Clinical application of risk assessment in PAH: Expert center APRN recommendations.

Performing longitudinal and consistent risk assessments for patients with pulmonary arterial hypertension (PAH) is important to help guide treatment decisions to achieve early on and maintain a low-risk status and improve patient morbidity and mortality. Clinical gestalt or expert perception alone may over or underestimate a patient's risk status. Indeed, regular and continued use of validated risk assessment tools more accurately predict patients' survival. Effective PAH risk assessments are often underutilized even though many seasoned clinicians will attest to using these tools routinely. We present recommendations based on real-world experience in varied clinical practice settings around the United States for overcoming barriers to facilitate regular, serial formal risk assessment. Expert advanced practice provider clinicians from mid to large-size medical centers collaborated to formulate recommendations based on multiple discourses and discussions. Enlisting the help of support staff, such as medical assistants and nurses, to fill in available risk parameters in risk assessment tools can save time for providers and increase efficiency, as can technology-based solutions such as integrating risk assessments into electronic medical records. Modified, abbreviated risk assessment tools can be applied to a patient's clinical scenario when all of a patient's data are not available to complete a more comprehensive assessment. Initial discussions regarding the overall meaning and prognostic importance of risk scores may assist patients to take on a more active role in terms of informed decision-making regarding their care. A collaborative approach can help clinics establish consistent use of risk assessment.

Current clinical utilization of risk assessment tools in pulmonary arterial hypertension: a descriptive survey of facilitation strategies, patterns, and barriers to use in the United States.

Practice guidelines suggest that treatment decisions in pulmonary arterial hypertension be informed by periodic assessment of patients' clinical risk. Several tools, well validated for risk discrimination, such as the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management calculator, were developed to assess pulmonary arterial hypertension patients' risk of death based on multiple parameters, including functional class, hemodynamics, biomarkers, comorbidities, and exercise capacity. Using an online survey, we investigated the use of risk assessment tools by pulmonary hypertension healthcare providers in the United States. Of 121 survey respondents who make treatment decisions, 59% reported using risk assessment tools. The use of these tools was lower for non-physicians (48% vs. 65% physicians) and for practitioners at centers with 1 to 100 pulmonary arterial hypertension patients compared with centers with >100 patients (47% vs. 64%). Risk was most frequently assessed by decision makers at the time of diagnosis (cited by 54%) and at the time of worsening symptoms (cited by 42%), suggesting that use of pulmonary arterial hypertension risk assessment tools remains low. In our survey, non-physicians compared with physicians cited two major barriers to increased tool use: lack of education and training (20% vs. 4%) and lack of clarity on the best tool to use (30% vs. 18%). Information technology tools, such as electronic medical record integration and web or phone-based risk calculating applications, were cited most frequently as ways to increase the use of risk assessment tools.

Identifying at-risk nursing students using a midcurricular examination.

The purpose of this study was to investigate the usefulness of the midcurricular HESI examination in identifying at-risk students early in their nursing program. The sample included baccalaureate nursing graduates from two university programs in the southeastern United States (n = 256). A quasi-experimental design was used to determine how well the midcurricular HESI predicted outcomes on the HESI E(2) and the NCLEX-RN passing status while controlling for demographic and institutional covariates. The study used logistic regression and multiple linear regression to analyze the hypotheses. The midcurricular HESI examination was found to be a statistically significant predictor of NCLEX-RN outcome both before (P = .044) and after (P = .041) controlling for demographic factors. The study further found a statistically significant relationship between the midcurricular HESI and the HESI E(2) examinations (P < .001). In the post hoc analyses, students from the Accelerated and Fast Track degree programs scored significantly higher than did students in the Traditional Track on the midcurricular HESI examination. There were no statistically significant differences in HESI E(2) scores or NCLEX-RN outcomes among the degree tracks. As anticipated, there was a statistically significant difference in both midcurricular HESI (P < .043) and HESI E(2) (P < .016) scores between students who passed and those who failed NCLEX-RN. This study indicates that the midcurricular HESI examination is very useful in predicting outcomes in baccalaureate nursing education programs.