Transition to Practice Study:
Outcomes Data
Mary Blegen, PhD, RN, FAAN
Mary Lynn, PhD, RN
Phase II Site Coordinator Meeting
February 1, 2012
Why do outcomes matter?
 When outcomes are used something is the
“cause” and something is the “effect” even if
the study is not “causal” in nature
 In other words “A” leads to “B” (or “B” is a
consequence of “A”)
If A leads to B …
A
B
And B isn’t available…
A
B
You are left with “A”
A
Which does not allow you
to examine the possible
impact of “A” on what you
think it might effect.
The “causes” are a bit easier
A
 In this study - Randomly assigned
organizations to intervention and control groups
 Surveys can easily be identical for all
participants
 Fairly easy to prompt for them to be completed
at or about the same time (or the appropriate
time)
 Some of the “A”s are demographics (personal
or institutional) and can be obtained whenever
“Outcomes” are not as easy
B
 The same variable will differ in its definition
across institutions, even if the same type
(e.g., differ hospital to hospital)
 In this Phase we have a mix of institutional
types (e.g., home care, long term care, etc.)
that leads to many different definitions
 Outcomes “over time” require more
motivation (and nudging) to obtain
What is important about outcome data?
 That the data collected are:
 The same across all institutions
(to the extent possible)
 What is measured
 How they are measured
(circumstance, method, timing)
 As complete as possible
 Each set of items or variables
 The “over time” component
B
The “over time” part is important
Ideal
Baseline
Baseline
6 months
9 months
9 months
12 months
12 months
Baseline
Baseline
6 months
6 months
9 months
Each
problematic
12 months
For this research study
Aim is to determine the effects of the TTP intervention, and
the feasibility of this intervention in non-hospital setting
 Must have valid data for comparison
 Across facilities – intervention and control
 Across time – before and after the study
(Valid means accurate, measuring what we intend to
measure, and comparable across agencies and time)
 Measures should be similar in all organizations
 Surveys will be the same
 Outcomes data will be appropriate for each type of
organization
 Data collected using the same definitions and care
Obtaining Comparable Data
is a major challenge
Particularly with different types of organizations
 39 long term care
 4 public health
 3 home health
 2 ambulatory care
Collecting Data TTP project
Outcomes and Context
 Nurse Participants
 Organizations
 Patient/Client/Resident
Nurse Participants
 New Nurse Survey





Job satisfaction
Knowledge
Perception of competence
Stress
Report of Errors
 Preceptor Survey
 Effectiveness
 Knowledge
 Perception of new nurse
Organization Data
 Size
 Number of Beds, Days of Care, Visits, Clients,
Services provided
 Nursing Staff Size and Composition
 Numbers of RNs, LPNs, unlicensed nursing
assistants
 Budgeted, Actual, New hires, Contract/Per diem
 Nursing Retention (turnover)
 Voluntary – organization could control
 Voluntary – organization could not control
 Terminations – organization decides
Outcomes of Nursing Care Provided
(patient, resident, client outcomes)
Site Coordinator reporting
 Patient/client satisfaction
 With data available at each organization
 Use existing data for each type of site
Quality Outcomes Assessment
 Site Coordinators will complete this survey
 Survey was adapted to provide a comparable
measure across our four types of sites
from Nursing Intervention subscale of the Community
Health Nursing Outcomes Inventory





Nurse considers patients’ prior functioning
Nurse identified goals/areas to jointly work with patient
Patients are in control of their health outcomes
Nurse ensures that services/resources are available
Nurse makes appropriate healthcare referrals
Service Outcomes: examples
 Nursing Home – Nursing Home Compare
 Pressure ulcers
 Depression / anxiety
 Flu/pneumonia vaccine
-- Weight Loss
-- Restraints
 Home Health – Home Health Compare




Pain decreased
Improvements in breathing, wound healing
Medication accuracy and knowledge
Flu/pneumonia vaccine
Service Outcomes: examples
 Ambulatory - Agency Healthcare Research
Quality
 Falls and fall risk assessment
 Medication reconciliation
 Flu/pneumonia vaccine
 ER visits within 28 days
 Public health –
 Immunizations for children
 Rate of Chlamydia
 Prenatal care in first trimester
Summary
 The planned data collection will evaluate the
Nurse Participants, Preceptors, Organization, Outcomes
 It will be similar across all organizations
(outcomes appropriate to site type)
 Collected at both Intervention and Control sites
 What is measured is nearly the same
 How they are measured is nearly the same
 As complete as possible at each point in time
 And, collected at two or more points in time to allow
comparison over time within each organization, in types of
organizations and for the entire sample.
Questions?