Purpose-The purpose of the study was to discover which patient and support system characteristics and interventions documented by home health clinicians were associated with improvement in urinary and bowel incontinence contrasting logistic regression and data mining approaches.Subjects and Setting-1,793 patients in this study had 2,072 episodes of care representing all non-maternity patients who were ages 18 or older and receiving skilled home health services in 2004 from a convenience sample of 15 home health agencies.Design-This study is a secondary analysis of data from 15 home health agencies' electronic health records.Instruments-Data for this study were documented by home care clinicians using the Outcome and Assessment Information Set (OASIS) structured assessment form and the Omaha System interventions, which is a standardized terminology.Results-There were 684 patients with urinary incontinence and 187 with bowel incontinence. By discharge 38% improved in urinary incontinence and 45% improved their bowel incontinence. Using logistic regression, no patient or support system characteristics were associated with improvement in either urinary or bowel incontinence, only a limited number of interventions were significant. A data mining decision tree was producible only for bowel incontinence, demonstrating a combination of patient and support system factors as well as selected interventions were important in determining whether patients would improve in bowel incontinence.Conclusions-Home health patients have complex comorbid conditions requiring home care nurses to have broad, generalized knowledge. Future research is needed to determine if the inclusion of a certified wound, ostomy, and continence nurse would improve outcomes.
Federal and state initiatives are aligning around the goal that by 2014 all Americans will have electronic health records to support access to their health information any time and anywhere. As a key health care provider, nursing data must be included to enhance patient safety, effectiveness, and efficiency of care that is patient-centric. The purpose of this study was to test the feasibility of abstracting, integrating, and comparing the effective use of a standardized terminology, the Omaha System, across software vendors and 15 homecare agencies. Results showed that the 2,900 patients in this study had an average of four problems on care plans, with interventions most frequently addressing surveillance (39%) and teaching (30%). Findings in this study support the feasibility of integrating data across software vendors and agencies as well as the usefulness for describing care provided in homecare. However, before exchanging data across systems data quality issues found in this study need attention. There was missing data for 10.8% of patients as well as concerns about the validity of using the problem rating scale for outcomes. Strategies for effective use of standardized nursing terminologies are recommended.
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