Clinical Topics

Objective This research identifies specific care coordination activities used by Aging In Place (AIP) nurse care coordinators and home healthcare nurses when coordinating care for older community dwelling adults and suggests a method to quantify care coordination.

Methods A care coordination ontology was built based on activities extracted from 11,038 notes labeled with the Omaha Case Management category. From the parsed narrative notes of every patient, we mapped the extracted activities to the ontology, from which we computed problem profiles and quantified care coordination for all patients.

Results We compared two groups of patients: Aging in Place who received enhanced care coordination (n=217) and Home Healthcare (HHC) who received traditional care (n=691) using 128,135 narratives notes. Patients were tracked from the time they were admitted to AIP or HHC until they were discharged. We found that patients in AIP received a higher dose of care coordination than HHC in most Omaha problems, with larger doses being given in AIP than in HHC in all four Omaha categories.

Conclusion "Communicate" and "manage" activities are widely used in care coordination. That confirmed the expert hypothesis that nurse care coordinators spent most of their time communicating about their patients and managing problems. Overall, nurses performed care coordination in both AIP and HHC, but the aggregated dose across Omaha problems and categories is larger in AIP.

Popejoy, L., Khalilia, M., Popescu, P., Galambos, C., Lyons, V., Rantz, M., Hicks, L., & Stetzer, F. (2015). Quantifying care coordination using natural language processing and domain-specific ontology. Journal of the American Medical Informatics Association, currently published online.*

This paper reviews randomized, controlled trials (RCTs) that have attempted to increase physical activity behavior by aging adults. A systematic review was necessary because numerous studies target older adults, and previous reviews have addressed a limited range of primary studies. Computerized database, ancestry, and extensive search strategies by authors of research reported in English between 1960 and 2000 located diverse intervention trials. RCTs reporting endurance physical activity or exercise behavioral outcomes for at least five subjects were included. Integrative review methods were used to summarize extant research. Forty-two studies were retrieved. Seventeen RCTs with 6,391 subjects were reviewed. A wide variety of intervention strategies were reported. The most common interventions were self-monitoring, general health education, goal setting, supervised center-based exercise, problem solving, feedback, reinforcement, and relapse prevention education. Few studies individually adapted motivational interventions, used mediated intervention delivery, or integrated multiple theoretical frameworks into the intervention. Links between individual intervention components and effectiveness were not clear. Common methodological weaknesses included small samples, untested outcome measures, and time-limited longitudinal designs. Significant numbers of aging adults increased their physical activity in response to experimental interventions. The amount of increased activity rarely equaled accepted behavior standards to achieve positive health outcomes. Further work is essential to identify successful strategies to increase activity by larger numbers of elders and to accelerate the increase in activity by those who change activity behaviors. Sex and ethnic differences need further investigation. There is a vital need for rigorously designed studies to contribute to this science.

Conn, V., Minor, M., Rantz, M.J., Burks, K. & Pomeroy, S. (2003). Integrative review of physical activity intervention research with aging adults. Journal of the American Geriatrics Society, 51(8): 1159-1168.

In meta-analysis, researchers combine the results of individual studies to arrive at cumulative conclusions. Meta-analysts sometimes include “grey literature” in their evidential base, which includes unpublished studies and studies published outside widely available journals. Because grey literature is a source of data that might not employ peer review, critics have questioned the validity of its data and the results of meta-analyses that include it.

Conn, V.S., Valentine, J.C., Cooper, H.M., & Rantz, M.J. (2003). Grey literature in meta-analysis. Nursing Research, 52(4): 256-261.

Meta-analyses synthesize multiple primary studies and identify patterns of relationships. Differences in primary study methodological quality must be addressed for meta-analysis to produce meaningful results. No single standard exists for addressing these quality variations. Quality measurement scales are fraught with development and application problems. Several strategies have been proposed to address quality. Researchers can set minimum levels for inclusion or require that certain quality attributes be present. An inclusive method is to weight effect sizes by quality scores. This allows the inclusion of diverse studies but relies on questionable quality measures. By considering quality an empirical question, meta-analysts can examine associations between quality and effect sizes and thus preserve the purpose of meta-analysis to systematically examine data. Researchers increasingly are combining strategies to overcome the limitations of using a single approach. Future work to develop valid measures of primary study quality dimensions will improve the ability of meta-analysis to inform research and nursing practice.

Conn, V.S., & Rantz, M.J. (2003). Research methods: Managing primary study quality in meta-analyses. Research in Nursing and Health, 26(4): 322-333.

This article describes the methods that one academic nursing unit used to move from receiving no National Institutes of Health funding to a top-20 ranking. A 1995 school task force recommended changes to move toward greater research productivity, including increased external funding. The school created a research infrastructure to support both the scientific development of research studies and the production of high-quality external grant applications. Barriers to research productivity were successfully managed. The research culture dramatically changed to emphasize innovation, autonomy, peer support and review, long-term investment in research productivity, penetration of research throughout school activities, and public display of research accomplishments. Academic nursing units can develop research cultures to support meaningful research that secures major external funding.

Conn, V.S., Porter, R.T., McDaniel, R.W., Rantz, M.J., & Maas, M.L. (2005). Building research productivity in an academic setting. Nursing Outlook, 53(5), 224-231.

AgingMO is Copyrighted by the Sinclair School of Nursing

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