Benchmarking nurse sensitive quality patient outcomes across the continuum of care

Abstract

The impact health care delivery changes have on nursing and subsequently on the health of individuals, families, and the community are unknown to the nursing profession as well as the public. Delineation of patient outcomes sensitive to nursing care and their benchmarks would enable the nursing profession to evaluate system changes being implemented. Establishing targets for patient outcomes will provide facilities with benchmarks to measure themselves against. The purposes of this study were first, to identify if the nurse sensitive patient outcomes identified by the AAN expert panel are appropriate and second, to establish benchmarks for these outcomes that are applicable across the continuum of care. The appropriateness and benchmarks were determined through a Delphi study with nurse experts identified from the health care continuum of primary health care providers, hospitals, home care, hospice, and long term care. The five patient outcomes are Appropriate Self Care Behaviors, Symptom Management, Health Promoting Behaviors, Perceptions of Being Well Cared For, and Health Related Quality of Life (HRQOL). All patient outcomes were deemed appropriate for all healthcare settings. Two indicators of Health Related Quality of Life were excluded by the panel from Acute Care. Consensus was reached for the majority of patient outcomes. There were only seven benchmarks out of 18 for each continuum of care (a total of 90) that did not achieve consensus. The acute care participants did not reach consensus on one indicator within Health Promoting Behaviors. The remaining six were from Hospice participants: one indicator of Appropriate Self Care, all indicators of Health Promoting Behaviors and two within Health Related Quality of Life. The majority of benchmarks were in the mid to high range. Long Term Care tended to have lower scores than the other settings. Patient self care behaviors were very low for hospice patients. The indicators that did not meet consensus criteria were stable indicating that scores were not changing between rounds. Sample size of participants prevent citation of results for Home Care, Hospice and Long Term Care. Benchmarks can be set and used to evaluate the effectiveness of nursing care and the impact of system changes.