2.50
Hdl Handle:
http://hdl.handle.net/10755/157717
Type:
Presentation
Title:
Voice of Evidence-Based Performance: Identification of Best Practice
Abstract:
Voice of Evidence-Based Performance: Identification of Best Practice
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Donaldson, Nancy, RN, DNSc, FAAN
P.I. Institution Name:UCSF School of Nursing, Physiological Nursing
Title:Director, Center for Nursing Research & Innovation
Contact Address:2 Koret Way, N631, Box 0610, San Francisco, CA, 94143, USA
Contact Telephone:415-502-1826
Co-Authors:Carolyn Aydin, PhD, Assistant Clinical Professor; Mary Foley, Associate Director; Susan Shapiro, RN, PhD, Senior Nurse Scientist
Purpose: Confronting the demand for evidence of comparative best performance public reports as well as the imperative to expedite performance improvement, clinical leaders are challenged to identify best performance and understand how to transfer successful practices into their settings. In its ongoing benchmarking, CalNOC reports identify the 25th, 50th, and 75th percentile cutpoints, enabling members to examine their relative performance on the continuum of near peer and all participating hospitals. The next step in using CalNOC evidence to advance patient care is to identify the best performing hospitals and validate effective strategies used by these hospitals to reduce falls, pressure ulcers, and restraint use. This presentation describes the conceptual and statistical methods used to answer the question: What constitutes evidence of comparative "best" performance? Method: Although similar methods were used for three strategic nursing quality measures: fall rates, pressure ulcer prevalence, and restraint prevalence fall rates are used in abstract as the exemplar. Two analyses were conducted: (1) total facility and (2) medical/surgical units only. 1. Monthly data were averaged to calculate mean falls per 1,000 patient days for each quarter for each hospital in the year. 2. For each facility or unit type (i.e., medical/surgical units) fall rates for each quarter were ranked in one of four quartiles: lower (best) quartile (below 25th percentile), second quartile (25-50th percentile), third quartile (50-75th percentile), and upper (worst) quartile (75-100th percentile). 3. Facilities with at least 3 quarters with a rank of 25th percentile or lower were considered "best performers" for that year. Facilities ranking at the 75th percentile or higher for at least 3 quarters were considered "worst performers" for that year. 4. In an effort to identify potential factors operating as "key levers" of best performance, statistical analyses were then conducted to determine whether variables such as hospital demographics, staffing, or fall prevention process variables differed among hospitals with consistently low fall rates when compared to those with consistently high fall rates. 5. Hospital rankings for 2006 and 2007 were compared to identify consistent best and worst performers over a two-year period. Validation interviews and surveys then identified analytic and qualitatively derived differences in fall related care processes and organizational culture for each group of hospitals. Findings: In 2006, the medical/surgical unit type analysis identified 16 hospitals as best performers for fall prevention (6 with all 4 quarters in the lowest quartile and 10 with 3 out of 4 quarters in lowest quartile). Eight of the 2006 identified hospitals were still best performers in 2007. Of the 14 hospitals in the worst quartile in 2006, 5 were still in the worst quartile in 2007. The 25th percentile cut-points ranged from 2.1-2.5 falls per 1,000 patient days, while 75th percentile cut-points ranged from 3.9 to 4.2 over the 8 quarters. Trends were not detected in the quartiles, indicating that average fall rates were stable. Next steps involve systematic comparisons for key processes of care differentiating best and worst performers, with the aim of explicating factors likely to explain best performance.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleVoice of Evidence-Based Performance: Identification of Best Practiceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157717-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Voice of Evidence-Based Performance: Identification of Best Practice</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Donaldson, Nancy, RN, DNSc, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">UCSF School of Nursing, Physiological Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director, Center for Nursing Research &amp; Innovation</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2 Koret Way, N631, Box 0610, San Francisco, CA, 94143, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">415-502-1826</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">nancy.donaldson@nursing.ucsf.edu, dfrantz@stanford</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Carolyn Aydin, PhD, Assistant Clinical Professor; Mary Foley, Associate Director; Susan Shapiro, RN, PhD, Senior Nurse Scientist</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Confronting the demand for evidence of comparative best performance public reports as well as the imperative to expedite performance improvement, clinical leaders are challenged to identify best performance and understand how to transfer successful practices into their settings. In its ongoing benchmarking, CalNOC reports identify the 25th, 50th, and 75th percentile cutpoints, enabling members to examine their relative performance on the continuum of near peer and all participating hospitals. The next step in using CalNOC evidence to advance patient care is to identify the best performing hospitals and validate effective strategies used by these hospitals to reduce falls, pressure ulcers, and restraint use. This presentation describes the conceptual and statistical methods used to answer the question: What constitutes evidence of comparative &quot;best&quot; performance? Method: Although similar methods were used for three strategic nursing quality measures: fall rates, pressure ulcer prevalence, and restraint prevalence fall rates are used in abstract as the exemplar. Two analyses were conducted: (1) total facility and (2) medical/surgical units only. 1. Monthly data were averaged to calculate mean falls per 1,000 patient days for each quarter for each hospital in the year. 2. For each facility or unit type (i.e., medical/surgical units) fall rates for each quarter were ranked in one of four quartiles: lower (best) quartile (below 25th percentile), second quartile (25-50th percentile), third quartile (50-75th percentile), and upper (worst) quartile (75-100th percentile). 3. Facilities with at least 3 quarters with a rank of 25th percentile or lower were considered &quot;best performers&quot; for that year. Facilities ranking at the 75th percentile or higher for at least 3 quarters were considered &quot;worst performers&quot; for that year. 4. In an effort to identify potential factors operating as &quot;key levers&quot; of best performance, statistical analyses were then conducted to determine whether variables such as hospital demographics, staffing, or fall prevention process variables differed among hospitals with consistently low fall rates when compared to those with consistently high fall rates. 5. Hospital rankings for 2006 and 2007 were compared to identify consistent best and worst performers over a two-year period. Validation interviews and surveys then identified analytic and qualitatively derived differences in fall related care processes and organizational culture for each group of hospitals. Findings: In 2006, the medical/surgical unit type analysis identified 16 hospitals as best performers for fall prevention (6 with all 4 quarters in the lowest quartile and 10 with 3 out of 4 quarters in lowest quartile). Eight of the 2006 identified hospitals were still best performers in 2007. Of the 14 hospitals in the worst quartile in 2006, 5 were still in the worst quartile in 2007. The 25th percentile cut-points ranged from 2.1-2.5 falls per 1,000 patient days, while 75th percentile cut-points ranged from 3.9 to 4.2 over the 8 quarters. Trends were not detected in the quartiles, indicating that average fall rates were stable. Next steps involve systematic comparisons for key processes of care differentiating best and worst performers, with the aim of explicating factors likely to explain best performance.</td></tr></table>en_GB
dc.date.available2011-10-26T20:08:15Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:08:15Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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