Linkages Between Nursing Care and Improved Patient Outcomes
Linkages Between Nursing Care and Improved Patient Outcomes
Health information technology (health IT or HIT) holds the potential to transform the quality of care and to establish linkages between nursing care and patient outcomes. This article defines eMeasurement and describes Quality of Care Definitions and Metrics for Evaluation. The authors explore the role of health IT to improve quality, barriers to eMeasurement, and health IT interventions by considering linkages between nursing care and patient outcomes for a select set of nursing sensitive indicators including patient falls, pressure ulcers, and the patient experience. We discuss specific challenges, such as barriers for routine data capture to populate nursing sensitive indicators and the use of health IT to promote positive outcomes. The conclusion addresses the implications of the current state of health IT and identifies areas for further nursing research.
There is longstanding evidence that linkages exist between nursing care and improved patient outcomes. Florence Nightingale used quality improvement data and statistics to support a hand washing campaign that prevented soldiers from dying of hospital acquired infections during the Crimean war (Gill & Gill, 2005). Over the past decade, the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative demonstrated the impact of nursing care on patient sensitive outcomes, such as fall prevention (Dykes et al., 2010; Dykes, Carroll, Hurley, Benoit, & Middleton, 2009; Shever, Titler, Mackin, & Kueny, 2011); pain management (Beck, Towsley, Berry, Brant, & Smith, 2010); and delirium prevention (Balas et al., 2012). Despite the scientific advancements that have occurred since the 1850s, the quality of care in United States remains suboptimal. A series of Institute of Medicine (IOM) reports published over the past decade suggest that error rates are high and the quality of care across the United States (U.S. healthcare system is variable (Adams & Corrigan, 2003; Kohn, Corrigan, & Donaldson, 1999; Lohr, 1990). Even where evidence exists, it is inconsistently applied in practice (McGlynn et al., 2003). The cost of healthcare is also of concern. Healthcare expenditures currently comprise 18% of the gross domestic product (GDP), and if the current trend continues, healthcare will consume 34% of the GDP by 2040 (Council of Economic Advisors, 2009).
Unsustainable costs and unreliable quality are stimulating changes in healthcare policy and practice. The use of health IT has long been recommended as a strategy to facilitate cost effective, high-quality, and safe patient care (Committee on Data Standards for Patient Safety, 2003). The American Recovery and Reinvestment Act (ARRA) provides incentives for providers and hospitals to adopt certified electronic health records and to use them in a meaningful way, including facilitating care coordination and electronic submission of data for quality reporting purposes (Centers for Medicare and Medicaid Services, 2010). Rapidly evolving healthcare policy that is driving adoption and use of health IT and quality measurement standards hold potential for transformation of the healthcare system but enhancements to both are needed. Clinical information systems have traditionally been designed to support clinical tasks and to capture data needed to support billing of physician services and regulatory requirements (Cusack et al., 2013). Secondary use of data for quality measurement represents a paradigm shift that requires transformative changes in practice and in the architecture and configuration of electronic systems (Tolar & Balka, 2012).
This article explores the use of "nursing sensitive" indicators and health IT to improve quality of care and to establish linkages between nursing care and improved patient outcomes. Nursing-sensitive indicators are defined as measures that reflect the structure, process and outcomes of nursing care (ANA, 2013). Nursing-sensitive outcome indicators are defined measurement strategies for patient or caregiver states that are sensitive to nursing care (Given & Sherwood, 2005). In this article, we will demonstrate the role of health IT in building linkages between nursing care and improved patient outcomes focusing on two mechanisms: 1) eMeasurement, and 2) health IT interventions directly targeting nursing sensitive indicators. The following set of indicators are used to demonstrate the current capabilities of health IT for building such linkages: patient falls, pressure ulcers and patient experience (Centers for Medicare and Medicaid Services, 2013). We will identify existing barriers and then make recommendations for improvements needed to routinely build linkages between nursing care and patient outcomes.
Abstract and Introduction
Abstract
Health information technology (health IT or HIT) holds the potential to transform the quality of care and to establish linkages between nursing care and patient outcomes. This article defines eMeasurement and describes Quality of Care Definitions and Metrics for Evaluation. The authors explore the role of health IT to improve quality, barriers to eMeasurement, and health IT interventions by considering linkages between nursing care and patient outcomes for a select set of nursing sensitive indicators including patient falls, pressure ulcers, and the patient experience. We discuss specific challenges, such as barriers for routine data capture to populate nursing sensitive indicators and the use of health IT to promote positive outcomes. The conclusion addresses the implications of the current state of health IT and identifies areas for further nursing research.
Introduction
There is longstanding evidence that linkages exist between nursing care and improved patient outcomes. Florence Nightingale used quality improvement data and statistics to support a hand washing campaign that prevented soldiers from dying of hospital acquired infections during the Crimean war (Gill & Gill, 2005). Over the past decade, the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative demonstrated the impact of nursing care on patient sensitive outcomes, such as fall prevention (Dykes et al., 2010; Dykes, Carroll, Hurley, Benoit, & Middleton, 2009; Shever, Titler, Mackin, & Kueny, 2011); pain management (Beck, Towsley, Berry, Brant, & Smith, 2010); and delirium prevention (Balas et al., 2012). Despite the scientific advancements that have occurred since the 1850s, the quality of care in United States remains suboptimal. A series of Institute of Medicine (IOM) reports published over the past decade suggest that error rates are high and the quality of care across the United States (U.S. healthcare system is variable (Adams & Corrigan, 2003; Kohn, Corrigan, & Donaldson, 1999; Lohr, 1990). Even where evidence exists, it is inconsistently applied in practice (McGlynn et al., 2003). The cost of healthcare is also of concern. Healthcare expenditures currently comprise 18% of the gross domestic product (GDP), and if the current trend continues, healthcare will consume 34% of the GDP by 2040 (Council of Economic Advisors, 2009).
Unsustainable costs and unreliable quality are stimulating changes in healthcare policy and practice. The use of health IT has long been recommended as a strategy to facilitate cost effective, high-quality, and safe patient care (Committee on Data Standards for Patient Safety, 2003). The American Recovery and Reinvestment Act (ARRA) provides incentives for providers and hospitals to adopt certified electronic health records and to use them in a meaningful way, including facilitating care coordination and electronic submission of data for quality reporting purposes (Centers for Medicare and Medicaid Services, 2010). Rapidly evolving healthcare policy that is driving adoption and use of health IT and quality measurement standards hold potential for transformation of the healthcare system but enhancements to both are needed. Clinical information systems have traditionally been designed to support clinical tasks and to capture data needed to support billing of physician services and regulatory requirements (Cusack et al., 2013). Secondary use of data for quality measurement represents a paradigm shift that requires transformative changes in practice and in the architecture and configuration of electronic systems (Tolar & Balka, 2012).
This article explores the use of "nursing sensitive" indicators and health IT to improve quality of care and to establish linkages between nursing care and improved patient outcomes. Nursing-sensitive indicators are defined as measures that reflect the structure, process and outcomes of nursing care (ANA, 2013). Nursing-sensitive outcome indicators are defined measurement strategies for patient or caregiver states that are sensitive to nursing care (Given & Sherwood, 2005). In this article, we will demonstrate the role of health IT in building linkages between nursing care and improved patient outcomes focusing on two mechanisms: 1) eMeasurement, and 2) health IT interventions directly targeting nursing sensitive indicators. The following set of indicators are used to demonstrate the current capabilities of health IT for building such linkages: patient falls, pressure ulcers and patient experience (Centers for Medicare and Medicaid Services, 2013). We will identify existing barriers and then make recommendations for improvements needed to routinely build linkages between nursing care and patient outcomes.