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Evaluating the Difference in Outcomes


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Evaluating the Difference in Outcomes

  1. 1. My Busy SUMR By Egor BuharinMentored by Matthew D McHugh, PhD, JD, MPH, RN, CRNP
  2. 2. Interesting Situation∗ Continuation of former research and new projects∗ October, 2010 – Center for Health Outcomes and Policy Research (CHOPR)∗ Flurry of projects
  3. 3. Visual Diagrams – Impact of Nurse Residency Programs
  4. 4. Visual Representation of research
  5. 5. Diagrams
  6. 6. Projects∗ End-of-Life Care: statistical programming∗ California’s Nurse-to-Patient Mandate∗ United Arab Emirates – several thousand nurse and patient surveys.
  7. 7. End of Life ∗ Set the scene. ∗ 2,423,995 people died in the U.S. Of these, estimated that 765,651 died in the hospital – 32 percent (2007) ∗ Among the elderly, 31 percent of deaths occurred in the hospital ∗ Approximately 75% of 65+ people have at least one chronic condition ∗ Chronically ill patients often spend their last days in a hospital – society ∗ 50 percent of the conscious patients who die in the hospital have moderate-to- severe pain at least half the time. – New England Journal of Medicine ∗ Passive euthanasia – legal ∗ Hospice• The Costs of End-of-Life Hospitalizations, 2007 - Yafu Zhao, M.S. and William Encinosa, Ph.D• AHRQ - Preventing Disability in the Elderly With Chronic Disease
  8. 8. +50,000,000 observation
  9. 9. Dartmouth – End of Life Trend Report44 page report: Dartmouth Institute forHealth Policy and Clinical Practice ∗ 67 to 99 years ∗ full Part A and Part B entitlement throughout the last two years of life ∗ Persons enrolled in managed care organizations were excluded from the analysis. ∗ Patients with surgical admissions only were excluded (a patient ∗ whose only hospital admission was for bypass surgery could only be assigned to ∗ the hospital where the surgery was performed) ∗ based on the first qualifying ∗ ICD-9-CM diagnosis code encountered on the claim closest to death
  10. 10. Experience My Struggles My Supports∗ I don’t know what I don’t know ∗ Medicare Data∗ Learning STATA ∗ Researchers’∗ Learning SAS assistance∗ Identify all readmissions associated with the ∗ Resources (forums patients that passed and textbooks) during the years of collected data∗ Combine patient data with hospital data
  11. 11. Lessons Learned / Experience Gained ∗ Beauty of tutorials ∗ Frustration of poor organization / lack of standardization ∗ Importance of efficiency ∗ Value of programmer comments
  12. 12. Background: California’s Nurse Mandate Claims that a lower patient-to-nurse ratio promotes better patient outcomes 1999 – Legislation signed into law 2002 – Final ratios hospitals would face are released 2004 – Mandate implemented
  13. 13. California’s Nurse to Patient Mandate∗ Linda H. Aiken, PhD, RN; Sean P. Clarke, PhD, RN; Douglas M. Sloane…∗ Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction ∗ each additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission ∗ 7% increase in the odds of failure-to-rescue. ∗ 23% increase in the odds of burnout and a 15% increase in the odds of job dissatisfaction. Policy
  14. 14. Propelled Research: 2056∗ Magnet Hospitals∗ Hospital or department closings (not significant)∗ Public reporting: Nurse to Patient Ratios – increased competitiveness among hospitals∗ Lower percentage of skilled nurses (BSN trained): paper
  15. 15. California’s Nurse-to-Patient Mandate∗ California hospitals on average followed the trend of hospitals nationally by increasing their nursing skill mix, and they primarily used more highly skilled registered nurses to meet the staffing mandate∗ staffing mandate resulted in roughly an additional half-hour of nursing per adjusted patient day beyond what would have been expected in the absence of the policy∗ Lower Medicare Mortality Among a Set of Hospitals Known for Good Nursing Care – Magnet Hospital have 9.4 fewer deaths per 1000 patients∗ My part; literary reviews
  16. 16. Tremendous Gain∗ Inside the head of a researcher∗ Discuss inherent problems∗ Search for solutions∗ Be part of the developmental processes
  17. 17. United Arab Emirates∗ Established as a country in 1973∗ 30% of world’s cranes in Dubai – 2008∗ The UAE is classified as a high-income developing economy by the International Monetary Fund.∗ A high per-capita nominal GDP of US$47,407 for the last fiscal year.
  18. 18. Dubai∗ Monday, May 10th, 2010∗ Dr. Lauren Arnold - consultant to the UAE Ministry of Health and Executive Director of the newly formed UAE Council on Nursing∗ Operates out of the Office of Her Royal Highness Princess Haya
  19. 19. ∗ Ghada Sherry. Ghada is Head of practice Development Section, Federal Department of Nursing, Ministry of Health∗ Deputy Minister∗ Dr. Fatima Rafai, Chief Nurse of UAE∗ Dr. Linda Aiken∗ Dr. Hanif Al Qassimi, Minister of Health for United Arab Emirates∗ Dr. Lauren Arnold
  20. 20. The Surveys∗ 30 general hospitals of over 100 beds in the UAE∗ EU research protocol surveying nurses and patients∗ Grant from Emirates Foundation and the Ministry∗ Nursing survey - 8 pages, 15 questions each.
  21. 21. Intent∗ Use empirical data to sculpt a modern healthcare system∗ Very malleable – as oppose to the healthcare system of the United States∗ Create a international model
  22. 22. Coding∗ First – skim through packets searching for excessive mistakes.∗ Interesting findings from first glance: Nurses were eager to vent.∗ Physical and verbal abuse from patients, patients’ families, and superiors – Very Dissatisfied
  23. 23. Technical Lessons∗ Properly construct survey ∗ Typos ∗ Leave no room to wiggle ∗ BASIC∗ Importance of automated coding ∗ Countless work-hours ∗ Time consuming labor
  24. 24. Appreciation∗ Matthew D McHugh, PhD, JD, MPH, RN, CRNP∗ All personnel and faculty that make SUMR possible∗ SUMR Scholars