Chapter010

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 10
The Role of Outcomes in
Evaluating Practice Change

Outcomes Management (OM)
• A technology of patient experience designed to help
patients, payers, and providers make rational medical
care-related choices based on better insight into the
effect of these choices on patient life

Principles Supporting OM
• Emphasizing practice standards that providers can use to
select interventions
• Measuring patient functional status, well-being, and
disease-specific clinical outcomes
• Pooling outcome data on a massive scale
• Analyzing and disseminating outcomes, in relation to the
interventions used, to appropriate decision makers and
stakeholders

Health Outcomes Institute’s Outcomes
Management Model
• Provides steps to guide measurement of the impact of
new interventions on improving healthcare outcomes
• Four phase process
1. Defining outcome measures
2. Assessing traditional practice; interdisciplinary
engagement
3. Implementing EBP initiatives
4. Analysis of process and outcomes
• See Figure 10.1

Question
• Tell whether the following statement is true or false.
• The Health Outcomes Institute’s Outcomes Management
Model provides a four-step process for the critical
appraisal of evidence.

Answer
• False
• Rationale: The Health Outcomes Institute’s Outcomes
Management Model delineates a process that can be used
to guide measurement of the impact of new interventions
on improving healthcare outcomes. It does not provide a
specific process for critical appraisal of the literature.

Quantifying the Effect of Interventions
• Acceptance of new evidence-based initiatives can be
fostered by measuring the failed outcomes achieved with
traditional practices
− Outcomes measurement as a change promoter

Sources of Data: Internal Evidence
• Healthcare organizations have a wealth of data that can
be used to measure outcomes
− Quality management departments
− Finance departments
− Human resource departments
− Clinical systems
− Administration
− Electronic health records

Question
• Which of the following would be the best source for
measuring the outcomes related to a proposed change in
the skills mix in the nursing care at a hospital?
a. Finance
b. Human resources
c. Quality management
d. Administration

Answer
• b. Human resources
• Rationale: Human resource departments are a key source
of data surrounding skills mix, staffing levels, staff
demographics, recruitment, and retention. Departments
such as finance, administration, and quality management
would be less likely to provide data on the current skills
mix at the hospital.

Asking the Right Questions from the
Right Sources
• It is common to encounter barriers to getting the data
needed to answer questions about the impact of current
practice
• Be clear about what data you need
• Ensure it is in a usable format (electronic)

When Existing Data Sources are
Unavailable
• Sometimes, the data required are not available from any
source
• Efficiently gathering new data takes forethought,
ingenuity, and familiarity with collection techniques and
the importance of measurement
• Measurement instruments must be evaluated as to
whether they are valid and reliable

Levels of Data
• Categorical versus numerical
• Nominal – descriptive, low-level data
• Ordinal – ranking data from lowest to highest
• Interval – numeric values with fixed values separating
each point
• Ratio – similar to interval level, but with a true zero
point

Question
• A rating scale asks patients to gauge their nausea by
describing it as “no nausea,” “slightly nauseous,”
“significantly nauseous,” or “severely nauseous.” This
scale provides the nurse with data at what level?
a. Nominal
b. Ordinal
c. Interval
d. Ratio

Answer
• b. Ordinal
• Rationale: Likert-type scales like the one presented
provide ordinal level data. Phenomena are scaled in an
ascending manner, but it is not possible to extrapolate
insights from the data mathematically.

Reporting to Key Stakeholders
• All parties involved with the process of practice change
should have an opportunity to understand the results
achieved
• Reports can be constructed in any way the organization
chooses to present the data. Examples include
− Scorecards
− Dashboards

Designs for Comparing Traditional
Practice New Interventions
• Quasi-experimental and experimental methods are
typically used to generate outcomes that reflect the
impact of the comparison
• Effect size, power, and probability should be identified
• Ethical considerations

Summary
• Demonstrating that practice change has indeed brought
about improved outcomes is imperative
• Evaluation of outcomes must be conducted in a manner
that is valid and reliable
• Outcomes must be widely disseminated

Chapter010

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Chapter010