July/August 2013

Columbia Nursing Research Spotlighted at AcademyHealth Forum

Elaine Larson "PhD candidate Catherine Cohen and Professor Patricia Stone, PhD presented on HAIs in nursing homes at the AcademyHealth conference."

Selected from among the nation’s leading healthcare health sciences researchers, nurse scientists from Columbia University School of Nursing presented at the AcademyHealth Electronic Data Methods Forum on June 22 in Baltimore, MD. AcademyHealth represents a broad community of health research and policy professionals whose focus is using health services research to improve health care. The Forum took place in advance of AcademyHealth’s annual research meeting and brought together a select multi-disciplinary group of more than 150 researchers, policymakers and practitioners working at the cutting edge of applied health science.

The meeting included more than 50 peer-reviewed poster and podium presentations, as well as various panel sessions. One panel session, “Evolving Primary Care and Workforce Models”, was chaired by Assistant Professor Lusine Poghosyan, PhD, and included Jennifer Nooney, PhD, (Health Resources and Services Administration), Jeongyoung Park, PhD, (Association of American Medical Colleges), Susan Skillman, MS, (University of Washington), Joanne Spetz, PhD, (University of California, San Francisco) and James Williams, BA, (The Lewin Group). Another session, “Building a Learning Health System - Where have We Been, Where are We Going?, chaired by Ned Calonge, MD, of The Colorado Trust, included Professor of Biomedical Informatics Suzanne Bakken, PhD, RN, FAAN, FACMI.

Capsule summaries of some of the poster presentations by Columbia Nursing researchers are featured below.

Nurse Practitioners as Primary Care Providers: Practice Environments and Outcomes in Two States with Varying Scope of Practice Regulations. – L. Poghosyan, C. Sun, S. Brown-Stonbraker.

While there is a significant push nationwide to expand the nurse practitioner (NP) workforce, there’s been little research on NP practices in primary care settings and how these work environments may affect NP outcomes. To get a better sense of this dynamic, a Columbia Nursing team headed by Assistant Professor Lusine Poghosyan, PhD, RN, investigated NP practice experiments in Massachusetts and New York, two states with differing scope of practice (SOP) regulations. The study found that NPs in MA reported better practice environments than those in NY, resulting in more job satisfaction in MA (30.2% vs. 22.5%) and fewer NPs intending to leave their current jobs. NPs in both states reported better working relationships with physicians than with administrators. The study confirms that institutional support and visibility of the NP role are integral to a successful NP practice, an important finding that encourages the creation of practice environments that minimize NP turnover and maximize job satisfaction. This finding supports Institute of Medicine recommendations on expanding the NP workforce in primary care settings.

Development of a Data Collection Tool Characterizing State Focus on the Prevention of Healthcare-associated Infection (HAI) in Nursing Homes (NH). – C. Cohen, C. Herzig, E. Carter, M. Pogorzelska-Maziarz, P. Stone.

Healthcare-associated Infections, or HAIs, have long been the leading cause of morbidity and mortality for the elderly living in nursing homes. Today, approximately 1.7 million Americans live in nursing homes, with an anticipated increase to 5.3 million by 2030 as the “baby boom” generation ages. Without infection control, incidence of HAIs is also expected to grow. Currently, 1.6 to 3.8 million infections occur annually among nursing home residents, resulting in 388,000 deaths, with as much as $137 million spent on antimicrobial therapy and up to $2 billion in hospitalizations. PhD student Catherine Cohen and her team from Columbia Nursing developed a data collection tool that captures information from state Departments of Health websites and other sources, noting activities and policies that attempt to reduce HAIs in nursing home populations. By systematically characterizing these efforts nationwide, the tool showed a high variability in state efforts aimed at reducing HAIs. For example, while 34 states have laws mandating that hospitals report HAI rates, only two states have HAI data-reporting requirements for nursing homes. The tool allows for meaningful comparison of state health policy activities through consistent data collection. Understanding the ways that state Departments of Health attempt to reduce HAIs can inform the work of health policy researchers, infection preventionists, geriatricians and other healthcare workers in nursing homes.

Participatory Design and Formal Representation of Data Elements for a Nursing Care Transfer Summary. – S. Yoon, A. Wilcox, S. Bakken.

Postdoctoral Research Scientist Sunmoo Yoon, PhD, RN, headed a team that designed an electronic care summary for patients being transferred from acute care to skilled nursing facilities. To do this, the team interviewed user needs and assessed selected data elements from the WICER Research Data Warehouse, or RDW. The WICER (Washington Heights/Inwood Informatics Infrastructure for Comparative Effectiveness Research) project integrates data from multiple sources, including inpatient and skilled nursing facilities. Essentially, the summary created by this study combines qualitative factors contributed by medical staff with various quantitative factors (such as heart rate, pain ratings and blood pressure) from the RDW. The team mapped the information into the standardized terminologies for interoperability among different electronic health systems. The result is an electronic summary document that provides nurses with all the information needed to successfully manage the transfer of patients between facilities.

Ambulatory Care Sensitive Conditions and 30-Day Hospital Readmission for Adults with Diabetes. – A. Smaldone, C. Jeon.

This study, presented by Arlene Smaldone, DNSc, CPNP-PC, CDE, assistant dean, Scholarship and Research, focused on determining the rate of 30- and 90-day hospital readmissions involving ambulatory care sensitive conditions (ACSC) among adults with diabetes and other factors associated with ACSC hospital readmissions. The study examined information on adult patients hospitalized with a principal diagnosis (PDM) or secondary diagnosis (SDM) of diabetes over a 3-year period, using data from the clinical data warehouse of a large tertiary care facility in Manhattan. The study found that of 68,622 patients, 6,674 (9.7%) were readmitted within 30 days and 11,495 (16.8%) were readmitted within 90 days. ACSC readmission was 6 times higher for PDM patients compared to both SDM patients and patients without diabetes. Further, diabetes and its complications accounted for 100% of ACSC PDM readmissions. The implications are that while hospitalization for ACSC is avoidable, assessing patients’ diabetes knowledge and self-maintenance from the start and connecting them with community resources upon discharge would reduce hospitalizations and save money.

Individual and Contextual Correlates of Intent to Use Electronic Personal Health Records among a Largely Hispanic Immigrant Population. – R. Lucero, J. Shang, J. Liu, S. Bakken.

Starting in 2014, physicians will be required to ensure that at least 5% of their patients can access, download, and transmit their medical records through a patient portal or via electronic Personal Health Records, or ePHRs. However, there have been few studies to determine which populations intend to use ePHRs and how various personal factors may influence a patient’s decision. Assistant Professor Robert Lucero, PhD, RN, led a team that focused on 304 patients among an urban Hispanic immigrant population to explore the possible cultural factors that night be associated with the use of ePHRs. The patients surveyed for this study were primarily female (81%), Hispanic (94%), and born outside he U.S. (86%), with a mean age of 48 years old; half of the study group reported their health as “good.” The survey included self-reported health and other measures, as well as specific questions regarding each individual’s intent to use ePHRs. Among other findings, the study showed that factors indicating a willingness to use ePHRs include living in a household where the internet is used to look up medical information and membership in a social networking site like Facebook. Also, patients who reported good health were twice as likely to indicate they would use an ePHR as those reporting fair or poor health. The report concludes that educating patients will be critical to ePHR adoption and that a consumer-centered design will be important to the broad acceptance and use of ePHRs in the community.

Strategies for Engaging Latino Community Stakeholders in Patient Reported Outcomes for Comparative Effectiveness Research. – S. Bakken, A. Arcia.

Professor Suzanne Bakken, PhD, RN, FAAN, presented information about a research initiative that employed a bilingual team of community health workers to collect data on more than 6,000 residents of northern Manhattan as part of the WICER project (Washington Heights/Inwood Informatics Infrastructure for Comparative Effectiveness Research). One challenge of this research was to create ways of sharing this data so survey participants can understand it and thus take actions to improve their own health. Toward this end, Bakken and her team designed graphic visual representations of information, or infographics. They also conducted focus groups to assess the participants’ general understanding and preferences, and to gather suggestions for refining the product. The resulting infographics display information on blood pressure, mental health and associated lifestyle behaviors, such as nutrition and exercise, which are critical health topics in this primarily Latino community. When the infographics are finalized in the future, survey participants will be able to access them in either English or Spanish through the web portal GetHealthyHeights.org.