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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? Orare there intervening variables caused by group dynamics that affect the successfultransfer?Answer: Individual interventions for health improvement, social support and changingbehaviors include weight loss, self-care for chronic conditions, cardiac rehabilitation,etc. However based on systematic reviews of specific lifestyle behaviors focused onindividual behavior change, there is a lack of guidelines for designing, evaluating orreporting health improvement interventions in group settings (Hoddinott, Allan, Avenell,& Britten, 2010). So, yes, the characteristics and dynamics of the group affect theimpact 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, andGlanz (1988). They believe that the level at which the intervention occurs needs to be evaluated becauseit 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 LevelAlthough 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