Outcome Measures of Health Care and Nursing

Nursing Care and Health Outcomes Measure 

Outcome Measures,Research Based Outcomes,Outcomes and Clinical Variables,SF-36 Measures Eight Concepts.

Outcome Measures

    Outcomes of nursing and health care encompass changes in both client variables and organizational variables as a consequence of specific processes. Examples of client outcomes include satisfaction and preferences, disease or problem specific indicators, functional status, and quality of life. 

    Examples of organizational outcomes include internal customer satisfaction (ie, nurse or physician satisfaction), personnel safety (ie, injuries from needles and other “sharps”), and cost-effectiveness. 

    Client-focused variables that cross multiple diseases and conditions, such as mortality, nosocomial infections, falls, skin integrity, and medication errors, have been reported as both client and organizational outcomes.

Research Based Outcomes

    The national thrust toward outcomes management and research emanates from studies of medical practice variation, which became a priority research agenda in the 1980s. Outcomes management is an ongoing, research-based quest to meet specified quality goals. 

    Outcomes research seeks to determine whether specific interventions or practice models are beneficial in naturalistic environments. It is aimed at broad based populations and includes service settings other than academic medical centers or large urban environments. 

    In addition to randomized clinical trials, investigators attempt to link information about client outcomes with large administrative and clinical databases. Given an impetus to improve the outcomes of nursing care, investigators must solve various puzzles around appropriate target populations, the right outcome variables, and the associated process and structure variables.

Outcomes and Clinical Variables 

    Outcome measures incorporate intermediate clinical variables, such as blood pressure, as well as more extended outcomes, such as return to work. Researchers and managers are challenged to select or design outcome measures and establish their reliability and validity by issues related to sensitivity, specificity, situational contaminants such as severity of illness, and response set and other biases. 

    Variations in definitions, formulas, and data collection procedures frustrate between group comparisons, particularly for researchers who work with the large databases available from government agencies and organizations within the health care industry. 

    Contextual factors influence client outcomes, including organization ownership (public/private, profit/not for profit), involvement in teaching, case mix, volume of patients treated, organization size, and the extent to which the organization engages in high tech procedures. Still to be determined is the impact on client outcomes of the integration of health care providers into complex networks.

SF-36 Measures Eight Concepts

    Projects to develop standardized measures abound. For example, John Ware Jr. and colleagues (Medical Outcomes Trust, 1993) published the SF-36 Health Survey, which investigators are using with increasing frequency to assess health status and quality of life from the client's point of view. The SF-36 measures eight concepts: 

(a) limitations in physical activities because of health problems

(b) limitations in social activities because of physical or emotional problems

(c) limitations in usual role activities because of physical health problems

(d ) psychological stress and well-being

(c) limitations in usual role activities because of emotional problems

(f) bodily pain

(g) vitality

(h) general health perceptions.

    Prominent among efforts to standardize measures for outcomes research is the ongoing project conducted by McCloskey and Bulechek (1996), M. Johnson and Maas (1997), and their colleagues at the University of Iowa College of Nursing to develop and maintain taxonomies of nursing interventions and out comes.     

    In a different arena, the Joint Commission on Accreditation of Healthcare Organizations (1997) has initiated a program that will require organizations seeking accreditation to report patient outcomes. 

    Under that program, Oryx Outcomes: The Next Evolution in Accreditation, hospitals choose two clinical performance indicators for reporting from among 60 measurement systems; the selected outcomes must relate to at least 20% of the hospital's patient population. 

    The Agency for Health Care Policy and Research (AHCPR) and the president and fellows of Harvard College have released a computerized compendium of approximately 1,200 clinical performance measures developed by public and private sector organizations to examine the quality of health care. 

    CONQUEST 1.0 (Computerized Needs Oriented Quality Measurement Evaluation System) can be accessed and downloaded from the AHCPR World Wide Web home page at (http://www.ahcpr.gov/).