Jeffs Lianne, Jiang Depeng, Wilson Gail, Ferris Ella, Cardiff Brenda, Lanceta Mary, White Peggy, Pringle Dorothy
Keenan Research Centre, Li KaShing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Nurs Leadersh (Tor Ont). 2012 Dec;25(4):48-62. doi: 10.12927/cjnl.2013.23263.
Integral to understanding and leveraging performance data to monitor and drive quality improvement (QI) efforts to enhance patient care is a partnership between researchers (who generate data) and nurse executives (who lead QI efforts). In Canada, evidence-based, nursing-sensitive patient outcome data are included in the Health Outcomes for Better Information and Care (HOBIC) initiative. A descriptive study was undertaken to examine the relationships and predictive abilities of HOBIC measures with length of stay (LOS) and alternate levels of care (ALC) measures. Specifically, we were interested in determining (a) whether relationships among the HOBIC measures exist and (b) whether any of the HOBIC measures are associated with, and could subsequently be used to predict, the patient and the destination to which he or she is discharged (ALC). Our interest in understanding these relationships and predictive abilities was both research driven and practice driven, with the intent eventually to use study findings to target clinical practice and data feedback strategies. To address the two research aims, this study employed both descriptive and inferential statistical approaches with multiple analytic approaches. Study results suggest that many of the HOBIC measures are related, with a higher score in one measure corresponding to a higher score in another measure. The exception is the therapeutic self-care (TSC) measure, in which higher scores on other HOBIC measures were correlated with lower TSC scores. Associations were also found with the predictive ability of certain HOBIC measures on LOS and ALC. Our study findings call for nurse leaders to emphasize the importance to clinical nurses on hospital units of focusing their efforts on assisting patients in managing their fatigue and dyspnoea effectively; increasing their ability to engage in activities of daily living, functional status and therapeutic self-care; and preventing or minimizing pressure ulcers and falls in acute care patients. In turn, these efforts may decrease patients' LOS.
理解并利用绩效数据来监测和推动质量改进（QI）工作以提升患者护理水平的关键在于研究人员（负责生成数据）与护士管理人员（负责领导QI工作）之间的合作。在加拿大，基于证据的、护理敏感型患者结局数据被纳入“健康结局促进更好信息与护理”（HOBIC）倡议中。开展了一项描述性研究，以检验HOBIC指标与住院时间（LOS）及替代护理级别（ALC）指标之间的关系和预测能力。具体而言，我们感兴趣的是确定：（a）HOBIC指标之间是否存在关系；（b）是否有任何HOBIC指标与患者及其出院目的地（ALC）相关，进而能否用于预测。我们对理解这些关系和预测能力的兴趣既受研究驱动，也受实践驱动，最终目的是利用研究结果来确定临床实践和数据反馈策略。为实现这两个研究目标，本研究采用了描述性和推断性统计方法以及多种分析方法。研究结果表明，许多HOBIC指标之间存在关联，一个指标得分较高对应另一个指标得分也较高。例外的是治疗性自我护理（TSC）指标，其他HOBIC指标得分较高与TSC得分较低相关。还发现某些HOBIC指标对LOS和ALC具有预测能力。我们的研究结果呼吁护士领导者向医院各科室的临床护士强调，要重视协助患者有效管理疲劳和呼吸困难；提高他们参与日常生活活动、功能状态和治疗性自我护理的能力；预防或尽量减少急性护理患者的压疮和跌倒。反过来，这些努力可能会缩短患者的住院时间。
