APNs’ Impact: Outcomes, Quality & Cost-Effectiveness

Advanced nursing practice (APN) is relevant in the context of different aspects of care in various healthcare institutions and has particular expressions and influences. The peculiarities of these employees’ work may be assessed in terms of such aspects as the outcomes of interventions, medical aid quality, and cost-effectiveness. As a rationale for specific arguments and assumptions, topical research will be brought in with real control trials and testing appropriate hypotheses. Conclusions based on the analysis of these sources may provide an opportunity to evaluate APNs’ effectiveness in different clinical environments and determine the impact of their activities on the quality and outcomes of care.

Outcomes of Care

• The article by Schofield and McComiskey (2015) allows evaluating the results of the professional practice of APN employees in group activities.
• The authors argue that about 15% of candidates for APN positions were active participants in the labor market from 2012 to 2014 (Schofield & McComiskey, 2015, p. e19).
• As a location for the study, a new medical center is taken where the activities of APNs are analyzed in the context of the impact on the patient’s recovery regime.
• According to the findings, many employees who have recently received their APN status experience significant difficulties in “managing patients in deteriorating clinical scenarios” (Schofield & McComiskey, 2015, p. e23).
• Based on the results of the study, fellowship coordinators help new employees better accomplish tasks and improve the results of their professional work.
• Casey et al. (2017) analyze the results of APN practitioners’ interventions about chronic and acute care.
• Date synthesis is carried out to highlight the key aspects of the impact of specialists.
• As a field of analysis, the existing findings of academic studies are presented and evaluated.
• According to the analysis, Casey et al. (2017) note that the outcomes of care conducted by APNs should be assessed by using special measurements, in particular, statistical correlations, to get a comprehensive picture of performance.

Quality of Care

• McLeod, Stolee, Walker, and Heckman (2014) analyze the impact of the Care Transitions Model on the quality of advanced nursing practice.
• The assessment method is based on the use of standard statistical calculations by using Cronbach’s alpha methodology.
• As a sample, a group of older adults with musculoskeletal disorders is taken, and the work of APN specialists is viewed about the quality of medical care.
• According to the study, McLeod et al. (2014) argue that APN practitioners “help patients to navigate hospital-to-home transitions and support patients to self-manage their care” (p. 19).
• Metzger and Rivers (2014) consider the role of coordinators in improving the quality of care provided by APNs.
• A special organizational leadership model is used as the main assessment tool.
• The authors state that the proposed practice of change in the activities of medical employees in question may influence the quality of care positively (Metzger & Rivers, 2014).
• The proposed model contributes to increased control over APNs and improved outcomes of specialists’ work.
• Sastre-Fullana et al. (2017) evaluate the professional competencies of APNs in terms of the quality of care.
• As a measurement practice, a special model is used, which includes eight key evaluation factors.
• The authors note that in Spain, this methodology is relevant, and among the competencies used, the management and quality of work occupy the most significant positions (Sastre-Fullana et al., 2017).
• According to the results of the study, APNs’ competencies and, in particular, the quality of care provided, depending on a chosen control strategy over the performance of direct duties.

Cost-Effectiveness of Care

• Stern et al. (2014) analyze the cost-effectiveness of APNs in caring for patients with pressure ulcers.
• In healthcare settings, emergency departments are utilized, and the work of the staff is assessed not only from the standpoint of quality but also cost-effectiveness.
• The results of the analysis show that the effective activity of APNs in the considered clinical environment contributes to a cost reduction of approximately $650 per one patient (Stern et al., 2014, p. 83).
• The result of the study is the assertion that policymakers should take into account the modern methods of controlling APNs’ activities to reduce the cost of medical services.
• According to Koh, Wang, Richards, Chan, and Cheng (2016), costly hospital readmissions are a significant problem in the healthcare system, and the work of APNs should involve the efficient allocation of resources.
• The considered randomized controlled trial is based on the assessment of the modern telehealth methodology as a productive tool in reducing costs.
• As a control group, “172 patients with acute myocardial infarction” are involved, and the economical distribution of funds is one of the objectives of the intervention (Koh et al., 2016, p. 1357).
• The effective performance of APNs is one of the pledges of patient education through telehealth and, therefore, readmission reduction.

Conclusion

The analysis of relevant studies makes it possible to determine the outcomes of care carried out by advanced practice nurses, the quality of their work, as well as cost-effectiveness practices. Proper coordinating work is seen as a valuable mechanism in most of the reviewed academic articles. The productivity of APNs’ activities is the combination of factors, and the assessment of various components of specialists’ work can make it possible to find the most significant aspects influencing the proposed variables.

References

Casey, M., O’Connor, L., Cashin, A., Smith, R., O’Brien, D., Nicholson, E.,… Stokes, D. (2017). An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review. Nurse Education Today, 56, 35-40. doi:10.1016/j.nedt.2017.06.004

Koh, K. W. L., Wang, W., Richards, A. M., Chan, M. Y., & Cheng, K. K. F. (2016). Effectiveness of advanced practice nurse-led telehealth on readmissions and health-related outcomes among patients with post-acute myocardial infarction: ALTRA Study Protocol. Journal of Advanced Nursing, 72(6), 1357-1367. doi:10.1111/jan.12933

McLeod, J., Stolee, P., Walker, J., & Heckman, G. (2014). Measuring care transition quality for older patients with musculoskeletal disorders. Musculoskeletal Care, 12(1), 13-21. doi:10.1002/msc.1043

Metzger, R., & Rivers, C. (2014). Advanced practice nursing organizational leadership model. The Journal for Nurse Practitioners, 10(5), 337-343. doi:10.1016/j.nurpra.2014.02.015

Sastre-Fullana, P., Morales-Asencio, J. M., Sesé-Abad, A., Bennasar-Veny, M., Fernández-Domínguez, J. C., & De Pedro-Gómez, J. (2017). Advanced practice nursing competency assessment instrument (APNCAI): Clinimetric validation. BMJ Open, 7(2), e013659. doi:10.1136/bmjopen-2016-013659

Schofield, D. L., & McComiskey, C. A. (2015). Postgraduate nurse practitioner critical care fellowship: Design, implementation, and outcomes at a tertiary medical center. The Journal for Nurse Practitioners, 11(3), e19-e26. doi:10.1016/j.nurpra.2014.11.001

Stern, A., Mitsakakis, N., Paulden, M., Alibhai, S., Wong, J., Tomlinson, G.,… Zwarenstein, M. (2014). Pressure ulcer multidisciplinary teams via telemedicine: A pragmatic cluster randomized stepped wedge trial in long term care. BMC Health Services Research, 14(1), 83. doi:10.1186/1472-6963-14-83