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      The impact on patient health and service outcomes of introducing nurse consultants: a historically matched controlled study

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          Abstract

          Background

          The position of nurse consultant (NC) was introduced in Hong Kong by the Hospital Authority in January 2009. Seven NCs were appointed in five clinical specialties: diabetes, renal, wound and stoma care, psychiatrics, and continence. This was a pilot to explore the impact of the introduction of NCs on patient health and service outcomes.

          Methods

          The present paper describes a historically matched controlled study. A total of 280 patients, 140 in each cohort under NC or non-NC care, participated in the study. The patient health and service outcomes of both cohorts were evaluated and compared: accident and emergency visits, hospital admissions, length of hospital stays, number of acute complications, number of times of treatment or regimen altered by nurses according to patient’s condition, glycated haemoglobin A1c (HbA1c) levels, urea and urea-to-creatinine ratios, and number of wound dressings for patients in corresponding specialty units. A patient satisfaction instrument was also used to assess the NC cohort.

          Results

          The study showed that patients under NC care had favourable patient health and service outcomes compared with those under non-NC care. The NC cohort also reported a high level of patient satisfaction.

          Conclusions

          The study demonstrates that the introduction of NCs in specialty units may have a positive impact on patients’ health and service outcomes. The high level of patient satisfaction scores indicates that patients appreciate the care they are receiving with the introduction of NCs.

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          Most cited references22

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          Defining and classifying clinical indicators for quality improvement.

          J Mainz (2003)
          This paper provides a brief review of definitions, characteristics, and categories of clinical indicators for quality improvement in health care. Clinical indicators assess particular health structures, processes, and outcomes. They can be rate- or mean-based, providing a quantitative basis for quality improvement, or sentinel, identifying incidents of care that trigger further investigation. They can assess aspects of the structure, process, or outcome of health care. Furthermore, indicators can be generic measures that are relevant for most patients or disease-specific, expressing the quality of care for patients with specific diagnoses. Monitoring health care quality is impossible without the use of clinical indicators. They create the basis for quality improvement and prioritization in the health care system. To ensure that reliable and valid clinical indicators are used, they must be designed, defined, and implemented with scientific rigour.
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            A reengineered hospital discharge program to decrease rehospitalization: a randomized trial.

            Emergency department visits and rehospitalization are common after hospital discharge. To test the effects of an intervention designed to minimize hospital utilization after discharge. Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card. General medical service at an urban, academic, safety-net hospital. 749 English-speaking hospitalized adults (mean age, 49.9 years). A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment. Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers' follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment. Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed. This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report. A package of discharge services reduced hospital utilization within 30 days of discharge. Agency for Healthcare Research and Quality and National Heart, Lung, and Blood Institute, National Institutes of Health.
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              Patient satisfaction as an indicator of quality care.

              In this review of the theoretical and empirical work on patient satisfaction with care, the most consistent finding is that the characteristics of providers or organizations that result in more "personal" care are associated with higher levels of satisfaction. Some studies suggest that more personal care will result in better communication and more patient involvement, and hence better quality of care, but the data on these issues are weak and inconsistent. Further research is needed to measure specific aspects of medical care and the ways in which patient reports can complement other sources of information about quality. In addition, more research on the determinants of satisfaction and the relationship between quality and satisfaction among hospitalized patients is recommended.
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                Author and article information

                Contributors
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central
                1472-6963
                2013
                23 October 2013
                : 13
                : 431
                Affiliations
                [1 ]Chair Professor of Nursing and Director, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
                [2 ]The Nethersole School of Nursing, 7/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
                [3 ]Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
                [4 ]Formerly Associate Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
                [5 ]Formerly Nursing Director, Hospital Authority, Hong Kong, SAR, China
                [6 ]Principal Nursing Officer, Hospital Authority, Hong Kong, SAR, China
                Article
                1472-6963-13-431
                10.1186/1472-6963-13-431
                4016548
                24152979
                d4d27fac-929a-4795-8f9b-ee617176ad9a
                Copyright © 2013 Lee et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 January 2013
                : 22 October 2013
                Categories
                Research Article

                Health & Social care
                nurse consultant,patient outcomes,patient satisfaction,hong kong
                Health & Social care
                nurse consultant, patient outcomes, patient satisfaction, hong kong

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