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DOI: 10.4338/ACI-2011-06-RA-0038
Problem Stabilization
A Metric for Problem Improvement in Home Visiting ClientsCorrespondence to:
Publication History
received:
06 June 2011
accepted:
16 September 2011
Publication Date:
16 December 2017 (online)
Summary
Background: Public health nurse (PHN) home visiting programs have been widely employed to improve life course trajectories for high risk mothers. Home visiting programs are often lengthy, during which PHNs simultaneously address multiple problems using diverse interventions over several client encounters. To manage PHN caseloads it is critical to understand the trajectory of client improvement and the optimal duration or services. PHN documentation data enable intervention trajectory research for specific client problems. A new metric called problem stabilization is proposed for evaluating interim improvement during PHN home visiting. Problem stabilization is an intervention pattern for a client problem that is characterized by co-occurring actions (i.e. teaching, guidance, and counseling; treatments and procedures; case management; and/or surveillance) during a client encounter; followed by surveillance actions only for that problem during a subsequent client encounter. The purpose of the study was to investigate problem stabilization during home visiting services for high risk mothers.
Methods: A retrospective cohort was created using family home visiting intervention documentation data from a local Midwest public health agency over a six year period (2000–2005). The data set consisted of Omaha System interventions for 720 high risk mothers. Analysis was conducted using descriptive statistics and Kaplan Meier curves.
Results: On average 30.1% of the time, client problems stabilized before discharge. Stabilization patterns differed by problem. Time to stabilization was longest for Caretaking/parenting and Ante-partum/postpartum problems, and shortest for Residence and Mental health problems.
Conclusions: Problem stabilization, a proposed intermediate outcome of PHN home visiting care, appears to be meaningful in describing client response to PHN intervention. This metric is an example of meaningful use of structured clinical electronic health record data for program evaluation and clinical decision support.
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Keywords
Public health nursing - home visiting - standards - interventions - outcomes - methods - Omaha system
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Conflicts of Interest
The authors are informatics specialists and/or statisticians with expertise in use of the Omaha System in education and research. All authors declare no conflict of interest in the preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the authors’ employers.
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References
- 1 Barnard KE. Developing, implementing, and documenting interventions with parents and young children. Zero to Three. 1998; February/March: 23-29.
- 2 Eckenrode J, Campa M, Luckey DW, Henderson Jr CR, Cole R, Kitzman H. et al. Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Arch Pediatr Adolesc Med 2010; 164 (01) 9-15.
- 3 Healthy Families America.. [Internet]; 2011. Available from: http://www.healthyfamiliesamerica.org home/index.shtml.
- 4 Monsen KA, Fitzsimmons LL, Lescenski BA, Lytton AB, Schwichtenberg LD, Martin KS. A public health nursing informatics data-and-practice quality project. CIN: Computers, Informatics, Nursing 2006; 24 (03) 152-158.
- 5 Monsen KA, Fulkerson JA, Lytton AB, Taft LL, Schwichtenberg LD, Martin KS. Comparing maternal child health problems and outcomes across public health nursing agencies. Maternal & Child Health Journal 2010; 14 (03) 412-421.
- 6 Martin KS. The Omaha System: A key to practice, documentation, and information management Reprinted 2nd Ed. ed. Omaha, NE: Health Connections Press; 2005
- 7 Martin KS, Scheet NJ. Visiting Nurse Association of Omaha. The Omaha System: Applications for community health nursing. Philadelphia: Saunders; 1992
- 8 The Omaha System: Solving the clinical data-information puzzle.. [Internet]; 2011. Available from: omaha-system.org.
- 9 Monsen KA, Martin KS. Developing an outcomes management program in a public health department. Outcomes Management 2002; 6 (02) 62-66.
- 10 Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. Journal of the American Statististical Association 1958; 53: 457-481.
- 11 Monsen KA, Banerjee A, Das P. Discovering client and intervention patterns in home visiting data. West J Nurs Res 2010; 34: 1031-1054.
- 12 Monsen KA, Radosevich DM, Kerr MJ, Fulkerson JA. Public health nurses tailor interventions for families at risk. Public Health Nurs 2011; 28 (02) 119-128.
- 13 Barlow J, Davis H, McIntosh E, Jarrett P, Mockford C, StewartBrown S. Role of home visiting in improving parenting and health in families at risk of abuse and neglect: Results of a multicentre randomised controlled trial and economic evaluation. Arch Dis Child 2007; 92 (03) 229-233.
- 14 Kitzman H, Olds DL, Henderson Jr CR, Hanks C, Cole R, Tatelbaum R. et al. Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA 1997; 278 (08) 644-652.
- 15 McNaughton DB. A naturalistic test of peplau’s theory in home visiting. Public Health Nursing 2005; 22 (05) 429-438.
- 16 Byrd ME. A concept analysis of home visiting. Public Health Nursing 1995; 12 (02) 83-89.
- 17 Byrd ME. The home visiting process in the contexts of the voluntary vs. required visit: Examples from fieldwork. Public Health Nursing 1995; 12 (03) 196-202.
- 18 Byrd ME. Child-focused single home visiting. Public Health Nurs 1997; 14 (05) 313-322.
- 19 Byrd ME. Long-term maternal-child home visiting. Public Health Nurs 1998; 15 (04) 235-242.
- 20 Koniak-Griffin D, Verzemnieks IL, Anderson NLR, Brecht M, Lesser J, Kim S. et al. Nurse visitation for adolescent mothers: Two-year infant health and maternal outcomes. Nurs Res 2003; 52 (02) 127-136.
- 21 Monsen KA, Lytton AB, Ferrari S, Halder K, Radosevich DM, Kerr MJ. et al. Evaluating reliability of assessments in nursing documentation. On-line Journal of Nursing Informatics. In press.
Correspondence to:
-
References
- 1 Barnard KE. Developing, implementing, and documenting interventions with parents and young children. Zero to Three. 1998; February/March: 23-29.
- 2 Eckenrode J, Campa M, Luckey DW, Henderson Jr CR, Cole R, Kitzman H. et al. Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Arch Pediatr Adolesc Med 2010; 164 (01) 9-15.
- 3 Healthy Families America.. [Internet]; 2011. Available from: http://www.healthyfamiliesamerica.org home/index.shtml.
- 4 Monsen KA, Fitzsimmons LL, Lescenski BA, Lytton AB, Schwichtenberg LD, Martin KS. A public health nursing informatics data-and-practice quality project. CIN: Computers, Informatics, Nursing 2006; 24 (03) 152-158.
- 5 Monsen KA, Fulkerson JA, Lytton AB, Taft LL, Schwichtenberg LD, Martin KS. Comparing maternal child health problems and outcomes across public health nursing agencies. Maternal & Child Health Journal 2010; 14 (03) 412-421.
- 6 Martin KS. The Omaha System: A key to practice, documentation, and information management Reprinted 2nd Ed. ed. Omaha, NE: Health Connections Press; 2005
- 7 Martin KS, Scheet NJ. Visiting Nurse Association of Omaha. The Omaha System: Applications for community health nursing. Philadelphia: Saunders; 1992
- 8 The Omaha System: Solving the clinical data-information puzzle.. [Internet]; 2011. Available from: omaha-system.org.
- 9 Monsen KA, Martin KS. Developing an outcomes management program in a public health department. Outcomes Management 2002; 6 (02) 62-66.
- 10 Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. Journal of the American Statististical Association 1958; 53: 457-481.
- 11 Monsen KA, Banerjee A, Das P. Discovering client and intervention patterns in home visiting data. West J Nurs Res 2010; 34: 1031-1054.
- 12 Monsen KA, Radosevich DM, Kerr MJ, Fulkerson JA. Public health nurses tailor interventions for families at risk. Public Health Nurs 2011; 28 (02) 119-128.
- 13 Barlow J, Davis H, McIntosh E, Jarrett P, Mockford C, StewartBrown S. Role of home visiting in improving parenting and health in families at risk of abuse and neglect: Results of a multicentre randomised controlled trial and economic evaluation. Arch Dis Child 2007; 92 (03) 229-233.
- 14 Kitzman H, Olds DL, Henderson Jr CR, Hanks C, Cole R, Tatelbaum R. et al. Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA 1997; 278 (08) 644-652.
- 15 McNaughton DB. A naturalistic test of peplau’s theory in home visiting. Public Health Nursing 2005; 22 (05) 429-438.
- 16 Byrd ME. A concept analysis of home visiting. Public Health Nursing 1995; 12 (02) 83-89.
- 17 Byrd ME. The home visiting process in the contexts of the voluntary vs. required visit: Examples from fieldwork. Public Health Nursing 1995; 12 (03) 196-202.
- 18 Byrd ME. Child-focused single home visiting. Public Health Nurs 1997; 14 (05) 313-322.
- 19 Byrd ME. Long-term maternal-child home visiting. Public Health Nurs 1998; 15 (04) 235-242.
- 20 Koniak-Griffin D, Verzemnieks IL, Anderson NLR, Brecht M, Lesser J, Kim S. et al. Nurse visitation for adolescent mothers: Two-year infant health and maternal outcomes. Nurs Res 2003; 52 (02) 127-136.
- 21 Monsen KA, Lytton AB, Ferrari S, Halder K, Radosevich DM, Kerr MJ. et al. Evaluating reliability of assessments in nursing documentation. On-line Journal of Nursing Informatics. In press.