Question

Post an explanation of the importance of quality measures using the clinical performance measure you identified as an example. Then, identify the performance measures used for NP productivity in Rhodes, Bechtle, and McNett (2015) article. Finally, share your opinion on incentive payment for care, including external motivators and at least one business model.

Answer 1

As nurse practitioners their role is in delivering health care, it is for nurse practitioners to provide the data and evidence to demonstrate the impact of nurse practitioners care on patient outcomes. There are several challenges that advanced practice nurses face to provide quality care and meet productivity goals. It is important to explore the connection of quality care and performance measures.

As nurse practitioners assume an increasing role in providing care to hospitalized patients, measuring the impact of their care on patient outcomes and quality of care measures becomes a necessary component of performance evaluation. The measurement of outcomes in health care has become mandatory as federal and state regulatory agencies, institutional guidelines, employers, and consumer groups advocate for quality health care on improving patient outcomes.

As nurse practitioners assume in providing care to hospitalized patients, measuring the impact of their care on patient outcomes and quality of care measures becomes a component of performance evaluation. A number of studies have demonstrated the impact of nurse practitioners care on patient outcomes, highlighting that nurse practitioners care promotes patient access to care, reduces complications, and results in improved patient knowledge, self-care management, and patient satisfaction.

A simple approach to defining nurse practitioners sensitive metrics is to determine what out comes are essential to the practice and the organization. It is critical for the nurse practitioners to look beyond direct patient care and capture the broad vision of a successful practice. A second approach to defining nurse practitioners metrics would be to begin with measurable goals based on competency. Measurement can be both qualitative and quantitative but must include defined targets.

Using quantitative data that reflects the care, over sight areas of the nurse practitioners such as days of foley catheter device use and days of central line device use provide measurable metrics that demonstrate the impact of care.

For example, a nurse practitioners hired to work with neurosurgical patients in the ICU could select outcomes such as total days from ICU admission to start of nutrition, total days from ICU admission until swallow evaluation ordered, and percent of patients with deep vein thrombosis prophylaxis to demonstrate the impact on outcomes associated with the role.

Many nurse practitioners perform procedures that require training under supervision, adherence to procedural protocols, competency checklists and for most inpatient nurse practitioners, completion of the privileging process to perform these procedures in dependently.

Documentation coding can be easily measured and closely monitored for compliance. A common measure is to evaluate quality pre and post adding nurse practitioners to the practice. A study, in measured consistency in practice guidelines by showing that surgical patients managed by nurse practitioners resulted in decreased length of stay, earlier mobility, lower rates.

Many physician practices are able to equate mortality rates and readmission rates directly to the physician. This is often more difficult for the inpatient nurse practitioners as the nurse practitioners is one of many providers that have participated in the patient’s care along the continuum. For the nurse practitioners who determines the insertion and removal date of the device, the nurse practitioners is directly associated with device days; thereby affecting the risk for infection.

Scorecards and dashboards are effective methods for displaying ongoing outcomes of nurse practitioners practice. nurse practitioners directly affected the process, prioritization to the practice, in line with evidence based institutional goals. A small number of clearly defined metrics were chosen by each group of nurse practitioners, prioritized by improvement need.

To maintain efficiency, it was important to incorporate data collection into the regular routine of the nurse practitioners, therefore electronic progress notes were developed for them to write their daily notes but also capture data for their particular metrics.

As outcomes of care are now used for bench marking hospital performance as well as to designate reimbursement, integrating nurse practitioners specific metrics to highlight the impact of nurse practitioners care provides value added data.

Plans for the development of new nurse practitioners roles could then be made based on considerations including savings that potentially could be realized through decreased length of stay, decreased readmissions, decreased complications, adherence to best practices, and throughput, among other outcomes.

As nurse practitioners assume an increasing role in providing care to hospitalized patients, the use of nurse practitioners associated metrics holds much potential for further delineating the scope of influence on patient care as well as quality of care measures.