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Methodological challenges to prospective study of an innovation: interregional nursing care management of cardiovascular patients
Author(s) -
Aadalen Sharon Price
Publication year - 1998
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1046/j.1365-2753.1998.00004.x
Subject(s) - medicine , psychological intervention , nursing , health care , family medicine , patient satisfaction , retrospective cohort study , intervention (counseling) , tertiary care , economics , economic growth
This paper discusses the methodological challenges of conducting a interregional intersystem study in a highly competitive health care environment. Nurses from a three‐hospital rural health consortium and an urban tertiary medical centre collaborated in a two‐phase study (a) to describe current interregional cardiovascular health care process (phase I) and (b) to test an interregional nurse‐coordinated cardiovascular health care model (phase II). Phase I was a 1‐year exploratory descriptive retrospective study involving patient interviews and chart reviews. Findings from the phase I study suggested a pattern of patient health problems occurring weeks and months following successful tertiary centre interventions. Phase II was quasi‐experimental prospective study with 90 intervention subjects and 64 comparison group subjects who completed pencil and paper survey tools over a 12‐month period following discharge from the tertiary centre. Nurse and doctor providers completed a satisfaction survey twice, at an interval, 1 year. Concurrent data collection via telephone calls (comparison group) and a retrospective record review (intervention group) provided data on cost, resource use and system efficiency. Initial results of phase II are presented, together with tests of significance for hypotheses related to interregional nurse care management and patient outcomes, patient satisfaction, cost/system efficiency, and provider satisfaction. Methodological considerations and recommendations related to phases I and II of this interregional collaborative cardiovascular project are presented and discussed.