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 … AB

And B isn’t available… AB

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.

Questions?