Nurse Practitioner Impact on Patient Health Outcomes A P R IL N. KAPU, D NP, A P R N, ACNP - B C, FA A NP, F CCM

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1 Nurse Practitioner Impact on Patient Health Outcomes A P R IL N. KAPU, D NP, A P R N, ACNP - B C, FA A NP, F CCM NORTH CAROLINA NURSES ASSOCIAT ION NP SPRING SYMPOSIUM 20 17

2 Objectives Value Outcomes Strategies for Success Education Experience Knowledge translation Healthcare policy

3 What is Value?

4 The Value Equation in Healthcare Value = Outcomes / Cost: "Value - neither an abstract ideal nor a code word for cost reduction - should define the framework for performance improvement in healthcare" Focus on Patient: "The goal is what matters for patients and unites the interests of all actors in the system."

5 Communicating Value in Health Care Value can be perceived differently by different parties. Shared values unite the interests and activities of all stakeholders. Health care that is focused on the patient s perception of value what matters to the patient unites healthcare team members through shared vision. If patient perceived value improves, all parties benefit while increasing system sustainability. Porter, What is Value in Health Care?, NEJM, 2010

6 Patients Value Care that is: Accessible (Multiple access points, Anytime) Affordable (Options) Reliable (Service, Clinical Quality)

7 The Value Equation Desired Care Cost Value

8

9 Patient Experience Provider Star Ratings

10 Vanderbilt NP-Led Rapid Response Outcomes 6 year reduction in out of ICU arrests Decreased ICU days Improved RN and patient satisfaction Clinical quality improvement Process improvement RRT/STAT Total RRT STAT

11 Vanderbilt Trauma NP Service Increased volume of cases by 14.3% 1.0 reduction in ALOS for entire trauma service 27.8 million reduction in hospital charges. Increased direct discharges by 21%. MD/RNs found the addition of ACNPs beneficial, improved patient care, improved workflow, improved communication and throughput. Time frame Overall Trauma service cases Overall Trauma Service, T1,2,3 T2 Intervention Unit Average hospital charges per case 12/1/09-11/30/ (1827 cases) $106, /1/10-11/30/ (1875 cases) $106, /1/11-11/30/ (2202 cases) $97, ISS

12 Four Vanderbilt ICU NP/PA Teams Reduction in ICU LOS and R/A LOS With increasing acuity from year to year

13 Measures of NP Professionalism Vanderbilt Center for Patient and Professional Advocacy APRN Professionalism Dashboard Vanderbilt CoWorker Observation Reporting System (CORS) Confidential reports from coworkers on professionalism Effective, evidence-based method for confidential peer messaging of reports. Vanderbilt Patient Advocacy Reporting System (PARS) Unsolicited patient complaints over period of time Risk score calculation Effective, evidence-based method for confidential peer messaging of risk score and complaints. Hickson, et al. JAMA Hickson, et al. So Med J

14 Choosing Wisely American Board of internal Medicine Campaign to reduce ordering of unnecessary labs and tests. Vanderbilt developed APRN Choosing Wisely workgroup 10 teams across adult and pediatric hospital Substantial reduction in unnecessary labs, tests and associated costs. Several poster presentations over the past few months.

15 Choosing Wisely Outcomes

16 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program Advanced Alternative Payment Models Merit Based Incentive Program (MIPS) Quality Costs/Resource Use Clinical Improvement Advancing Care (EHR reporting)

17 What about me? Know your worth... Know where you are going

18 Determining metrics What are outcomes valued by your patients? What are outcomes valued by your practice? What are outcomes valued by your institution? Are any of these outcomes directly affected by NPs?

19 Developing data definitions Define your outcome and goal. How will the outcome be measured? Is there data already being collected on this metric? If so, how can the data be mined and presented in a meaningful format? Can informatics be created to automatically collect the data? If not, how can the NP collect the data? If the NP is collecting the data, can the collection process be integrated in to the current workflow? What is your target value? Reach value? Unacceptable value? How will you address unacceptable values consistently? How will the NP and others in your practice be able to monitor this data?

20 Qualitative Metrics for Nurse Practitioners Professionalism Behavior Involvement Leadership Communication Patients/Families Health Care Team Oral/Written Tools Questionnaires Surveys Evaluation forms Discussions Direct observance Confidential reporting methods Chart audits

21 Quantitative Metrics for Nurse Practitioners Performance Indicators Blood transfusion patterns Ventilator days Hand hygiene Protocol adherence Outcomes Data Length of stay Readmission rates Nosocomial infection rates Checklists Technical performance Complication rates Frequency of procedures performed Performance (protocols, time outs) Tools Dashboards Scorecards Graphs Reports Checklists

22 NPs are GOAL DRIVEN! Patient experience Clinical outcomes Productivity Service delivery Increasing access Affordable options Consistent care

23 Other Essential NP Impact Factors Education Experience Knowledge Translation Policy Engagement

24 Education Hire professionals who have graduated from an accredited institution Advanced practice nursing built on holistic and comprehensive care principles

25 Experience Post graduation on the job training Fellowships, residencies Exposure, experience, expertise in practice

26 Knowledge Translation Practice based learning and improvement Discovery and innovation Continuous knowledge acquisition and translation Evidence based practice

27 Interprofessional Collaboration

28 Healthcare Policy Engagement Policy affects NP practice Policy impacts patient care Essential to be engaged in policy state and federal Policy impacts accessible, affordable, quality care

29 Grassroots NPs Impacting Change One NP can make a phone call, One NP can be active in your community, One NP can write letters to your local, state and federal representatives, One NP can precept students, One NP can mentor another, But one NP cannot do it alone, If one NP here and there work on legislative changes you get a scenario like the patchy grass above, But if NPs work together towards a common goal then the lawn is plush and green. -- Cindy Cooke, President AANP

30 NC s Modernize Nursing Practice Act The North Carolina General Assembly will consider the Modernize Nursing Practice Act during the legislative session. The Modernize Nursing Practice Act has been filed as House Bill 88 and Senate Bill 73, and would bring North Carolina into closer alignment with national standards for nurse practitioners, and all nursing. Stay engaged, stay involved Don t give up! Healthcare teams, organizations, communities and patients need you! They need your practice and your care!

31 North Carolina Nurses Association Nurse Practitioner Symposium 2017

8/31/2015. Session C719 Outcomes of a Study Addressing Challenges in APRN Practice and Strategies for Success. Vanderbilt University Medical Center

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