Tuesday, June 26, 2012

[EQ] An Analysis of Nursing and Healthcare System Outcomes

Better Care: An Analysis of Nursing and Healthcare System Outcomes

Gina Browne, McMaster University, Hamilton, Ontario Faculty of Health Sciences: School of Nursing, Health and Social Service Utilization Research Unit, Department of Clinical Epidemiology and Biostatistics

Stephen Birch, McMaster University, Hamilton, Ontario Faculty of Health Sciences: Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis

Lehana Thabane, McMaster University, Hamilton, Ontario Faculty of Health Sciences: Health and Social Service Utilization Research Unit, Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis


Canadian Health Services Research Foundation Canadian Nursing Association CNA/CHSRF
CNA/CHSRF series of reports to inform the CNA National Expert Commission

The Health of Our Nation – The Future of Our Health System: Paper 2, June 2012

Available online PDF [135p.] at: http://bit.ly/NJLAhW

Appendix B: http://bit.ly/LNuI6j

“……The purpose of this review of nursing intervention literature was to document the comparative effects and costs of models of nursing intervention on patient outcomes, such as morbidity and mortality, and on system outcomes, such as health resource use.


This information will be used to provide suggestions about innovative, effective and efficient models of nursing intervention in preparation for the 2014 new federal health accord.

Eligible reviews and studies were those of interventions provided by nurses that documented:

- patient outcomes related to mortality and morbidity, such as functional status, quality of life, coronary or adverse events, and caregiver burden; and

- system outcomes related to use of emergency departments, hospitalizations, length of stay, admissions to nursing homes, and/or total direct cost of health service use from a payer perspective; or

- patient impacts related to wait times or access to care.


This review was conducted in three stages:

1. In the initial stage we evaluated high-quality reviews.

2. The second stage involved reviewing high-quality studies of nursing interventions because of limitations in the initial reviews.

3. In the third stage we reviewed studies from McMaster University’s System-Linked Research Unit on Health and Social Service Utilization (SLRU) that involved economic evaluations conducted from a societal perspective alongside clinical trials. In addition, these studies included not only patient outcomes but also health and social effects – direct, indirect and cash transfer effects – of comparative treatments for various illnesses. We did this third stage because the description of

costing methods in the previous studies lacked detail.


To determine whether nurse interventions were comparatively more effective and less costly, we used an analytic framework for economic evaluations to simultaneously summarize the patient effects and system costs qualitatively and in aggregate.

We initially examined over 4,000 reviews and studies to determine whether they met both eligibility criteria and “high-quality standards” for the conduct of reviews and studies. Twenty-seven reviews, 29 studies and nine economic evaluations met the initial minimum eligibility criteria and 75% of the 21 standards of quality for reviews and studies. Included studies were conducted in the United Kingdom, Canada, Australia, the United States and the Netherlands. Included economic evaluations were conducted in southern Ontario…..”


Executive Summary


Section 1: Literature Review and Promising Nurse-Led Practices

Section 2: Costs Averted, Key Clinical Programs and Performance Measurement

2.1 Service innovations documenting similar outcomes at a provincial or national level

2.1a Treatment for chronic pressure ulcers

2.1b Adoption of leading practices in home wound care

2.1c Palliative home care
2.1d Ontario’s Chronic Disease Prevention and Management Framework

2.1e Chronic disease management in the community or at home

2.1f Managing people requiring alternative levels of care

2.1g Home telehealth for chronic disease management

2.2 Key clinical programs across the range of determinants of health: Implications for achieving better care for Canadians

2.3 Strategic investments made and required for monitoring , evaluation , performance measurement and research

2.4 A last word


Appendix A: Search Terms With Results, Criteria and Strategies

Appendix B: Excluded Reviews and Studies

Appendix C: Results of Our Review of High-Quality Reviews

Appendix D: Characteristics of High-Quality Studies, Participants and Intervention Programs

Appendix E: Economic Evaluations of Nursing Intervention Programs



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