Lessons Learned from Testing the Quality Cost Model of Advanced Practice Nursing (APN) Transitional Care

Abstract

Purpose-To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research.Organizing Construct-The Quality Cost Model of APN Transitional Care.Methods-Review of published results of seven randomized clinical trials with very low birthweight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and women with high risk pregnancies in which half of physician prenatal care was substituted with APN care. Ongoing work with the model is linking the process of APN care with the outcomes and costs of care. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptFindings-APN intervention has consistently resulted in improved patient outcomes and reduced health care costs across groups. Groups with APN providers were rehospitalized for less time at less cost, reflecting early detection and intervention. Optimal number and timing of postdischarge home visits and telephone contacts by the APNs and patterns of rehospitalizations and acute care visits varied by group.Conclusions-To keep people well over time, APNs must have depth of knowledge and excellent clinical and interpersonal skills that are the hallmark of specialist practice, an in-depth understanding of systems and how to work within them, and sufficient patient contact to effect positive outcomes at low cost. Keywordsadvanced practice nurses; Quality Cost Model; transitional care; costs; outcomes Dramatic changes in health care have occurred over the past 2 decades resulting in merged health systems, shortened hospital stays, rapid growth of outpatient and home care services and changed systems of reimbursement (Lesser & Ginsburg, 2001). The goal is to provide the most effective health care services at the lowest cost. Examining the effectiveness of health care providers has accompanied these changes. Today's data-driven health care systems require that provider practices are based on evidence and that provider time and number of patient contacts be justified (Delaney, Reed, & Clarke, 2000).In 1980, responding to changes occurring in health care, a team of researchers at the University of Pennsylvania developed a model of transitional care delivered by advanced practice nurses (APNs) that could serve as a safety net for vulnerable patient groups being discharged early from hospitals; this approach might maintain quality care and reduce health care costs . Since 1980 research with this model of care has been conducted in two phases. The first phase, which remains ongoing, focused on testing, refining, and modifying the model for use with different patient groups. Consistent success in improving patient outcomes and reducing health care costs in patient gr...

Déploiement de nouveaux rôles infirmiers au Québec et pouvoir médical

“…Ces rôles comportent le plus souvent deux volets, l'un d'intervention clinique et l'autre de coordination pour assurer des soins continus et aider les utilisateurs de soins et leurs familles à naviguer dans le système de santé. Certaines études montrent pourtant la valeur ajoutée de ces nouveaux rôles infirmiers (BROOTEN et al, 2002 ;BRYANT-LUKOSIS et al, 2004 ;BUCHAN et CALMAN, 2004 ;LAURANT et al, 2005).…”

“…Pensons à trois de ces nouveaux rôles qui attirent particulièrement l'attention, celui de l'infirmière dans les Groupes de médecine de famille (GMF), de l'infirmière praticienne spécialisée (IPS) et de l'infirmière pivot en oncologie (IPO). Des résultats de recherche montrent les effets positifs de ces rôles sur la qualité des soins, sur les résultats de soins et sur la satisfaction de la clientèle (HAGAN et MORIN, 2000 ;SHUM et al, 2000 ;BUTLER et al, 2001 ; VAN SOEREN et MICEVSKI, 2001 ;BROOTEN et al, 2002 ;BRYANT-LUKOSIS et al, 2004 ;SUSSMAN et al, 2004 ;FILLION et al, 2006). Cet article a pour but d'analyser le déploiement de trois nouveaux rôles infirmiers en contexte québécois et les facteurs qui influencent ce déploiement en portant un intérêt particulier à la dimension du pouvoir médical.…”

Transition: A concept of significance to nursing and health care professionals

“…These tasks necessarily require complex yet competent management from transition service stakeholders (patients, their families, and healthcare providers) in order to achieve the best possible outcomes in terms of patient's health and well being. It is recognized that transition can be improved through being actively managed, [10] and models and frameworks to facilitate effective management already exist, [11] with calls for further work in this area. [12] Healthcare professional's encounters with patients and family have obvious significance during periods of health-illness transitions.…”

The Effects of Advanced Practice Nurses (APNs) as Intensivists in a Surgical Intensive Care Unit (SICU) on Patient Outcomes, Healthcare Charges, and APN Intensivist Services in the SICU

“…Several other studies have documented the role of APNs in different practice areas providing high quality care and low cost thus benefitting the patient, provider, and healthcare system (Brooten et al, 1986(Brooten et al, , 1994(Brooten et al, , 2002Hoffman, Tasota, Zullo, Scharfenberg, & Donahoe, 2005;Kleinpell, 2005;Rudy et al, 1998;Sidani et al, 2006;Spisso, O'Callaghan, McKennan, & Holcroft, 1990). Care provided by APNs in acute care has been documented in numerous studies examining quality of care, (Kleinpell & Gawlinski, 2005), morbidity, and mortality (Gracias et al, 2008;Hoffman et al, 2005;Munro & Taylor-Panek, 2007;Russell, VorderBruegge, & Burns, 2002;Sole, Hunkar-Huie, Schiller, & Cheatham, 2001;Burns et al, 2003;Meyer & Miers, 2005).…”

“…The role and use of advanced practice nurses (APNs) has expanded globally due to increased needs for health care providers with advanced knowledge and skills (Sheer Joint Dialogue Group, 2008 Several hundred studies have been conducted examining APN practices including outcomes of APN practices in primary care compared to physician practices (Mundinger, 2000), acute care nurse practitioner (ACNP) hospital managed care compared to that of physicians (Kleinpell & Gawlinski, 2005) and research examining effects of APNs on patient outcomes and health care costs in vulnerable, high volume or high cost patient groups (Brooten et al, 2002 (Bupert, 2004, p 4-6).…”