Evidence-based Standardized Care Plans for Use Internationally to Improve Home Care Practice and Population Health

Abstract

SummaryObjectives: To develop evidence-based standardized care plans (EB-SCP) for use internationally to improve home care practice and population health. Methods: A clinical-expert and scholarly method consisting of clinical experts recruitment, identification of health concerns, literature reviews, development of EB-SCPs using the Omaha System, a public comment period, revisions and consensus. Results: Clinical experts from Canada, the Netherlands, New Zealand, and the United States participated in the project, together with University of Minnesota School of Nursing graduate students and faculty researchers. Twelve Omaha System problems were selected by the participating agencies as a basic home care assessment that should be used for all elderly and disabled patients. Interventions based on the literature and clinical expertise were compiled into EB-SCPs, and reviewed by the group. The EB-SCPs were revised and posted on-line for public comment; revised again, then approved in a public meeting by the participants. The EB-SCPs are posted on-line for international dissemination. Conclusions: Home care EB-SCPs were successfully developed and published on-line. They provide a shared standard for use in practice and future home care research. This process is an exemplar for development of evidence-based practice standards to be used for assessment and documentation to support global population health and research. BackgroundStandardized terminologies (vocabularies) have potential to enable information exchange across populations and settings. They are defined as "a set of standardized terms and their synonyms that record patient findings, circumstances, events, and interventions with sufficient detail to support clinical care, decision support, outcomes research and quality improvement" [1]. Nursing scholars have led development of standardized interface terminologies since the 1970's. Currently, computer applications are driving widespread adoption of these terminologies to describe health assessments and health care interventions [2,3]. However, unless standards are used consistently across settings, data generated during clinician documentation are not likely to be comparable [3,4]. To enable optimal information exchange and meaningful use of data in research and program evaluation, standardized terminologies must also be used systematically to describe standards of care consistently across settings. Such efforts to promote evidence-based health care are essential to maximize clinician influence on population health outcomes. Disseminating research findings to practice settings is a daunting task [5]. Low success rates have been reported from passive dissemination such as publications and presentations. More effective approaches such as verbal reminders and educational outreach are needed in order to change practice behaviors of clinicians and other health care professionals [6,7]. However, these solutions are labor and cost-intensive, and are thus unrealistic in a resource-constrained health care environment. ...

Integrative Nursing and Omaha System–Based Nursing Care Interventions in Older Women Feeling Loneliness (INOSEL): Study Protocol for a Randomized Controlled Trial

“…The use of the Omaha System in the care of the elderly makes it easier for health care professionals to provide the care at any time or anywhere in line with the principles of integrative nursing and can increase the well-being of the elderly. This system used in community care settings focuses on holistic care and facilitates holistic nursing practice (Monsen et al, 2011;The Omaha System, 2019). The Omaha System problem diagnostics and interventions are consistent with holistic philosophy and the principles of IN (Delaney et al, 2014;Austin, 2019).…”

Exploring the Value of Clinical Data Standards to Predict Hospitalization of Home Care Patients

“…Inconsistencies in documentation due to time constraints in home care practice settings, variations in agency documentation policies, and semantic equivalence in patient care plans may bias Omaha System data and HRS results. These threats should be addressed through uniform data collection protocols and policies across EHRs to enable data comparison and to ensure process interoperability, and the use of standardized care plans integrating evidence-based practice [48][49][50].…”

“…An additional care description term may be customized to further describe the intervention. Evidence-based standardized care plans (EB-SCPs) have been developed using the Intervention Scheme [48,49]. These are similar to computerized provider order entry (CPOE) using order sets.…”

“…Development of the HRS was based on methodology used to create the MRI described in 1.3.2, in which the sum of selected patient problems (numerator) is adjusted by averaged baseline assessment scores (denominator) [48]. For example, upon admission if a patient had the problems of Cognition, Urinary function, Circulation, and Medication regimen, the sum of weights for these problems would be a score of 6.…”