The U.S. Preventive Services Task Force (USPSTF) has based its recommendations on an evidence-based
model of clinical prevention (Leipzig et al., 2010). However, patients with multifactorial serious illness
may complicate outcomes research. Most outcomes measurements are based on one disease or
condition and the associated outcomes. Elderly populations are increasingly likely to have comorbidities
that are not considered; therefore, the results of most outcomes measurements are not easily
summarized for systematic review and the development of recommendations.
Individuals Versus Groups
Outcomes are most often measured at the individual level with no consideration of the interaction and
dynamics between patients in the same groups.
Question:
Do interventions that work with individuals transfer successfully to
groups? Or
are there intervening variables caused by group dynamics that affect the successful
transfer?
Answer:
Individual interventions for health improvement, social support and
changing
behaviors include weight loss, self-care for chronic conditions, cardiac rehabilitation,
etc. However based on systematic reviews of specific lifestyle behaviors focused on
individual behavior change, there is a lack of guidelines for designing, evaluating or
reporting health improvement interventions in group settings (Hoddinott, Allan,
Avenell,
& Britten, 2010). So, yes, the characteristics and dynamics of the group affect the
impact of an intervention that may be effective with individuals.
The literature is unclear as to which intervention is more effective and efficient at improving health
outcomes: individual or group. There are a variety of group factors that can create and influence,
including leadership style, the characteristics of the individual participants, and the multiple interactions
that take place within a group context. Hoddinott, Allan, Avenell, and Britten (2010) propose an in-depth
framework to be utilized as an initial step toward creating interventions for groups.
Another consideration for outcomes measurement has been discussed by McLeroy, Bibeau, Steckler, and
Glanz (1988). They believe that the level at which the intervention occurs needs to be evaluated because
it will influence the outcome measurements. They theorize that the macro, meso, or micro levels each
have their own variables that can affect individual and group outcomes.
Nurse-Sensitive Process and Outcome Indicators at the Population Level
Although there are many ways to measure outcomes, the APN can view the alternatives of clinical
quality, customer satisfaction, core business processes, and utilization of healthcare resources.
Comparison of outcomes is essential to support the reliability and validity of the outcome measures. For
this purpose, standardized data definitions should be utilized. In recognition of the importance of
comparison data sets, external comparisons and guidelines for standardized numerators and
denominators have been developed by both private and governmental agencies. The APN should be
familiar with the organizations that are driving forces in this area. The following are examples of
