Extending the Nurse Practitioner Concurrent Intervention Model to Community-Acquired Pneumonia and Chronic Obstructive Pulmonary Disease

Groß, Peter; Aho, Linda; Ashtyani, Hormoz; Levine, Jerome; McGee, M. Lisa; Moran, Stephen; Anton, Thomas J.; Feldman, Joseph; Kuyumjian, Arpi G; Skurnick, Joan

doi:10.1016/s1549-3741(04)30043-2

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…Compliance with CMS indicators greatly improved, and length-of-stay decreased without a rise in the readmission rate for discharged patients. 38 Here we have guidelines that actually work. But do the guidelines cause change or merely channel it?…”

Section: A Multifaceted Approach To Ebm Implementationmentioning

confidence: 99%

The Promises And Pitfalls Of Evidence-Based Medicine

Timmermans¹,

2005

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Evidence-based medicine (EBM) aims to address the persistent problem of clinical practice variation with the help of various tools, including standardized practice guidelines. While advocates welcome the stronger scientific foundation of such guidelines, critics fear that they will lead to "cookbook medicine." Studies show, however, that few guidelines lead to consistent changes in provider behavior. The hopes, fears, and mixed record of EBM are rooted in the traditional professional perspective of the clinician as sole decisionmaker. Multifaceted implementation strategies that take the collaborative nature of medical work into consideration promise more effective changes in clinical practice. E v i d e nc e -b a se d m e di c i n e (EBM) is commonly defined as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."1 The term is loosely used and can refer to anything from conducting a statistical meta-analysis of accumulated research, to promoting randomized clinical trials, to supporting uniform reporting styles for research, to a personal orientation toward critical self-evaluation. EBM was initially defined in opposition to clinical experience, but later definitions have emphasized its complementary character and have aimed to improve clinical experience with better evidence.2 One common implementation of EBM involves the use of clinical practice guidelines during medical decision making to encourage effective care. The Institute of Medicine (IOM) defines clinical guidelines as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."3 An expert committee does the work of sifting through the scientific literature for clinicians and offers coherently sequenced recommendations based on the best available evidence aimed at everyday decision-making situations. Guidelines can be applied to any aspect of clinical care: how and when to order diagnostic or screening tests, when to provide certain medical services, how these should be performed, and how long 1 8 J a n u a r y / F e b r u a r y 2 0 0 5 H i s t o r y & C o n t e x t

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Section: A Multifaceted Approach To Ebm Implementationmentioning

confidence: 99%

The Promises And Pitfalls Of Evidence-Based Medicine

Timmermans¹,

2005

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“…Success was attributed to the wide engagement of stakeholders; forming multidisciplinary teams championed by a nurse practitioner; making changes based on local input; dissemination via workshops, grand rounds, and mailings; and collecting data on process measures. 58…”

Section: Improving Guideline Uptakementioning

confidence: 99%

Clinical Practice Guidelines

Murad

2017

Mayo Clinic Proceedings

307

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Trustworthy clinical practice guidelines should be based on a systematic review of the literature, provide ratings of the quality of evidence and the strength of recommendations, consider patient values, and be developed by a multidisciplinary panel of experts. The quality of evidence reflects our certainty that the evidence warrants a particular action. Transforming evidence into a decision requires consideration of the quality of evidence, balance of benefits and harms, patients' values, available resources, feasibility of the intervention, acceptability by stakeholders, and effect on health equity. Empirical evidence shows that adherence to guidelines improves patient outcomes; however, adherence to guidelines is variable. Therefore, guidelines require active dissemination and innovative implementation strategies.

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“…In another case, NPs provided quality care for Community Acquired Pneumonia (CAP) and Chronic Obstructive Pulmonary Disease (COPD) based on the Center for Medicaid and Medicare Services (CMS) performance measures. This resulted in 90% compliance with all CMS measures, significant reductions in length of stay and cost savings (length of stay decreased by 1.34 days; US$2,576 profit per case) and cost savings occurred without an increase in pneumonia readmissions (Gross et al, 2004).…”

Section: Literature Overviewmentioning

confidence: 99%

Practical Insights on Expanding Nurse Practitioner’s Role During and Post Hospitalization in U.S. Health Care

Kumar

McKewan

2011

Home Health Care Management & Practice

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Aim:The purpose of this study is to investigate expanding the role of nurses in the current U.S. health care system from the standpoint of nurse-patient interactions and nursing interventions to improve patient care and reduce overall health care costs. Background: Many failures in nurse-patient interactions in the hospital and in postrelease setting can be eliminated with different forms of patient-centered care that include patient education, support, and counseling. Method: This study makes use of extensive review of literature from academic databases to analyze increased Nurse Practitioner (NP) role in nurse-patient interactions during patients' in-hospital experience and postrelease environment. Conclusions: Expanding the role of nurses would improve the overall health care system in the United States and save money over the long run. Long-term follow-up with patients would promote a healthier lifestyle and reduce the likelihood of return to the hospital. NPs are uniquely positioned to potentially serve as change agents within health care systems. Implications: Nursing educators and managers will need to work closely with policy makers to implement the expanded role of nurses to improve the U.S. health care system.

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Extending the Nurse Practitioner Concurrent Intervention Model to Community-Acquired Pneumonia and Chronic Obstructive Pulmonary Disease

Cited by 7 publications

References 27 publications

The Promises And Pitfalls Of Evidence-Based Medicine

The Promises And Pitfalls Of Evidence-Based Medicine

Clinical Practice Guidelines

Practical Insights on Expanding Nurse Practitioner’s Role During and Post Hospitalization in U.S. Health Care

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