1-12-2016 1

Omaha System Research

• In this presentation we will share some examples of research using the Omaha System

• Karen Monsen

• Aenne Werner

• Nicole Koster

1-12-2016 2

My background

• Public health nurse visiting families in the community

• Charged with automating documentation for outcomes: Omaha System was the surprise!

• Began looking for outcomes in the data in 1999 in the community

• Became a full time university researcher in 2007

• Began international research in 2010

• All of my research is in partnership with community

Serious and Persistent Mental Illness

– One Client, Nine Problems

Gapp, N., Weber, J., Monsen, K. A., & Darst, E. (2015). Feasibility of using the Omaha System for assessment to determine optimal living situation for persons with severe and persistent mental illness. Annals of Psychiatry and Mental Health, 3,2,1026.

Knowledge Ratings Predict Optimal Living Situation • Gap between Knowledge and Status determined by

observations of patient and interviews with staff

• Comparison of client’s Knowledge, Behavior, and Status ratings

– Wilcoxon Signed Ranks Test

• Substantiates need for structure in the environment

Data Mining to Show Outcomes

Linking interventions

With Outcomes

Home Care Intervention Patterns

• 621,385 interventions - 2,862 patients

– Kmeans and Expectation Maximization created clusters

• Patients were most likely to be hospitalized if they received insufficient care

– Analyzed clusters in comparison with hospitalization outcomes

Monsen, K. A., Westra, B. L., Yu, F., Ramadoss, V. K., & Kerr, M. J. (2009). Data management for intervention effectiveness research: Comparing deductive and inductive approaches. Research in Nursing and Health, 32(6), 647-656.

Monsen, K. A., Westra, B. L., Oancea, S. C., Yu, F., & Kerr, M. J. (2011). Linking home care interventions and hospitalization outcomes for frail and non-frail elderly patients. Research in Nursing and Health, 34(2), 160-168.

Policy-Practice Comparisons

• Federally Qualified Health Center USA – How do FQHCs reach out

to underserved? • Surveillance

• Buutzorg Nederland – How do nurse-led teams tailor

interventions to meet the unique needs of community dwelling home care and hospice patients? • Case management

• Advanced Nursing Care Japan – How does the Japanese government

define the interventions that nurses with special advanced training may perform in Japan? • Treatments and procedures

• Nurse-led Clinics Mexico – How do nurses provide holistic

care in nurse-led academic healthcare centers? • Teaching, guidance and

counseling

Standardization Enables Comparison

• Skin problems of home care patients in Istanbul compared to Minnesota

• Services for high risk mothers with and without intellectual disabilities

• Outcomes of public health nursing services across counties

• Outcomes of Hispanic mothers with and without the Mental health problem

Monsen, K. A., Fulkerson, J. A., Lytton, A. B., Taft, L. L., Schwichtenberg, L. D., & Martin, K. S. (2010). Comparing maternal child health problems and outcomes across public health nursing agencies. Maternal and Child Health Journal, 14(3), 412-421. Monsen, K. A., Honey, M., & Wilson, S. (2010). Meaningful use of a standardized terminology to support the electronic health record in New Zealand. Applied Clinical Informatics, 1(4), 368-376. Monsen, K. A., Sanders, A. N., Yu, F., Radosevich, D. M, & Geppert, J. S. (2011). Family home visiting outcomes for mothers with and without intellectual disabilities. Journal of Intellectual Disabilities Research, 55(5), 484-499. Garcia, C., McNaughton, D., Radosevich, D.M., Brandt, J.K., Monsen, K.A. (2013). Family home visiting outcomes for Latina mothers with and without mental health problems. Public Health Nursing, 30, 5, 429-38.

Sickle Cell Anemia Guideline 130 Interventions for 19 Problems

Omaha System Guidelines – Sughanda Rajput et al., 2015

Variability in Practice Patterns

Scope of Practice

• Understanding details about what nurses and other health care workers can do and should do for various types of clients

• Improving quality of care and population health outcomes

Monsen, K.A., Foster, D. J., Gomez, T., Poulsen, J. K., Mast, J., Westra, B. L., & Fishman, E. (2011). Evidence-based standardized care plans for use internationally to improve home care practice and population health. Applied Clinical Informatics, 2, 373-384.

Measuring Complexity of Nursing

CM

44%

S

19%

TGC

22%

TP

15% 34.7% of minutes had at least two interventions

Observing Nursing

• Using the Omaha System as the basis for observations enriches our understanding of the complexity of care

• Studies underway in school nursing, acute care, and public health nursing

Schenk, et al. (In review) Time motion analysis of nursing work in ICU, telemetry and med-surg units.

Diabetes Signs/Symptoms

Monsen, K. A., Handler, H. E., Le, S. M., & Riemer, J. G. (2014). Feasibility of using the Omaha System for self-report of symptoms by adults with diabetes. Online Journal of Nursing Informatics (OJNI), 18 (3).

Patient/Consumer Applications

• The Omaha System is relatively simple and provides a comprehensive, holistic picture of health

• Can be used to describe patient strengths as well as signs/symptoms

• Current research

– refining the Omaha System for use by consumers

– evaluation of strengths compared to needs and outcomes

Monsen, K. A., Peters, J., Schlesner, S., Vanderboom, C. E., & Holland, D. E. (2015). The gap in Big Data: Getting to wellbeing, strengths, and a whole person perspective. Global Advances, 4, 3, 31-39.

Importance of Tailoring Care

• Our most recent work uses visualization techniques to understand what really makes a difference

– Patient baseline scores (50%)

– Patient problems (16%)

– Nursing interventions tailored to meet patient needs (16%)

– The nurse - being a great nurse makes a big difference! (17%)

Monsen, K. A., Peterson, J. J., Mathiason, M. A., Kim, E., Votava, B., & Pieczkiewicz, D. S. (in press). Discovering nurse-specific intervention patterns using visualization techniques. Western Journal of Nursing Research. Monsen, K. A., Chatterjee, S. B., Timm, J. E., Poulsen, J. K., & McNaughton, D. B. (2015). Factors explaining variability in health literacy outcomes of public health nursing clients. Public Health Nursing, 32(2), 94-100.

Your Ideas

• The Omaha System is a practice tool that enables research that can support practice

• Your ideas are critical to this research agenda

Next: Aenne and Nicole!