The association of nurse practitioners' mortality risk assessments and advance care planning discussions on nursing home patients' clinical outcomes
| Autor: | Robert MacArthur, Susan E. Mullaney, A. James Lee, Karen Devereaux Melillo |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
Advance care planning medicine.medical_specialty Palliative care Medicare Advantage Risk Assessment Advance Care Planning 03 medical and health sciences 0302 clinical medicine Nursing 030502 gerontology Surveys and Questionnaires Outcome Assessment Health Care medicine Humans Nurse Practitioners 030212 general & internal medicine Mortality General Nursing Aged Aged 80 and over Descriptive statistics business.industry Medical record General Medicine Focus Groups Middle Aged Focus group Nursing Homes Long-term care Family medicine Female 0305 other medical science Risk assessment business |
| Zdroj: | Journal of the American Association of Nurse Practitioners. 28:304-310 |
| ISSN: | 2327-6924 |
| DOI: | 10.1002/2327-6924.12317 |
| Popis: | Purpose To investigate the impact nurse practitioners’ (NPs) documented mortality risk assessments (MRAs) and advance care planning (ACP) discussions have on clinical outcomes for newly enrolled Medicare Advantage nursing home patients. Methods Data collection in this mixed-method study consisted of quantitative data from a convenience sample of NPs’ MRAs and medical record reviews 6 months later, and qualitative data from two NP focus groups. Quantitative analyses include descriptive statistics, bivariate ANOVA, and logistic regression. The qualitative content analysis included an iterative process of rereading transcribed notes, identifying codes, themes and significant statements. Conclusions MRAs prioritize ACP discussions with patients/families (p = .0258). Positive clinical outcomes following ACP discussions include more patients with a comfort goal of care (86% increase), fewer patients with a full-code status (26% reduction), and a reduction in hospitalizations (p = .025). NPs agreed that ACP discussions have a positive impact on patient outcomes including a “good death.” Implications for practice MRAs and ACP discussions are beneficial to achieving better outcomes and fewer hospitalizations. Opportunity exists to further develop policy changes focused on enhancing the NPs’ role in MRAs and ACP discussions with nursing home patients and families. |
| Databáze: | OpenAIRE |
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