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”)

If A leads to B …

A B

And B isn’t available…

A B

You are left with “A”

AWhich 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 BaselineBaselineBaseline

6 months 6 months 6 months

9 months

12 months

9 months9 months

12 months 12 months

Ideal

Each problematic

For this research studyAim 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.

Questions?