RESUMO
The key elements of the evaluation process of an evidence-based practice (EBP) program and the infrastructure needed as identified by a large health care organization. The EBP evaluation program has 2 major elements for measuring success. The first component for evaluation is the impact on the clinical outcomes of care and the second is the fiscal implications of implementing the EBP. This article focuses on the fiscal evaluation component and describes a process to calculate the cost of care compared to before and after implementation of the EBP. The literature to support the care calculations is examined and a cost algorithm is described.
Assuntos
Enfermagem Baseada em Evidências/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Pesquisa em Avaliação de Enfermagem/economia , Qualidade da Assistência à Saúde/economia , Benchmarking , Colorado , Humanos , Liderança , Pesquisa em Avaliação de Enfermagem/estatística & dados numéricos , Qualidade da Assistência à Saúde/normasRESUMO
Nursing is often considered expensive in the cost analysis of academic programs. Yet nursing programs have the power to attract many students, and the national nursing shortage has resulted in a high demand for nurses. Methods to systematically assess programs across an entire university academic division are often dissimilar in technique and outcome. At a small, private, Midwestern university, a model for comprehensive program assessment, titled the Quality, Potential and Cost (QPC) model, was developed and applied to each major offered at the university through the collaborative effort of directors, chairs, deans, and the vice president for academic affairs. The QPC model provides a means of equalizing data so that single measures (such as cost) are not viewed in isolation. It also provides a common language to ensure that all academic leaders at an institution apply consistent methods for assessment of individual programs. The application of the QPC model allowed for consistent, fair assessments and the ability to allocate resources to programs according to strategic direction. In this article, the application of the QPC model to School of Nursing majors and other selected university majors will be illustrated.
Assuntos
Bacharelado em Enfermagem/economia , Modelos Econométricos , Escolas de Enfermagem/economia , Universidades/economia , Bacharelado em Enfermagem/normas , Humanos , Pesquisa em Avaliação de Enfermagem/economia , Escolas de Enfermagem/normas , Universidades/normasRESUMO
BACKGROUND: In 2008 the Nursing Secretariat of Ontario's Ministry of Health and Long-Term Care formed a Nursing Workload Steering Committee to oversee the implementation of three demonstration projects with the objectives: to assess the feasibility of Health Outcomes for Better Information and Care (HOBIC) data as a measure of nursing workload, determine the indicators that best support nurse leaders to measure nursing work and make informed staffing decisions, and develop a model that predicts acute care nursing costs. RESULTS: Three HOBIC scales--activities of daily living (ADLs), continence and fatigue--explained a small amount of the variance in nurse judgment of the amount of nursing time patients require in the first 24 hours of care. Nurses in the study appreciated providing their professional judgment to help estimate the nursing work requirements of patients. The priority and secondary indicators most important for decision-making included medical severity of patients, environmental complexity, nurse experience, patient turnover, nurse-to-patient ratio, cognitive status, infection control, nurse vacancy, predictability of patient types, nursing interventions, patient volumes, co-morbidities, patient self-care abilities, physical and psychosocial functioning, unit type and medical diagnosis. A fairly robust model was developed using existing data sources to estimate nursing input into a patient's costs. The model explained between 69% and 80% of the variation in nursing costs for each patient. CONCLUSION: In order to effectively measure, plan and cost nursing, we need to determine what nursing is. In the future, recognition of nurses as knowledge workers will require us to consider the many patient and environmental factors that affect the ability of nurses to apply their professional judgment to care for patients.
Assuntos
Liderança , Enfermeiros Administradores , Pesquisa em Avaliação de Enfermagem/economia , Enfermagem/organização & administração , Carga de Trabalho/economia , Atividades Cotidianas , Tomada de Decisões , Economia da Enfermagem , Fadiga , Estudos de Viabilidade , Pesquisas sobre Atenção à Saúde , Humanos , Assistência de Longa Duração , Modelos de Enfermagem , Análise Multivariada , Ontário , Estudos Prospectivos , Análise de Regressão , Meio Social , Estatísticas não Paramétricas , Inquéritos e Questionários , Recursos HumanosRESUMO
More than 500,000 premature infants are born in the United States every year. Preterm birth results in a multitude of negative adverse outcomes for children, including extended stays in the neonatal intensive care unit (NICU), developmental delays, physical and mental health/behavioral problems, increased medical utilization, and poor academic performance. In addition, parents of preterms experience a higher incidence of depression and anxiety disorders along with altered parent-infant interactions and overprotective parenting, which negatively impact their children. The costs associated with preterm birth are exorbitant. In 2005, it is estimated that preterm birth cost the United States $26.2 billion. The purpose of this study was to perform a cost analysis of the Creating Opportunities for Parent Empowerment (COPE) program for parents of premature infants, a manualized educational-behavioral intervention program comprising audiotaped information and an activity workbook that is administered to parents in 4 phases, the first phase commencing 2 to 4 days after admission to the NICU. Findings indicated that the COPE program resulted in cost savings of at least $4864 per infant. In addition to improving parent and child outcomes, routine implementation of COPE in NICUs across the United States could save the healthcare system more than $2 billion per year.
Assuntos
Custos Hospitalares , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/economia , Pais , Poder Psicológico , Desenvolvimento de Programas/economia , Análise Custo-Benefício , Feminino , Gastos em Saúde , Hospitalização/economia , Humanos , Recém-Nascido , Tempo de Internação/economia , Masculino , Pesquisa em Avaliação de Enfermagem/economia , Estados UnidosRESUMO
The study describes the design and implementation of an Internet-based, computed-assisted telephone survey about the care-planning process in 107 long-term care facilities in the Midwest. Two structured telephone surveys were developed to interview the care planning coordinators and their team members. Questionmark Perception Software Version 3 was used to develop the surveys in a wide range of formats. The responses were drawn into a database that was exported to a spreadsheet format and converted to a statistical format by the Information Technology team. Security of the database was protected. Training sessions were provided to project staff. The interviews were tape-recorded for the quality checks. The inter-rater reliabilities were above 95% to 100% agreement. Investigators should consider using Internet-based survey tools, especially for multisite studies that allow access to larger samples at less cost. Exploring multiple software systems for the best fit to the study requirements is essential.
Assuntos
Coleta de Dados/métodos , Pesquisas sobre Atenção à Saúde/métodos , Internet/estatística & dados numéricos , Pesquisa em Avaliação de Enfermagem/métodos , Telefone/estatística & dados numéricos , Segurança Computacional , Custos e Análise de Custo , Coleta de Dados/economia , Coleta de Dados/normas , Pesquisas sobre Atenção à Saúde/economia , Health Insurance Portability and Accountability Act , Humanos , Internet/economia , Meio-Oeste dos Estados Unidos , Estudos Multicêntricos como Assunto/enfermagem , Pesquisa em Avaliação de Enfermagem/economia , Casas de Saúde/normas , Processo de Enfermagem/normas , Variações Dependentes do Observador , Planejamento de Assistência ao Paciente/normas , Qualidade da Assistência à Saúde/normas , Projetos de Pesquisa , Inquéritos e Questionários/normas , Telefone/economia , Estados UnidosRESUMO
Economic evaluation is a critical tool for nursing and health care. The authors claim that economic inquiry needs to be supported by expertise in ethical inquiry, that the nursing profession needs to examine values concurrently with economics. Drawing on 2 ethnographic studies of nursing practice, the authors illustrate nurses' invisible work, their invisible triaging of clients, and the invisible costs to nurses and clients. They argue that invisible work, triage, and costs are embedded in a number of values, and that if nursing is to respond to the consequences of health reform, it must examine the values inherent in economic measurement and subsequent health-policy decisions; what is invisible may go "uncounted" unless economic evaluation is informed by ethical inquiry. The authors conclude by suggesting that economic and ethical inquiry be integrated in order to foster a system that is more humane as well as more effective and efficient for all those involved in health-care delivery.
Assuntos
Atitude do Pessoal de Saúde , Economia da Enfermagem , Emoções , Ética em Enfermagem , Descrição de Cargo , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Pesquisa em Avaliação de Enfermagem/economia , Recursos Humanos de Enfermagem/economia , Recursos Humanos de Enfermagem/psicologia , Triagem/economia , Carga de Trabalho , Antropologia Cultural , Atitude Frente a Saúde , Canadá , Tomada de Decisões Gerenciais , Saúde Holística , Humanos , Avaliação em Enfermagem , Pesquisa em Avaliação de Enfermagem/métodos , Pesquisa em Avaliação de Enfermagem/normas , Pesquisa Metodológica em Enfermagem , Autonomia Profissional , Valores Sociais , Gerenciamento do TempoRESUMO
Marie Cerinus uses a study into the value of clinical supervision to illustrate some of the resource issues involved in the conduct of action research. She describes the range and level of financial and personal commitment required if the research is to be successful.
Assuntos
Competência Clínica/normas , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa em Avaliação de Enfermagem/métodos , Supervisão de Enfermagem/organização & administração , Custos e Análise de Custo , Pesquisa sobre Serviços de Saúde/economia , Humanos , Pesquisa em Avaliação de Enfermagem/economia , Projetos de Pesquisa , Fatores de TempoRESUMO
An activity-based cost management system provides a framework to integrate the disciplines of quality and cost management. The integration occurs through the development of performance measures that collectively measure operations with respect to internal and external customers. It is the measurement process that allows management staff to evaluate where they are, determine where they want to be, and set a course of action that closes the gap between the two.