clinical interventions are considered to be processes. A model is presented in the following article that relates multiple factors affecting quality of care to desired outcomes. It extends previous models by positing dynamic relationships with indicators that not only act upon, but reciprocally affect the various components.
Scope and Sources: The proposed model was derived from a synthesis of the authors' experience in quality of care practice and research, as well as selected previous theories.
Conclusions: The quality health outcomes model is sufficiently broad (a) to guide development of databases for quality improvement and outcomes management, (b) to suggest key variables in clinical intervention research, and (c) to provide a framework for outcomes research and outcomes management that compares not only treatment options, but organizational or system level interventions. The model also has several policy implications.     

The truth is in the eye of the beholder? Quality in rehabilitation from the patients' perspective

The definition of "good" quality in health research and quality management in health care and rehabilitation are primarily based on health professionals and their associations. But laypersons, patients, and participants in rehabilitation programmes, too, develop cognitive concepts about what defines good quality in health care. Until now systematic knowledge about the role of the patients' views on quality in rehabilitation is rare. Existing data demonstrate that patients report detailed ideas about indicators and preconditions of good quality of rehabilitative care. Patients' quality concepts differ in some aspect from the quality definitions of health care professionals. There is some evidence that patients' views on quality are a necessary extension and completion of programme evaluation and of quality management. They influence usage and selection of rehabilitation facilities and programme elements and probably patient satisfaction and long-term outcomes as well. Patients' ideas could contribute to gaining a deeper understanding of patients' needs. Here, patients are experts to define challenges for long-term improvements in health and health-related behavior with regard to everyday life and related resources and barriers. Taking patients' views on the quality of rehabilitation into account could help to adapt rehabilitation features, programmes and long-term offers more adequately to patients' needs. More systematic evidence is however needed as a basis for further developments in rehabilitation programmes.     

Quality and quality assurance in the health care setting: an equitable life?

Research studies alluding to quality and quality assurance within the health care arena are increasingly utilized to justify management initiatives, particularly in relation to the provision and resourcing of patient services, both within the institutional and community setting. The following paper considers the role and utility of quality indicators and presents a critical analysis of the literature pertaining to the concept of quality as it applies to the provision and organization of health care and the relationship between quality assurance and patient satisfaction per se. The paper concludes with a dual challenge not only to nurses to better understand and articulate the specific contribution of the discipline, particularly in relation to positive patient outcomes, but also to current, narrow focused interpretations of quality assurance and calls for definitions of quality to reflect an appreciation of the particular involvement and role of the patient in determining policy affecting care provision.     

Analysis of the Home Health Symptom Management Model

The Home Health Symptom Management Model examines symptom management from the perspective of the home health patient. Results obtained from the model can be used to develop strategies for home health nursing that will improve the management of patients' symptoms, thus affecting outcomes and the cost of patient care. Case managers could use this information when arranging and evaluating home healthcare. The model can further be used in practice to assist home health nurses in their awareness of various factors that may predict numbers of home health visits.