With the ongoing implementation of the Affordable Care Act, many health care providers are transitioning from a fee-for-service model to a more patient-focused, value-based emphasis.
Instead of reimbursing medical providers based on the number of tests conducted, this new mindset centers on patient outcomes and quality of care. Has hospital care been good enough to reduce readmissions? Do patients understand their discharge instructions? Do they know how to prevent further problems?
To achieve these goals, hospitals are concentrating on patient values, research evidence and clinical expertise. While positive outcomes are at the heart of all branches of medicine, many medical professionals are focused on the effectiveness of new drugs, medical procedures and devices. By contrast, the nurses who work directly with patients are dedicated to improving patient care and decreasing errors.
So it should come as no surprise that these issues are at the heart of applied nursing research at Idaho higher education institutions.
Their emphasis is on quality and safety, with the goal of also improving protocols while dealing with an increasingly complex patient population. As people live longer, patients are more likely to have a variety of secondary medical concerns. That means a 70-year-old who comes to the hospital for knee surgery also may have diabetes, heart disease or pulmonary problems. And many patients insured for the first time may show up with symptoms made more severe by limited access to care.
All of these variables increase the chance for error. To combat that, nurse researchers are finding new ways for students to learn and practice skills. These include the use of the Boise State University College of Health Sciences Simulation Center, one of only two accredited simulation centers in the Pacific Northwest and winner of an Outstanding Work (WOW) award from the Western Interstate Commission for Higher Education’s Cooperative for Educational Technologies.
The center mimics a real health care setting and includes adult and juvenile mannequins programmed to present medical scenarios that students and faculty can work out together. Students learn new skills and practice social interactions under the watchful eye of an instructor with no chance of harming a patient. And assistant professor Janet Willhaus has created simulation scenarios involving veterans to help students deal with additional combat-related issues.
In addition, BSU associate professors of nursing Kelley Connor and Ann Butt are looking at ways to use 3D computer simulation to improve learning outcomes and give students a chance to practice procedures.
Researchers also are working to improve the care provided to new mothers and their babies. Jane Grassley, the Jody DeMeyer Endowed Chair of Nursing at Boise State, has looked at the benefits of skin-to-skin contact between mother and infant following a cesarean section birth and ways to improve breast-feeding outcomes in new mothers. Data show that the first 48 hours can make or break success in breast-feeding, which offers long-term health benefits for both babies and mothers.
On the other end of the aging spectrum, Boise State clinical instructor Lucy Zhao is studying the causes of falls in older patients in acute care hospitals — a major cause of injuries. And a $1.5 million grant from the federal Health Resources and Service Administration to Idaho State University’s Kelly Fanning and Mary Nies will fund a model to provide health care to underserved senior refugees in Idaho.
In between you’ll find a lot of research aimed at improving the physical and emotional care of Idahoans of all ages. These include work by BSU assistant professor Faye Carlson to understand the characteristics of victims of child sexual abuse in order to enhance services to the children and their families.
Research also extends to those providing care, both finding ways to make that care safer for the nurse (think back injuries or exposure to viruses) and how to make it more pleasant, as with a long-running study by BSU emeritus nursing professor Cynthia Clark on civility in the nursing field. Her work shows that civility allows for more effective communication, community building and the ability to find common ground.
And a collaboration between Idaho State nursing researchers and Saint Alphonsus Cancer Care Centers, called “Patient Voice in Healthcare,” is looking at ways to increase patient-provider communication to improve care. The goal of all these nurse researchers is to increase the well-being of all Idahoans and ensure that when we need it, our care is the best it can be.
I think that’s worth a healthy investment in research.
Mark Rudin is vice president for research and economic development at Boise State University. His column looks at the state of scientific discovery and economic development in Idaho and beyond.