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Biomedical subjects

P A Prescott

Publications and source records attributed to P A Prescott.

At least 19 recordsLinked to original sources
PubMed1995

Identification and referral of hospitalized patients in need of home care.

Given current concerns about the cost-effectiveness of home health care, better targeting of home health services for high risk groups is viewed as one way to provide controls on both service delivery and costs. The purpose of this exploratory study was to determine the degree to which patients with identifiable levels of need for services were referred for home health care and if selected clinical and functional status measures are useful in distinguishing need for service. Using a convenience sample of 145 patients ready for hospital discharge, data were collected on physical function, dependency at discharge, perceived helpfulness of others, social support, readiness for self-care, and planned adherence to treatment as well as demographic and medical variables. Using a combination of study variables, 93% of patients not in need of services could be correctly classified. In addition, patients in need of service but not referred by their physicians were found to differ significantly from patients not in need of care on all dimensions. Suggestions are offered for further research to determine if and what systematic factors influence referral decisions for home health care and which specific patient characteristics are associated with the most cost-effective long-term outcomes.

Female↗
PubMed1992

Nursing intensity. Going beyond patient classification.

Two patient classification systems, Medicus and GRASP, were compared to the Patient Intensity for Nursing Index (PINI). Approximately 50% of the variability in both classification systems was not accounted for by PINI items. The patterns of correlation between PINI items and GRASP and Medicus scores indicated that these two classification systems do not measure nursing resource use in the same way. Nurse administrators should be aware that estimates of nursing care costs will vary depending on the patient classification system used to measure nursing intensity.

Costs and Cost Analysis↗
PubMed1991

The Patient Intensity for Nursing Index: a validity assessment.

The psychometric assessment of a new measure of nursing intensity, The Patient Intensity for Nursing Index (PINI) is reported. Four dimensions of nursing intensity are measured by the PINI: (a) severity of illness, (b) dependency, (c) complexity of care, and (d) time. There are 10 items rated on a 5-point ordinal scale. A purposively drawn sample of 6,445 patients was obtained from five hospitals, with 487 registered nurses (RNs) providing daily patient ratings from 29 medical-surgical and intensive care units. Substantial interrater reliability was demonstrated. Validity testing included confirmatory factor analysis, hypothesis-testing, contrasted groups, and an observational study of time. The factor structure confirmed specified components of severity, dependency, and complexity, with time loading on all three factors. PINI scores were significantly related to medical severity of illness, length of hospital stay, disposition at discharge, number of secondary medical diagnoses and specialty consults, and scores on three different hospital classification systems used for staffing. PINI scores were significantly different for high- and low-intensity DRGs. Observed time spent delivering nursing care to specific patients was significantly correlated with nurse estimates of time.

Dependency, Psychological↗
PubMed1991

Patient intensity for nursing index: the measurement model.

One part of the psychometric evaluation of the Patient Intensity for Nursing Index (PINI), a new measure of nursing intensity, is reported. The PINI has four interrelated components: (a) severity of illness, (b) dependency, (c) complexity of care, and (d) time. Taken together, the 10 items that make up these four components comprise the multidimensional construct of nursing intensity. Using the factor analytic approach and a model specification search, the measurement model for the Patient Intensity for Nursing Index was identified. The structure consists of Dependency, Severity, and Complexity with time (hours of nursing care) loading on each factor. When results were cross-validated using data from four other hospitals, support emerged for a consistent pattern of factor loadings. The loadings themselves, however, are only partially invariant. Further examination of the relationship between severity and time is suggested and areas for future research are identified.

Dependency, Psychological↗
PubMed1991

Changing how nurses spend their time.

The results of work sampling studies are used to examine how nurses spend their time and to relate nurses' time to the shortage of nursing practice in hospitals. Four types of proposals for improving the delivery of nursing care in hospitals are discussed. The likely impact of these proposals on how nurses spend their time and the consequences of increasing the effectiveness of professional nursing practice are explored.

Career Mobility↗
PubMed1991

Predictors of hospital readmission. A meta-analysis.

Summarizing the results of research related to identifying potential predictors of hospital readmissions has been difficult because of conflicting results across studies. Using the techniques of meta-analysis, the results from 44 studies were examined in the present study. Overall, the mean readmission rate was 27%, with significant differences based on patient diagnosis. Although diagnosis, age, initial length of hospital stay, and prior use of hospital resources were related to readmission, the strength of the relationship is trivial. Combining data from 12 intervention studies designed to reduce readmission indicated that the overall treatment effect was not significant. Further research is needed to determine demographic, clinical, and social predictors of readmission if strategies are to be developed to reduce readmission and the resulting health care costs.

Age Factors↗
PubMed1990

The process of rater training for observational instruments: implications for interrater reliability.

Although the process of rater training is important for establishing interrater reliability of observational instruments, there is little information available in current literature to guide the researcher. In this article, principles and procedures that can be used when rater performance is a critical element of reliability assessment are described. Three phases of the process of rater training are presented: (a) training raters to use the instrument; (b) evaluating rater performance at the end of training; and (c) determining the extent to which rater training is maintained during a reliability study. An example is presented to illustrate how these phases were incorporated in a study to examine the reliability of a measure of patient intensity called the Patient Intensity for Nursing Index (PINI).

Employee Performance Appraisal↗
PubMed1989

Measuring patient intensity. A reliability study.

The purpose of this study was to determine the interrater reliability for each of 12 dimensions of a measure of Patient Intensity for Nursing (PINI). Three hospitals in two states participated in this project with 121 Registered Nurses prepared in the use of the PINI. The interrater reliability was determined by day shift nurses rating their patients late in the shift and evening shift nurses rating the same patients early in their shift. Paired ratings of 657 patients were included in this analysis, and the reliability was substantial (kappa = greater than .60) for 10 of the 12 dimensions across hospitals. These findings provided the foundation for revision of the instrument, which is currently undergoing additional testing.

Activities of Daily Living↗
PubMed1989

Shortage of professional nursing practice: a reframing of the shortage problem.

The nursing shortage is discussed in terms of supply, demand, and wages, and the current situation is compared with previous nursing shortages. Reasons for the shortage are examined and reframing the problem from a shortage of nurses to a shortage of professional nursing practice is suggested as a strategic first step in solving the problems of nurse staffing in acute care general hospitals. Four kinds of shortage situations are identified; only one kind, vacancy, results from vacant positions. The other three types, transient, position, and scheduling, are the result of administrative decisions regarding the use of nursing personnel. A fundamental restructuring of how hospitals use nurses is needed, and this solution will in the long run be more effective in solving the shortage problem than is the effort simply to add more nurses into the existing system.

Critical Care↗
PubMed1988

Nursing: a major hospital cost component.

Selected studies of nursing costs demonstrate a wide variation per patient-day and per patient stay within the same DRG. These differences could reflect either actual differences in nursing practice or methodological differences in calculating practice costs. We examined several alternative methods to find hospital nursing costs of the same group of patients. Measures of patient illness--AS-SCORE severity of illness, Relative Intensity (RIMs), MacLeod nursing intensity, and a per diem measure--were compared for variations in nursing cost. Various definitions of nursing cost itself also were compared using the same patients. Two approaches to defining nursing cost elements--by nursing unit and by hands-on patient care-are discussed. Several nursing cost studies reporting data for DRG 121 (myocardial infarction with complications and/or comorbidity) were compared with our data. The nursing care costs in several studies of these same patients varied from $706 to $1,778 per stay (a 60 percent difference); reasons for these cost differences are discussed. It is suggested that at least part of this variability reflects methodological differences. Cost data should be reported carefully to facilitate comparisons with the results of other studies. Efforts should begin toward designing nursing cost studies using comparable measures and cost-finding methodologies.

Costs and Cost Analysis↗