Research Brief: Rural Hospital Collaborative and HF Outcomes

This week, we'd like you to introduce you to a team of researchers at the University of Maryland and Johns Hopkins University, led by Robin Newhouse and Laura Morlock.  This team conducted a study which identified the linkages between processes of nursing care and the quality of patient outcomes, while also addressing the pressing need for mentorship in implementing evidence-based heart failure (HF) care in rural hospitals. The team conducted a randomized control trial with twenty three rural hospitals from five states in the eastern United States. In the course of their project, the team found that heart failure core measures improved significantly between 2007 and 2009, but that nursing support and staffing does not predict core measure improvement. Heart failure core measures are reported by acute care hospitals as a measure of quality care for HF patients. They found that there is no relationship between the smoking cessation core measure, nursing smoking cessation counseling activity, and patient intent to quit smoking. Finally, they found that nurses in better practice environments use more evidence-based smoking cessation interventions. This study is one of the first to focus on linkages between rural nursing and patient outcomes, and has affected the engagement of nurses in 23 rural hospitals in improvements in heart failure care. Qualitative evidence suggests profound changes in the uptake of evidence and the formation of multidisciplinary teams.

Access the research brief.

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Nurse Staffing Matters - New INQRI Study

A study led by Robin Newhouse and Laura Morlock published in the current issue of Medical Care underscores the importance of  nurse staffing in providing quality care. The researchers tested in 23 ruaral hospitals a quality collaborative intervention to improve care for heart failure patients.

The intervention focused on four key measures of heart failure care. At the end of the study, the researhceers found no quantitative difference between the intervention and control groups on implementation of the key measures. They did find that hospitals with more stable nurse staffing - lower turnover - implemented more of the measures. 

The researchers assert that the study speaks to the central role of nurses in quality improvement.

Report: Higher Payments Are No Cure For Doctor Shortage

Earlier this week, Jordan Rau, reporting for Kaiser Health News, detailed a recent report by the Institute of Medicine that recommended that Medicare should not raise reimbursements to lure practitioners to rural areas. The panel of experts suggested that instead of raising reimbursements, Medicare should provide payment for the use of telemedicine, in addition to supporting the expansion of scope of practice laws in restrictive states. By promoting the use of advanced practice nurses, the IOM believes it is possible to close the primary care physician gap using the existing workforce and network of resources currently available.

To read more about the report, click here.

RN Labor Supply Bubble: What Does it Mean for Rural Health Care?

Over the past year, many studies have predicted that a temporary employment bubble is approaching for Registered Nurses in many urban areas. In response to one of the more recent articles discussing this trend, authored by Staiger, Auerbach, & Buerhaus and appearing in the April edition of the New England Journal of Medicine, the Online Journal of Rural Nursing and Health Care's editor, Pamela Stewart Fahs, DSN, RN, brought up the important question as to how this trend will effect rural nursing. Dr. Fahs discussed how the upcoming labor supply bubble may actually improve rural nursing by making these health care facilities more competitive with their urban counterparts. By having a tougher job market, new nurse graduates may be more willing to relocate than they have been in the past.

To read Dr. Fahs' editorial, click here.

To read more blogposts relating to nursing workforce issues, click here.

UMass Nursing Students Seek to Help the Vulnerable Live Through Emergencies

Last week, Scott Merzbach, Staff Writer for the Daily Hampshire Gazette, detailed how nursing students at the University of Massachusetts are assisting elderly individuals better prepare for emergency situations. The program aims to develop an emergency preparedness plan that could ensure a better municipal response to future crises and also provide information and resources to the elderly and people with mobility limitations and chronic illnesses. The University of Massachusetts School of Nursing initiated this program after hearing complaints from elderly individuals that they lacked proper resources to deal with even a simple crisis, such as losing power for over a 24 hour period.

Click here to read more about this innovative program.

Clinics Focused on Medicare Patients Making a Difference

Over the weekend, Rosemary Shinohara, of the Anchorage Daily News, reported about the recently opened Alaska Medicare Clinic. The clinic was established with the intention of holding down costs and improving patient satisfaction by utilizing interdisciplinary teams, made up of registered nurses and medical aides, that spend a great deal of time with patients before they are seen by the lone physician on site.

Click here to read the full news article.

Performance-Based Payment Incentives May Harm Nursing Conditions

Highly touted as a way in which to improve patient outcomes, pay-for-performance incentives have been gaining steam in hospitals nationwide. However, as reported on endnurse.com, a recent study published in Health Affairs suggests that linking reimbursement to quality of care goals could undermine the nursing workforce and shake up the nursing practice environment. The study, conducted by Ellen Kurtzman, RN, MPH, FAAN, assistant research professor in the GW School of Nursing, suggests that while payment incentives do have favorable effects on patient outcomes, they have little to no positive effect on nurse staffing and turnover rates.

Click here to read the article.

Click here to directly access the study, login credentials are necessary to access Health Affairs articles.