Patricia A. Prescott

Issues in the use of kappa to estimate reliability.

Selected issues regarding the application of the kappa statistic in assessing the reliability of measures to classify patients are discussed. Data are used to illustrate how the methods used to estimate reliability can influence the resulting coefficient. Suggestions for a more comprehensive approach to the study of the psychometric properties of measures of patient classification are then offered.

Predictors of hospital readmission. A meta-analysis.

Summarizing the results of research related to identifying potential predictors of hospital readmissions has been difficult because of conflicting results across studies. Using the techniques of meta-analysis, the results from 44 studies were examined in the present study. OveralI the mean readmission rate was 27%, with significant differences based on patient diagnosis. Although diagnosis, age, initial length of hospital stay, and prior use of hospital resources were related to readmission, the strength of the relationship is trivial. Combining data from 12 intervention studies designed to reduce readmission indicated that the overall treatment effect was not significant. Further research is needed to determine demographic, clinical, and social predictors of readmission if strategies are to be developed to reduce readmission and the resulting health care costs.

Nursing Intensity: Going Beyond Patient Classification

Two patient classification systems, Medicus and GRASP, were compared to the Patient Intensity for Nursing Index (PINI). Approximately 50% of the variability in both classification systems was not accounted for by PINI items. The patterns of correlation between PINI items and GRASP and Medicus scores indicated that these two classification systems do not measure nursing resource use in the same way. Nurse administrators should be aware that estimates of nursing care costs will vary depending on the patient classification system used to measure nursing intensity.

Nurse practitioner effectiveness: a review of physician-nurse comparison studies.

This article discusses selected conceptual and methodological issues associated with studies evaluating nurse practitioner effectiveness by comparing nurse practitioner and physician practice. The particular areas covered include: the comparison criteria and the standards and the research methods used in these studies. Recommen dations for future studies include: (1) activities representing the full range of the nurse practitioner role should be included in any comprehensive evaluation of nurse practitioners; (2) explicit criteria with adequate sensitivity should form the basis of comparisons between nurse practitioners and physicians; (3) empirically established relationships between process and outcome variables should form the basis for estab lishing nonarbitrary performance standards whenever possible; (4) random sampling of nurse practitioners and physicians should be used when possible. When random sampling is not possible, providers should be selected using variables known to correlate with quality of care; (5) random assignment of patients to providers is strongly recommended, taking care to use clients new to both providers; (6) use of multiple data sources is recommended to decrease the current heavy reliance on audits; (7) conclusions should point out differential findings identifying those which favor physicians, those which favor nurse practi tioners, and those identifying no differences between providers.

Measuring patient intensity. A reliability study.

The purpose of this study was to determine the interrater reliability for each of 12 dimensions of a measure of Patient Intensity for Nursing (PIN!). Three hospitals in two states participated in this project with 121 Registered Nurses prepared in the use of the PINI. The interrater reliability was determined by day shift nurses rating theirpatients late in the shift and evening shift nurses rating the same patients early in their shift. Paired ratings of 657 patients were included in this analysis, and the reliability was substantial (x = > .60) for 10 of the 12 dimensions across hospitals. These findings provided the foundation for revision of the instrument, which is currently undergoing additional testing.

The Nurse Practitioner Rating Form Part 11: Methodological Development pdf not opened

The Nurse Practitioner Rating Form (NPRF) was developed and tested over a two-year period. A series of studies were conducted to examine the reliability and validity of the NPRF under a variety of conditions. The final inter-rater reliability estimates for the Activity Categories and the Content of Teaching Categories were ′xx = .83 and ′xx = −85 respectively, and the estimates for the nurse practitioners™ communication and client participation scales were ′xx = .75 and ′xx = .76. It was noted that further evaluation of the psychometric properties of the NPRF, especially the nurse practitioner communication and client participation scales is needed.

Supplemental Nursing Services: How and Why Are

Everyone uses supplemental nursing services-or do they? Studies done in 1978 showed that 27 percent of Pennsylvania hospitals, 58 percent of Chicago area hospitals, and 68 percent of California hospitals were using supplementary agency personnel(1-3). In our 1981 survey of 855 hospitals across the country, we found that 332-39 percent of our sample-were using nurses from supplemental service agencies. Further, through statistical techniques, we estimated that one-third of all short-term general hospitals (N= 4,251) used nurses from supplemental service agencies in 1981.*