Process and Outcome Data in Clinical Practice (Essay Sample)

` Process and outcome YourFirstName YourLastName University title
PROCESS AND OUTCOME
Introduction
Nursing is a care centered profession that seeks to alleviate human suffering and disability. Optimum nursing care is a measured standard that sets forth an accepted, safe and quality care that caters for the needs of both the patient and the health care team. The quality of care needs to undergo an assessment process that takes into account three aspects: structures, process and outcome. Though quality of care may be a difficult tool to assess, citing challenges with patient dynamics and inconsistencies, a well laid out quality assessment tool would suffice. There is a relationship between the process of health care delivery and the quality, otherwise denoted as the patient outcome. In order to assess this relationship there ought to be some data to analyze and draw conclusive findings. An illustration of the use of process and outcome data is exemplified using the five moments of hand hygiene. Therefore, this paper will identify and explain the use of process and outcome data using the five moments of hand hygiene as an illustration, in the delivery of a safe and quality nursing care in health institutions.
By definition, process and outcome are both tools of assessment of the quality of nursing care. Process is defined as the activities done by both the patient and the health care providers towards restoration of health (Donabedian, 1997, p.1145). It is a wide scope that looks into the health seeking behaviors of the patient towards healing and restoration of their health. The kind of health seeking behavior of a patient is directly related to the overall outcome of their health condition. Verna and Bourne (2013), observe that knowledge, self-help patient behaviors about their own health is an essential ingredient to develop and effect policies and social interventions that would influence the care delivery process in a positive way (p.260). Patient looks for information based on their own knowledge and level of understanding of their health problems, and seeks the advice and opinion of a healthcare provider. Such information seeking behaviors have resulted in the reduction of the cost of care and management. (Gutierrez et al., 2014, p.86). Process, as well, refers to the activities of the health care provider in making a diagnosis and in recommending or implementing an intervention (Kairy, Lehoux, Vincent, & Visintin, 2009, p.432). The process of care is multifaceted. Both the patient and the care provider have a role. The doctor makes a diagnosis, informs the patient about the plan of care, the patient is given an opportunity to consider the options, and then the care process begins (Cooperberg, Birkmeyer, & Litwin, 2009, p.414). It is necessary for both the patient and the care giver to be involved in the care process in order to ensure optimum care. Gutierrez et al (2014), notes that an increased user involvement results in better treatment compliance, improved levels of patient satisfaction, and better health outcomes (p.87).
On the other hand, outcome describes the effects of health care on the health status of the patient and the population (Donabedian, 1997, p.1145). Outcome of health care service is a multipronged approach that entails the knowledge of the patient on health issues, patient satisfaction levels, and positive changes in the patient behavior (Reeves et al, 2013, p.3). Improved health status of the patient from the time of admission to the time of discharge is an indicator of good patient outcomes from the care service that was rendered. Weeks et al. (2010), agrees that the quality of health care service can be assessed by the changes in the health status of the patient from admission time to discharge as well as the patient satisfaction levels (p.996). However, they observe that changes in health status and patient satisfaction levels measure different aspects of health care outcomes and quality (Weeks et al.,2010, p.997). They suggest that comprehensive measure will need to consider both the health status and patient satisfaction in order to make a conclusive co-relation with outcome and quality of care. Independently, patient satisfaction may not relate with a change in health status. Example is a patient may have had an improvement in their health status from the time of admission, but may not be satisfied with the care that they received. A change in health status is more likely to be related to the process of care the patient received (Kairy, Lehoux, Vincent, & Visintin, 2009, p.432). Patient satisfaction has a bearing on a number of factors that entails patient-doctor relationship, communication, interpersonal interactions between the patient and the hospital staff and the waiting time before a patient is attended to (Kumari et al., 2009, p. 34). Outcome as measured through an improvement in the health status is a factor of a patient-centered care approach. Patient centered care give the patient a feel of ownership in the care process. Psychologically, this would aid the healing process thereby improving the health outcomes. Patient centered care influences the patient’s health through the patient’s perceptions that their care was given the approach it desired (Bertakis & Azari, 2011, p.232). It, as well, reduced the number of diagnostic tests and referrals, increased efficiency of care and improved the health status of the patient (Sepucha, Fowler, & Mulley, 2004, p.57).
By definition, process and outcome data refers to information contained in the medical record about a patient or a group of patients (Donabedian, 1997, p.1145). Medical record of a patient provides information about the process of care and the outcome of a single patient while medical records about a group of patients provide information about the health outcomes and the care process about a subset of a population with the same health characteristics (Palmer, 1998, p.480). Medical data is an important source of information for monitoring the progress a clinical case of interest, what was done and what was achieved. Shih (2011), concurs that without a detailed health information system, that evaluates the response of a health program, it becomes difficult to assess the efficacy of the program; therefore it impedes the effectiveness in funds and resource allocation (p.604). Medical records as the sole source of process and outcome data have some flaws. As noted earlier in this paper, process and outcome of health care is dependent on the interpersonal interactions between the patient and the health care team. Patient satisfaction is also dependent on communication skills and the waiting time at the facility. These are not recorded in the medical records; therefore, they cannot be assessed. Donabedian et al. (1988), posits that the medical records is often times incomplete in what it contains, frequently omitting essential information on technical care and the interpersonal interaction between the patient and the health care staff(p.1145). Additionally, some of the recorded information could be inaccurate attributed to errors in the diagnosing process, clinical observation, assessment, decoding and transmission of the information from one health care worker to the other (Nambisan, Kreps, & Stan, 2013, p.4).
The challenges notwithstanding, medical records are arguably the only ‘reliable’ source of health information on the process and outcome of care. To make it more accurate, there is need for supplemental information in the diagnostic, investigative tests and interviews before and after the care. The current limitations of medical record can be rectified through an independent source of information such as X-ray radiographic films, ultrasound findings, re-examination of the patient, electrocardiography, and a repeat examination of pathological specimens (Menachemi & Collum, 2011, p. 4). For a long term assessment of outcomes, patient interviews, questionnaires and a re-examination of the patient may suffice (Menachemi & Collum, 2011, p. 4). In case medical records may be deficient in information, videotaping, audio recording or direct observation by a colleague may be of value. (Sepucha, Fowler, & Mulley, 2004, p.58).
In most situations, clinical data is collected by physicians and scientists. Its analysis is dependent on the purpose for its usage. If it is intended for a research project, then it will be collected and analyzed by scientists. If it is needed for purposes of monitoring and evaluating a medical intervention, then it is collected and analyzed by physicians and other interested health care teams (Lober, Baer, Karras, & Duchin, 2004, p. 1213).clinical data is important to the physicians because it is essential for describing the natural history of an illness in a given setting. It provides a framework for the development of standards of practice for the physicians and other health care workers. Process and out come data is essential for the establishment of policies that influence the health care practice. Selman and Harding (2010), observe that the development and evaluations of public health policies and interventions depend on clinical data such as the cancer registries, coroner’s reports and traffic crash reports (p.8). Thereafter, incidence rates of key health outcomes are determined and acted upon. Elsewhere, routinely collected medical data is used to inform a number of studies nationally as well as serving international community interests (Selman & Harding, 2010, p. 9).
The five moments of hand hygiene for nurses and other health care providers is an explicit example on how process and outcome data influences the provision of a safe and high quality nursing care in health facilities. It is the single most effective method...