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  1. 1. Module Twenty Two Lecture Evaluation
  2. 2. Evaluation <ul><li>Minimal studies have been published on evaluation; therefore, a challenge for nursing is presented in evaluating the effectiveness of APN </li></ul>
  3. 3. Evaluation <ul><li>Research examining patient and family outcomes provides qualitative and quantitative data regarding quality care as well as cost effectiveness. </li></ul><ul><li>The earliest research studied the effects of early hospital discharge and home follow up by APNs on low birth weight babies (Brooten, 1986). </li></ul>
  4. 4. Evaluation <ul><li>Evaluating the performance of APN consists of determining the provider’s ability to deliver quality care at a reasonable cost to a significant portion of the general population of a particular group. </li></ul>
  5. 5. Evaluation <ul><li>Due to the scarcity of research, organizations need to develop theoretical models to support outcome documentation, which, in turn, enhances political savvy and ensures a viable future for APNs. </li></ul>
  6. 6. Evaluation <ul><li>Four Step Approach by Resnick </li></ul><ul><li>Identify and describe current practice and its outcome </li></ul><ul><li>Collect data </li></ul><ul><li>Analyze data </li></ul><ul><li>Put research into practice </li></ul><ul><li>Resnick, B. (l997, August). Incorporating </li></ul><ul><li>Outcomes research into clinical practice: The </li></ul><ul><li>Four-step approach. AACN Clinical Issues, 11(3), </li></ul><ul><li>453-62. </li></ul>
  7. 7. Evaluation <ul><li>Participating in outcomes research will allow APNs to improve health care services and to secure the role of APNs in the changing healthcare arena. </li></ul>
  8. 8. What has research demonstrated? <ul><li>The APN can provide safe and effective care for the majority of ambulatory care patients, according to The Office of Technology and Assessment (l986). It concluded that APNs possessed the knowledge and expertise to meet the health needs of 50-90% of the ambulatory care patient population. </li></ul><ul><li>Office of Technology Assessment (l986). Nurse practitioners, physician assistants, and certified nurse midwives: A policy analysis (Care Study 37, OTA-HCS-37). Washington, D.C.: U.S. Government Printing Office. </li></ul>
  9. 9. Cont. <ul><li>The Office of Technology and Assessment concluded that nurse practitioners were more cost-effective and accessible than their physician counterparts in providing care to the majority of ambulatory care clients. </li></ul>
  10. 10. Evaluation <ul><li>Significant cost savings related to interventions by APNs. It is estimated that a NP can handle 63% of a physician’s caseload at 38% of the cost resulting in a 24% savings (McGrath, l990). </li></ul>
  11. 11. What research is needed? <ul><li>Ongoing documented contributions of the APNs role in providing care </li></ul><ul><li>APNs understand how the process of documentation relates to the delivery of quality care </li></ul><ul><li>Research and documentation on how APNs are effective based on long term outcomes </li></ul>
  12. 12. Effectiveness of APN and MD mix <ul><li>Research is needed on how the APN and MD work together in a variety of specialty care settings. </li></ul><ul><li>We need documentation on how the APN functions with Endocrinologists, Internists, Cardiologists, Gerontologists, etc. </li></ul>
  13. 13. Quality Care Provided by APN <ul><li>The ultimate goal of APN practice is to assure quality care </li></ul><ul><li>As APNs to ensure job security we must provide quality care and be cost effective </li></ul><ul><li>Being cost effective is not always associated with patient satisfaction or quality care </li></ul>
  14. 14. APNs Involvement in Quality Care <ul><li>Time is one type of structural evaluation measure that can be used to determine whether or not an APN is able to prioritize and categorize time to make an impact on patient care </li></ul><ul><li>However, time documentation studies do not provide a direct measure of APN’s effectiveness. Teaching might take an extra 15 minutes but save time in the future. </li></ul>
  15. 15. Cont. <ul><li>Productivity tools for APNs have been limited to the evaluation of the number of patient visits or amount of revenue generated </li></ul><ul><li>Instruments do not always reflect the amount of time with the patient versus the amount of travel time and administrative time </li></ul>
  16. 16. Research and more research <ul><li>A study which examined differences in quality of medical care, provided by physicians and non-physicians concluded that APNs provided comparable and sometimes superior care to that care which was provided by staff and resident physicians (Hall et al, l990) </li></ul>
  17. 17. Cont. <ul><li>Comparisons studies of APNs and physicians prescribing practices are beginning to emerge. A study conducted by Hamric et al (l998) found that APNs were safe and effective in their prescribing practices. </li></ul>
  18. 18. Cont. <ul><li>A study conducted by Powers et. Al (l984) found no significant differences between physician and APNs as related to outcomes of knowledge, satisfaction, compliance, and problem resolution. Patients seen by APNs reported more overall satisfaction with care provided. </li></ul>
  19. 19. Evaluation <ul><li>Criteria for Identifying Outcomes </li></ul><ul><li>Consideration must be given to associated risks, benefits, and costs of the expected outcomes </li></ul><ul><li>Expected outcomes need to be consistent with current scientific and clinical practice knowledge </li></ul><ul><li>Expected outcomes are modified based on changes in the client’s health care status </li></ul>
  20. 20. Components in Evaluating Medical Care Outcomes Process Structure
  21. 21. Stakeholders Purchaser Community Shareholder Patient
  22. 22. What to evaluate? <ul><li>Patient Satisfaction Survey </li></ul><ul><li>Timeliness </li></ul><ul><li>Closure to visit </li></ul><ul><li>Information/participation </li></ul>
  23. 23. Steps for measuring outcomes <ul><li>A problem is chosen </li></ul><ul><li>A target outcome is chosen </li></ul><ul><li>Data is collected </li></ul><ul><li>Literature is reviewed </li></ul><ul><li>Process is charted </li></ul><ul><li>Analyze and evaluate </li></ul><ul><li>Select an intervention </li></ul>
  24. 24. Clinical Value Biological/functional Outcomes Costs Satisfaction
  25. 25. Steps for Measuring Outcomes <ul><li>Select an objective measure of success </li></ul><ul><li>Set a timeline </li></ul><ul><li>Choose a number of patients </li></ul><ul><li>Chart the process </li></ul><ul><li>Intervention is implemented </li></ul><ul><li>Data is analyzed </li></ul><ul><li>Process is modified as needed </li></ul>
  26. 26. Evidence Based Practice <ul><li>If you don’t evaluate your accountability then you might find yourself trapped </li></ul>
  27. 27. Gold Standard Clinical Practice Guidelines <ul><li>Should specify a high level of detail </li></ul><ul><li>Should represent a consensus of experts across disciplines or specialties and serve as a widely cited, authoritative guide on the topic </li></ul>
  28. 28. Questions Regarding Clinical Practice Guidelines <ul><li>What are the recommendations? </li></ul><ul><li>Are the recommendations valid? </li></ul><ul><li>Will the recommendations help in caring for this patient? </li></ul>
  29. 29. Nurse Practitioner Rating Form <ul><li>History taking </li></ul><ul><li>Physical exam </li></ul><ul><li>Teaching </li></ul><ul><li>Charting and misc. </li></ul>
  30. 30. Evaluating the Care Provided by APNs <ul><li>The underutilization of APNs in the health care system is costing the nation due to scope of practice restrictions and other “denied access”. </li></ul>
  31. 31. Conclusions <ul><li>More research is needed to document the contributions of APNs </li></ul><ul><li>A majority of the documented research pertains to the cost effectiveness of the APN </li></ul><ul><li>More research is needed on outcome evaluation, evaluation research and assuring quality care </li></ul><ul><li>Research by APNs, regarding the effectiveness of APN practice is the foundation for establishing autonomy in the health care community. </li></ul>