Comparing three patient-controlled analgesia methods.

Among 301 patients randomly assigned to use one of three methods for patient-controlled analgesia (PCA), no statistically significant differences were found for self-reported pain or acceptability of PCA method. Methods yielded differences in on-demand bolus analgesia use and number of symptoms.

Outcomes of the Kaiser Permanente Tele-Home Health Research Project.

CONTEXT: Level of acuity and number of referrals for home health care have been escalating exponentially. As referrals continue to increase, health care organizations are encouraged to find more effective methods for providing high-quality patient care with cost savings. OBJECTIVE: To evaluate the use of remote video technology in the home health care setting as well as the quality, use, patient satisfaction, and cost savings from this technology. DESIGN: Quasi-experimental study conducted from May 1996 to October 1997. SETTING: Home health department in the Sacramento, Calif, facility of a large health maintenance organization. PARTICIPANTS: Newly referred patients diagnosed as having congestive heart failure, chronic obstructive pulmonary disease, cerebral vascular accident, cancer, diabetes, anxiety, or need for wound care were eligible for random assignment to intervention (n = 102) or control (n = 110) groups. INTERVENTION: The control and intervention groups received routine home health care (home visits and telephone contact). The intervention group also had access to a remote video system that allowed nurses and patients to interact in real time. The video system included peripheral equipment for assessing cardiopulmonary status. MAIN OUTCOME MEASURES: Three quality indicators (medication compliance, knowledge of disease, and ability for self-care); extent of use of services; degree of patient satisfaction as reported on a 3-part scale; and direct and indirect costs of using the remote video technology. RESULTS: No differences in the quality indicators, patient satisfaction, or use were seen. Although the average direct cost for home health services was $1830 in the intervention group and $1167 in the control group, the total mean costs of care, excluding home health care costs, were $1948 in the intervention group and $2674 in the control group. CONCLUSIONS: Remote video technology in the home health care setting was shown to be effective, well received by patients, capable of maintaining quality of care, and to have the potential for cost savings. Patients seemed pleased with the equipment and the ability to access a home health care provider 24 hours a day. Remote technology has the potential to effect cost savings when used to substitute some in-person visits and can also improve access to home health care staff for patients and caregivers. This technology can thus be an asset for patients and providers.

Documentation of care outcomes in an academic nursing clinic: an assessment.

PURPOSE: To assess documentation of client data collected at an academic nursing clinic using the Wilson and Cleary Health Related Quality of Life (HRQOL) conceptual model as a framework. DATA SOURCES: A chart audit of 100 randomly selected active client records was conducted. CONCLUSIONS: Although several significant HRQOL variables were documented, data regarding general health perception and quality of life were not present. The HRQOL conceptual model provided an appropriate structure for evaluating the documentation. Further effort must be made to include key HRQOL dimensions in the clinic's documentation system. IMPLICATIONS FOR PRACTICE: Documenting the quality of care provided in nursing clinics is essential in order for other professionals and the public to recognize nursing professionals as accountable and credible. This project formed the basis for a computerized outcomes-based client record system.

Description of a health-related quality of life conceptual model.

Outcomes are key to understanding the effectiveness of patient care. By incorporating patient outcomes such as health-related quality of life (HRQOL) into practice, researchers, administrators, and clinicians can determine optimal strategies for patient care. This article describes a health-related quality of life conceptual model. By uniting the biomedical and social science paradigms, this outcome model could be used for describing, explaining, and predicting quality patient care.

Dimensions of health-related quality of life in persons living with HIV disease.

The purpose of this secondary analysis was to test empirically the influence of biological and physiological variables, symptom status, functional status, general health perceptions, characteristics of the individual and characteristics of the environment on overall quality of life in persons living with HIV disease. Path analysis, using multiple linear regression, was used to examine the fit between a health-related quality of life (HRQOL) theoretical model and data from a sample of 142 persons with an AIDS diagnosis. Thirty-two per cent of the variance in overall quality of life was explained by the HRQOL model with symptom status having the greatest influence (beta = -0.237, R2(Y x 2) = 5%). This analysis suggests that symptom status, functional status and general health perceptions are key dimensions of HRQOL. With a focus on prevention, health promotion, symptom management, and the alleviation of acute and chronic illness effects, HRQOL may be appropriate for capturing the outcomes of nursing interventions.