The efficacy of a nurse practitioner consultative program to support care-in-place for the nursing home resident experiencing a change in condition
Stansfield, Melanie A.
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The frail older nursing home resident is at risk for a change in condition that results in transfer to the Emergency Department. In this cohort transfer is associated with deterioration in health and function. Over 50% of those transferred are returned without hospital admission (transfer/return care). The Theory of Thriving suggests that caring for a resident in place (care-in-place) may produce improved outcomes. A nurse practitioner consultative program (NPP) is available to promote care-in-place but evidence to support the program's efficacy is needed. To do so four hypotheses were tested. The first two proposed an NPP consult would result in more incidences of care-in-place and fewer incidences if transfer/return than usual care. Hypothesis three and four proposed scores indicating deterioration in health and function would be fewer in the care-in-place group than the transfer/return group as measured by the Minimum Data Set Canadian (MDS 2.0 Cdn) and Resident Assessment Protocols (RAPS). An ex post facto quasi-experimental design was used. Incidences were tabulated for the group cared for through NPP consult and the group cared for in the usual manner. MDS 2.0 Cdn scores were calculated at baseline ( t 0 ), 48 to 72 hours post change in condition ( t, 1 ) and again one week post t 1 ( t 2 ). There were 175 eligible incidents to assess hypothesis one and two. NPP patterns of transfer and care-in-place were compared to those of usual care through chi-square analysis. There were 86 eligible incidents to assess hypothesis three and four. An analysis of covariance was conducted to compare differences between groups while controlling for covariates. Hypotheses one, two and four were supported at a statistically significant level. Three significant differences were found in the function and behavior domains supporting hypothesis three. The remainder of scores for hypothesis three were not significantly different between groups. The NPP was found to be efficacious in promoting care-in-place and reducing transfer/return care, with equivalent or improved resident outcomes. These findings have the potential to inform clinical decision-making and resource allocation.