Wk 1: Patient Outcomes and Clinical Measurements

Question 1

Outcomes

Answer 1

ultimate validation of the effectiveness and quality of medical care

Question 2

Evaluating outcomes

Answer 2

result of interventions, self management, system of care and individual factors

Question 3

CNS competency r/t outcomes

Answer 3

Direct care- measurement of outcomes is essential for CNS to evaluate the efficacy of interventions delivered at ind. pt. level

Question 4

Regulatory Agencies

Answer 4

CMS Core Measures, NDNQI

Question 5

Outcome measures

Answer 5

assessed for appropriateness and rigor (reliability & validity)

Question 6

Nurse Sensitive Outcomes

Answer 6

improve quantity or quality of nursing care

Question 7

Patient reported outcomes (PRO)

Answer 7

Patients subjective complaints

Question 8

Patient reported outcomes measures (PROM)

Answer 8

performance measures. National Quality Forum (NQF), National Committee for Quality Assurance (NCQA).

Question 9

Rationale for PRO

Answer 9

better symptom control and QOL are associated with reduced costs and use of medical services and improved medication compliance, patient satisfaction and survival.

Question 10

Appraisal of tools to enhance EBP

Answer 10

Correct Problem, Does the Conceptual basis of instrument match my own, Was tool developed for same purpose as mine, Does tool have adequate reliability, validity, S&S, Tool easy to use

Question 11

Define Clinical Problem

Answer 11

Do you have significant problem where there is insufficient literature?

Question 12

Conceptual basis

Answer 12

disciplinary perspective and nature of clinical problem

Question 13

Nature of clinical problem

Answer 13

static or dynamic

Question 14

Modified Borg Scale

Answer 14

rating scale to match nurses point of view

Question 15

Parameters of instruments

Answer 15

purpose, aim, population and time orientation

Question 16

Reliability

Answer 16

consistency of insturment

Question 17

Types of Reliabilty

Answer 17

Stability, equivalence, internal consistency

Question 18

Stability

Answer 18

test-retest method and parallel forms, 0-1.0- closer to 1.0 is better

Question 19

Equivalence

Answer 19

interrated and parallel forms. Interrater should be at least 90% or correlation approaching 1.0

Question 20

Internal Consistency

Answer 20

how well a tool measures a single concept or how well the concepts intercorrelate. Measure 0-1.0, with .7 to .9 considered adequate.

Question 21

Validity

Answer 21

How well the instrument measures what it is supposed to

Question 22

Types of Validity

Answer 22

content criterion, construct

Question 23

Changes with validity

Answer 23

All validity considered construct: 5 categories of evidence- test content, response process, internal structure, relation to variables, consequence of testing

Question 24

More reports of validity

Answer 24

more evidence to demonstrate validity of instrument

Question 25

Test-content

Answer 25

techniques to verify items on tool reflect domain of possible items for that concept.
2 steps: items generated from literature, then evaluated by experts with strict guidleines

Question 26

Response process

Answer 26

how responders make their decisions- in method section

Question 27

Internal-structure

Answer 27

factor analysis or item analysis procedures.

Question 28

Criterion related evidence

Answer 28

tool is compared to established instrument

Question 29

Sensitivity and Specificity

Answer 29

sens- probability of tool to identify those who have characteristic of concern
spec- conditional probability of a tool to omit those without characteristic of concern.
Neither are ever 100%. Usually reported 0-1, closer to one being higher.

Question 30

Tool evaluation

Answer 30

ease of use, administered, interpreted, scored. patient issues, problems with its use.