1. Continuum of Care Outcomes: Strategic Actions for Nursing Joyce A. Verran Reviewers: Katherine Jones, Joyce Pulcini Betty Bekemeier; Bonnie Wesorick

2. Purpose Focus attention on the need to develop and measure generic patient outcomes across the health care continuum. Generic Outcomes: Appropriate across settings of care and applicable for all patients. Within the Episodes of Care Framework of NQF Builds on the early work of the Expert Panel on Quality

3. Background: Expert Panel Development of a model to define research in the area of quality Identified a set of generic patient outcomes – Health Related Quality of Life – Symptom Management to Criterion – Appropriate Self-Care – Perception o Being Well-Cared For – Health Promoting Behaviors – Adverse Incidents Two National conferences and several publications.

4. Background: National Context National Strategy for Quality Improvement in Health Care – System of Care Perspective needed to make care safer, ensure patient/family engagement and promote effective communication/coordination. National Quality Forum Episodes of Care Framework – Episodes of Care are a series of temporarily contiguous healthcare services – Health Related Quality of Life and Patient Experience with Care National Quality Forum Measurement Application Partnership – Utilizing Episodes of Care Framework for their work.

5. Proposal Other generic outcomes should be measured – Self-Care – Symptom Management Further work should be done to examine other than Episodes of Care sites. Benchmarking needs to be done across settings.

6. State of the Science: Self-Care; Symptom Management Appropriateness and Benchmarking – Clark, 2006 Delineation of Self-Care and Symptom Management – Richard and Shea, 2011 Measurement – Doran et al, 2006 – Badger, Segrin & Meek, 2011

7. Summary Recommendation Support Episode of Care measurement framework Include generic outcomes Support inclusion of HRQL and Expectations Actions Letters of support forwarded to MAP and NQF.

8. Summary Recommendations Recommend addition of Self (Care) Management and Symptom Management Actions Electronically convene group of experts – Consensus on description – Consensus on measurement Forward recommendations

9. Summary Recommendations Initiate further examination of generic outcomes for community care centers Actions Electronically convene experts to determine appropriateness of current outcomes and additional measures

10. Summary Recommendations Eventually develop a plan to benchmark generic outcomes Organizations to initiate actions: – Expert Panel on Quality – Nursing Alliance for Quality Care. Actions