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T Vliet P M Vlieland - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis a randomised comparison of Clinical Nurse Specialist care inpatient team care and day patient team care
Annals of the Rheumatic Diseases, 2003Co-Authors: W B Van Den Hout, Gerhardus J Tijhuis, J M W Hazes, F C Breedveld, T Vliet P M VlielandAbstract:Objective: To assess the relative cost effectiveness of Clinical Nurse Specialist care, inpatient team care, and day patient team care. Methods: Incremental cost effectiveness analysis and cost utility analysis, alongside a prospective randomised controlled trial with two year follow up. Included were patients with rheumatoid arthritis (RA) with increasing difficulty in performing activities of daily living over the previous six weeks. Quality of life and utility were assessed by the Rheumatoid Arthritis Quality of Life questionnaire, the Short Form-6D, a transformed rating scale, and the time tradeoff. A cost-price analysis was conducted to estimate the costs of inpatient and day patient hospitalisations. Other healthcare and non-healthcare costs were estimated from cost questionnaires. Results: 210 patients with RA (75% female, median age 59 years) were included. Aggregated over the two year follow up period, no significant differences were found on the quality of life and utility instruments. The costs of the initial treatment were estimated at €200 for Clinical Nurse Specialist care, €5000 for inpatient team care, and €4100 for day patient team care. Other healthcare costs and non-healthcare costs were not significantly different. The total societal costs did not differ significantly between inpatients and day patients, but were significantly lower for the Clinical Nurse Specialist patients by at least €5400. Conclusions: Compared with inpatient and day patient team care, Clinical Nurse Specialist care was shown to provide equivalent quality of life and utility, at lower costs. Therefore, for patients with health conditions that allow for any of the three types of care, the preferred treatment from a health-economic perspective is the care provided by the Clinical Nurse Specialist.
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a randomized comparison of care provided by a Clinical Nurse Specialist an inpatient team and a day patient team in rheumatoid arthritis
Arthritis & Rheumatism, 2002Co-Authors: Gerhardus J Tijhuis, J M W Hazes, F C Breedveld, Aeilko H Zwinderman, Wilbert B Van Den Hout, T Vliet P M VlielandAbstract:Objectives To compare in a randomized, controlled trial the Clinical effectiveness of care delivered by a Clinical Nurse Specialist, inpatient team care, and day patient team care in patients with rheumatoid arthritis (RA) who have increasing functional limitations. Methods Between December 1996 and January 1999, 210 patients with RA were recruited in the outpatient clinic of the rheumatology department of 6 academic and nonacademic hospitals. Clinical assessments recorded on study entry and weeks 6, 12, 26, and 52 included the Health Assessment Questionnaire (HAQ) and the McMaster Toronto Arthritis Patient Preference Disability Questionnaire as primary outcome measures, and the RAND-36 Item Health Survey, the Rheumatoid Arthritis Quality of Life questionnaire, the Health Utility Rating Scale, and the Disease Activity Score as secondary outcome measures. Patient satisfaction with care was measured on a visual analog scale in week 6 in all 3 groups and again in week 12 in the Nurse Specialist group. Results Within all 3 groups, functional status, quality of life, health utility, and disease activity improved significantly over time (P < 0.05). However, a comparison of Clinical outcome among the 3 groups and a comparison between the Nurse Specialist group and the inpatient and day patient care groups together did not show any sustained significant differences. Subgroup analysis showed that age had a significant impact on differences between the 3 treatment groups with respect to functional outcome as measured with the HAQ (P < 0.001). With increasing age, the most favorable outcome shifted from care provided by a Clinical Nurse Specialist and inpatient care to day patient care. Patients' satisfaction with care was significantly lower in the Nurse Specialist group than in the inpatient and day patient care groups (P < 0.001). Conclusion Care provided by a Clinical Nurse Specialist appears to have a similar Clinical outcome in comparison with inpatient and day patient team care. Although all patients were highly satisfied with multidisciplinary care, patients who received care provided by a Clinical Nurse Specialist were slightly less satisfied than those who received inpatient or day patient team care. Age appeared to be the only factor related to differences in functional outcome between the 3 treatment groups. The choice of management strategy may, apart from age, further be dependent on the availability of facilities, the preferences of patients and health care providers, and economic considerations.
Ann M Mayo - One of the best experts on this subject based on the ideXlab platform.
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the advanced practice Clinical Nurse Specialist
Nursing administration quarterly, 2017Co-Authors: Ann M Mayo, Tracy B Chamblee, Melinda Mercer Ray, Linda D Urden, Rachel MoodyAbstract:The Clinical Nurse Specialist (CNS), one of the 4 advanced practice registered Nurse (APRN) categories, has a unique role to play in contributing to high-quality patient care and system-level change across multiple health care settings. CNS practice requires advanced knowledge and skills, including specialty expertise, the ability to integrate new knowledge and innovation into the system of care, the ability to consult and collaborate with all health professions, and the mentoring of nursing staff to support and fully implement that new knowledge. The purpose of this article was to describe the role of the CNS, explain the background of the CNS role as it relates to APRN practice, provide current CNS workforce statistics, and share opportunities for hospitals and health systems to strategically use CNSs to advance patient and organizational goals.
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Clinical Nurse Specialist practice patterns
Clinical Nurse Specialist, 2010Co-Authors: Ann M Mayo, Anna Omery, Lynne M Agocsscott, Fatemeh Khaghani, Patricia G Meckes, Nora Moti, Jacqueline Redeemer, Marguerite Voorhees, Claudette Gravell, Emma CuencaAbstract:Purpose The study purpose was to describe Clinical Nurse Specialist (CNS) practice patterns (activities, outcomes, and practice barriers). Design A cross-sectional survey design was used for this research study. Setting and sample California Board of Registered Nursing certified CNSs (N = 1,523). Method Surveys were mailed to CNSs and included the CNS Activity Questionnaire, the Clinical Nurse Specialist Outcomes and Barriers Analysis Survey, and a demographic survey. Descriptive (means, percentages) and inferential (t tests and one-way analyses of variance) statistics were used to analyze the data. Conclusions Practicing CNSs (n = 947) demonstrated a role preference for expert Clinical practice. Practice patterns (activities, outcomes, and barriers) differed in terms of CNS specialty, years of experience, number of units covered, and CNS reporting structure. Clinical Nurse Specialists are spending time in the 5 broad role components expert (Clinical practice, consultation, education, Clinical leadership, and research) utilized by the California Board of Registered Nursing as an organizing framework for practice; however, CNS practice patterns from this study reflect more discrete and functional activities that may be better encompassed under the CNS spheres of influence practice model. A number of barriers to practice exist, the most commonly reported being reporting structure. Years of experience in the role result in differences in both practice patterns and perceptions of barriers. Recommendations for CNSs and organizations include evaluating CNS reporting structures, developing advanced practice outcome-based job descriptions and competencies, and designing performance evaluations that recognize differences between inexperienced and experienced CNSs.
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national validation of the nacns Clinical Nurse Specialist core competencies
Journal of Nursing Scholarship, 2009Co-Authors: Kathleen M Baldwin, Angela P Clark, Janet S Fulton, Ann M MayoAbstract:Purpose: To validate the 75 core National Association of Clinical Nurse Specialists' (NACNS) Clinical Nurse Specialist (CNS) competencies among practicing CNSs. Specific aims were to (a) determine the extent to which 75 core CNS competencies were used in current CNS practice, (b) determine the importance of those competencies to practicing CNSs, and (c) identify gaps between CNS core competencies and role expectations in current practice. Design: A survey design was used with both paper-and-pencil and online instruments. The survey included 150 items and three open-ended questions. Methods: A convenience sampling method was used, which targeted practicing CNSs. Findings: Respondents (N=505) were practicing CNSs who entered the field as RNs between 1956 and 2006. The survey had a high degree of internal consistency reliability (0.967%) between the subscales. The 75 NACNS core competencies were found to be useful and important for CNSs. A few gaps were identified between CNS core competencies and CNS role expectations in current practice. Conclusions: No one method for validating competencies will be satisfactory for all situations; however, the processes and methods used in this study were well suited to accomplish the goal of validating CNS core competencies. The process described here may be instructive to leaders of other national and international professional organizations interested in developing and evaluating competencies. Core competencies are useful and important to currently practicing CNSs. Clinical Relevance: The CNS role is growing internationally. Core CNS competencies can be a framework for CNS role development, education, and practice. As described here, a competency validation survey is one way to assure that CNSs are meeting healthcare needs.
Gerhardus J Tijhuis - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis a randomised comparison of Clinical Nurse Specialist care inpatient team care and day patient team care
Annals of the Rheumatic Diseases, 2003Co-Authors: W B Van Den Hout, Gerhardus J Tijhuis, J M W Hazes, F C Breedveld, T Vliet P M VlielandAbstract:Objective: To assess the relative cost effectiveness of Clinical Nurse Specialist care, inpatient team care, and day patient team care. Methods: Incremental cost effectiveness analysis and cost utility analysis, alongside a prospective randomised controlled trial with two year follow up. Included were patients with rheumatoid arthritis (RA) with increasing difficulty in performing activities of daily living over the previous six weeks. Quality of life and utility were assessed by the Rheumatoid Arthritis Quality of Life questionnaire, the Short Form-6D, a transformed rating scale, and the time tradeoff. A cost-price analysis was conducted to estimate the costs of inpatient and day patient hospitalisations. Other healthcare and non-healthcare costs were estimated from cost questionnaires. Results: 210 patients with RA (75% female, median age 59 years) were included. Aggregated over the two year follow up period, no significant differences were found on the quality of life and utility instruments. The costs of the initial treatment were estimated at €200 for Clinical Nurse Specialist care, €5000 for inpatient team care, and €4100 for day patient team care. Other healthcare costs and non-healthcare costs were not significantly different. The total societal costs did not differ significantly between inpatients and day patients, but were significantly lower for the Clinical Nurse Specialist patients by at least €5400. Conclusions: Compared with inpatient and day patient team care, Clinical Nurse Specialist care was shown to provide equivalent quality of life and utility, at lower costs. Therefore, for patients with health conditions that allow for any of the three types of care, the preferred treatment from a health-economic perspective is the care provided by the Clinical Nurse Specialist.
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two year follow up of a randomized controlled trial of a Clinical Nurse Specialist intervention inpatient and day patient team care in rheumatoid arthritis
Journal of Advanced Nursing, 2003Co-Authors: Gerhardus J Tijhuis, J M W Hazes, F C Breedveld, Aeilko H Zwinderman, P Theodora Vliet M VlielandAbstract:Two-year follow-up of a randomized controlled trial of a Clinical Nurse Specialist intervention, inpatient, and day patient team care in rheumatoid arthritis Aim. To compare the long-term effectiveness of care delivered by a Clinical Nurse Specialist (CNS) with inpatient team care and day patient team care in patients with rheumatoid arthritis and increasing functional limitations. Background. The role of CNSs in the management of patients with rheumatoid arthritis (RA) is evolving, and their effectiveness in comparison with care provided by a rheumatologist alone has been established. However, long-term controlled studies showing how the effectiveness of CNSs compares with that of other forms of co-ordinated care, such as multidisciplinary team care, are lacking. Methods. Two hundred and ten patients rheumatoid arthritis patients were randomized to care delivered by a CNS in a rheumatology outpatient clinic (12 weeks), inpatient team care (2 weeks) and day patient team care (3 weeks). Clinical assessments recorded on study entry, weeks 12, 26, 52, 78 and 104 comprised the health assessment questionnaire (HAQ) and MacMaster Toronto Arthritis (MACTAR) patient preference interview as primary outcome measures. Grip strength, walk test, RAND-36, Rheumatoid Arthritis Quality of Life questionnaire and disease activity score (DAS) were applied as secondary outcome measures. Results. No significant differences in medical treatment, use of services of other health professionals, introduction of adaptive equipment or number of hospitalizations were observed between the three treatment groups during 2 year follow-up, except that visits to Nurse Specialists were more frequent and home help was less frequent in the CNS group. A comparison of Clinical outcomes among the three groups and a comparison between the Nurse Specialist and inpatient and day patient care groups together did not show any significant differences. Within all three groups functional status, quality of life and disease activity improved significantly (P < 0.05). In general, the results obtained after 12 weeks remained stable until 104 weeks after the start of the study. Conclusion. Care provided by a CNS in an outpatient rheumatology clinic has a similar long-term Clinical outcome to inpatient and day patient team care in patients with rheumatoid arthritis. A CNS intervention appears to be an effective innovation in the care for patients with rheumatoid arthritis.
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a randomized comparison of care provided by a Clinical Nurse Specialist an inpatient team and a day patient team in rheumatoid arthritis
Arthritis & Rheumatism, 2002Co-Authors: Gerhardus J Tijhuis, J M W Hazes, F C Breedveld, Aeilko H Zwinderman, Wilbert B Van Den Hout, T Vliet P M VlielandAbstract:Objectives To compare in a randomized, controlled trial the Clinical effectiveness of care delivered by a Clinical Nurse Specialist, inpatient team care, and day patient team care in patients with rheumatoid arthritis (RA) who have increasing functional limitations. Methods Between December 1996 and January 1999, 210 patients with RA were recruited in the outpatient clinic of the rheumatology department of 6 academic and nonacademic hospitals. Clinical assessments recorded on study entry and weeks 6, 12, 26, and 52 included the Health Assessment Questionnaire (HAQ) and the McMaster Toronto Arthritis Patient Preference Disability Questionnaire as primary outcome measures, and the RAND-36 Item Health Survey, the Rheumatoid Arthritis Quality of Life questionnaire, the Health Utility Rating Scale, and the Disease Activity Score as secondary outcome measures. Patient satisfaction with care was measured on a visual analog scale in week 6 in all 3 groups and again in week 12 in the Nurse Specialist group. Results Within all 3 groups, functional status, quality of life, health utility, and disease activity improved significantly over time (P < 0.05). However, a comparison of Clinical outcome among the 3 groups and a comparison between the Nurse Specialist group and the inpatient and day patient care groups together did not show any sustained significant differences. Subgroup analysis showed that age had a significant impact on differences between the 3 treatment groups with respect to functional outcome as measured with the HAQ (P < 0.001). With increasing age, the most favorable outcome shifted from care provided by a Clinical Nurse Specialist and inpatient care to day patient care. Patients' satisfaction with care was significantly lower in the Nurse Specialist group than in the inpatient and day patient care groups (P < 0.001). Conclusion Care provided by a Clinical Nurse Specialist appears to have a similar Clinical outcome in comparison with inpatient and day patient team care. Although all patients were highly satisfied with multidisciplinary care, patients who received care provided by a Clinical Nurse Specialist were slightly less satisfied than those who received inpatient or day patient team care. Age appeared to be the only factor related to differences in functional outcome between the 3 treatment groups. The choice of management strategy may, apart from age, further be dependent on the availability of facilities, the preferences of patients and health care providers, and economic considerations.
Nancy Carter - One of the best experts on this subject based on the ideXlab platform.
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economic evaluation of Nurse practitioner and Clinical Nurse Specialist roles a methodological review
International Journal of Nursing Studies, 2017Co-Authors: Elena Lopatina, Faith Donald, Alba Dicenso, Ruth Martinmisener, Kelley Kilpatrick, Denise Bryantlukosius, Nancy Carter, Kim Reid, Deborah A MarshallAbstract:Abstract Background Advanced practice Nurses (e.g., Nurse practitioners and Clinical Nurse Specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of Nurse practitioner and Clinical Nurse Specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. Objective To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of Nurse practitioner and Clinical Nurse Specialist roles. Methods Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of Nurse practitioner and Clinical Nurse Specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. Results The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of Nurse practitioner and Clinical Nurse Specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic evaluations of Nurse practitioner and Clinical Nurse Specialist roles and should be routinely followed. However, seven out of 15 current guideline sections (describing a decision problem, choosing type of economic evaluation, selecting comparators, determining the study perspective, estimating effectiveness, measuring and valuing health, and assessing resource use and costs) may require additional role-specific considerations to capture costs and effects of these roles. Conclusion Current guidelines for economic evaluation should form the foundation for economic evaluations of Nurse practitioner and Clinical Nurse Specialist roles. The proposed role-specific considerations, which clarify application of standard guidelines sections to economic evaluation of Nurse practitioner and Clinical Nurse Specialist roles, may strengthen the quality and comprehensiveness of future economic evaluations of these roles.
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relationship between Clinical Nurse Specialist role implementation satisfaction and intent to stay
Clinical Nurse Specialist, 2016Co-Authors: Kelley Kilpatrick, Denise Bryantlukosius, Nancy Carter, Eric Tchouaket, Alba DicensoAbstract:PURPOSE/OBJECTIVE There is a lack of research examining the relationship between role satisfaction and intent to remain in one's professional role from the perspective of Nurses in advanced practice roles. The purpose of this study is to examine the strength of the relationship between Clinical Nurse Specialist (CNS) role implementation, role satisfaction, and intent to remain in a CNS role. DESIGN We conducted a secondary analysis of data from a cross-sectional survey. SETTING The setting of this study was Canada. SAMPLE We included 423 of 471 (90%) questionnaires of graduate-prepared CNSs. METHODS We surveyed all CNSs in Canada from April to August 2011. Cronbach's α (.79-.96) was used to assess the reliability of the portion of the questionnaire that measured CNS role dimensions. Using logistic regression analysis, we examined the relationship between CNS role implementation, role satisfaction, and intent to stay. RESULTS Clinical, research, scholarly and professional development, and consultation activities were significantly associated with improved CNS role satisfaction, and role satisfaction positively influenced intent to stay. However, CNS roles heavily focused on consultation activities negatively influenced CNS intent to stay. Only scholarly and professional development activities both improved role satisfaction and indirectly influenced intent to stay in the role. CONCLUSION/IMPLICATIONS There is a small positive association between some CNS role dimensions and role satisfaction, and role satisfaction positively influences intent to stay. However, too many consultation activities decreased CNS intent to remain in the role. Given the multidimensional role of the CNS and unique patient needs, CNSs will want to work closely with their managers to design a role that meets patient needs and optimizes CNS satisfaction and intent to stay in the role. Further research is needed to understand if CNS role implementation influences CNS departures and the relationship between intending to leave and actual departures from a CNS role.
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structural and process factors that influence Clinical Nurse Specialist role implementation
Clinical Nurse Specialist, 2016Co-Authors: Kelley Kilpatrick, Denise Bryantlukosius, Nancy Carter, Eric Tchouaket, Alba DicensoAbstract:Purpose/objectives The aim of this study was to examine the influence of structure and process on Clinical Nurse Specialist (CNS) role implementation. Design We conducted a secondary analysis of cross-sectional survey data. Setting The study was performed in Canada. Sample The authors included 445 of 471 questionnaires (94.5%) of graduate-prepared CNSs. Methods Based on Donabedian's framework, we conducted a secondary analysis of CNS responses using hierarchical regression. The internal consistency of the 6 CNS role dimensions and team dynamics subscales was excellent. Results The use of a framework to guide CNS role implementation influences all the role dimensions. Employer understanding of the CNS role, working in an urban catchment area, specialty certification, and more years in a CNS role had a direct positive influence on team dynamics. Full-time employment exerted a direct negative influence on this dimension. Furthermore, team dynamics (as a mediator variable), seeing patients in practice, and having an office in the Clinical unit exerted a direct positive influence on the Clinical dimension. Having an annual performance appraisal and a job description exerted a direct negative influence on the Clinical dimension. Employer understanding, working in an urban area, full-time employment, and specialty certification had an indirect effect on the Clinical dimension. Accountability to a nonNurse manager exerted a direct negative influence on the education dimension. The research and scholarly/professional development dimensions were influenced by more years in a CNS role. Accountability to a Nurse manager exerted a direct positive influence on the organizational leadership dimension; unionization and seeing patients in practice had a direct negative influence on this dimension. Seeing patients in practice and full-time employment exerted a direct positive influence on the consultation dimension. Implications The identification of structures and processes that influence CNS role implementation may inform strategies used by providers and decision makers to optimize these roles across healthcare settings and support the delivery of high-quality care.
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practice patterns and perceived impact of Clinical Nurse Specialist roles in canada results of a national survey
International Journal of Nursing Studies, 2013Co-Authors: Kelley Kilpatrick, Alba Dicenso, Ruth Martinmisener, Denise Bryantlukosius, Judith A Ritchie, Nancy CarterAbstract:Abstract Background Clinical Nurse Specialists are recognized internationally for providing an advanced level of practice. They positively impact the delivery of healthcare services by using specialty-specific expert knowledge and skills, and integrating competencies as clinicians, educators, researchers, consultants and leaders. Graduate-level education is recommended for the role but many countries do not have formal credentialing mechanisms for Clinical Nurse Specialists. Previous studies have found that Clinical Nurse Specialist roles are poorly understood by stakeholders. Few national studies have examined the utilization of Clinical Nurse Specialists. Objective To identify the practice patterns of Clinical Nurse Specialists in Canada. Design A descriptive cross-sectional survey. Participants Self-identified Clinical Nurse Specialists in Canada. Methods A 50-item self-report questionnaire was developed, pilot-tested in English and French, and administered to self-identified Clinical Nurse Specialists from April 2011 to August 2011. Data were analyzed using descriptive and inferential statistics and content analysis. Results The actual number of Clinical Nurse Specialists in Canada remains unknown. The response rate using the number of registry-identified Clinical Nurse Specialists was 33% (804/2431). Of this number, 608 reported working as a Clinical Nurse Specialist. The response rate for graduate-prepared Clinical Nurse Specialists was 60% (471/782). The practice patterns of Clinical Nurse Specialists varied across Clinical specialties. Graduate-level education influenced their practice patterns. Few administrative structures and resources were in place to support Clinical Nurse Specialist role development. The lack of title protection resulted in confusion around who identifies themselves as a Clinical Nurse Specialist and consequently made it difficult to determine the number of Clinical Nurse Specialists in Canada. Conclusions This is the first national survey of Clinical Nurse Specialists in Canada. A clearer understanding of these roles provides stakeholders with much needed information about Clinical Nurse Specialist practice patterns. Such information can inform decisions about policies, education and organizational supports to effectively utilize this role in healthcare systems. This study emphasizes the need to develop standardized educational requirements, consistent role titles and credentialing mechanisms to facilitate the identification and comparison of Clinical Nurse Specialist roles and role outcomes internationally.
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the Clinical Nurse Specialist role in canada
Nursing leadership, 2010Co-Authors: Denise Bryantlukosius, Faith Donald, Ruth Martinmisener, Kelley Kilpatrick, Nancy Carter, Sharon Kaasalainen, Patricia Harbman, Ivy Lynn Bourgeault, Alba DicensoAbstract:The Clinical Nurse Specialist (CNS) provides an important Clinical leadership role for the nursing profession and broader healthcare system; yet the prominence and deployment of this role have fluctuated in Canada over the past 40 years. This paper draws on the results of a decision support synthesis examining advanced practice nursing roles in Canada. The synthesis included a scoping review of the Canadian and international literature and in-depth interviews with key informants including CNSs, Nurse practitioners, other health providers, educators, healthcare administrators, nursing regulators and government policy makers. Key challenges to the full integration of CNSs in the Canadian healthcare system include the paucity of Canadian research to inform CNS role implementation, absence of a common vision for the CNS role in Canada, lack of a CNS credentialing mechanism and limited access to CNS-specific graduate education. Recommendations for maximizing the potential and long-term sustainability of the CNS role to achieve important patient, provider and health system outcomes in Canada are provided.
J M W Hazes - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis a randomised comparison of Clinical Nurse Specialist care inpatient team care and day patient team care
Annals of the Rheumatic Diseases, 2003Co-Authors: W B Van Den Hout, Gerhardus J Tijhuis, J M W Hazes, F C Breedveld, T Vliet P M VlielandAbstract:Objective: To assess the relative cost effectiveness of Clinical Nurse Specialist care, inpatient team care, and day patient team care. Methods: Incremental cost effectiveness analysis and cost utility analysis, alongside a prospective randomised controlled trial with two year follow up. Included were patients with rheumatoid arthritis (RA) with increasing difficulty in performing activities of daily living over the previous six weeks. Quality of life and utility were assessed by the Rheumatoid Arthritis Quality of Life questionnaire, the Short Form-6D, a transformed rating scale, and the time tradeoff. A cost-price analysis was conducted to estimate the costs of inpatient and day patient hospitalisations. Other healthcare and non-healthcare costs were estimated from cost questionnaires. Results: 210 patients with RA (75% female, median age 59 years) were included. Aggregated over the two year follow up period, no significant differences were found on the quality of life and utility instruments. The costs of the initial treatment were estimated at €200 for Clinical Nurse Specialist care, €5000 for inpatient team care, and €4100 for day patient team care. Other healthcare costs and non-healthcare costs were not significantly different. The total societal costs did not differ significantly between inpatients and day patients, but were significantly lower for the Clinical Nurse Specialist patients by at least €5400. Conclusions: Compared with inpatient and day patient team care, Clinical Nurse Specialist care was shown to provide equivalent quality of life and utility, at lower costs. Therefore, for patients with health conditions that allow for any of the three types of care, the preferred treatment from a health-economic perspective is the care provided by the Clinical Nurse Specialist.
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two year follow up of a randomized controlled trial of a Clinical Nurse Specialist intervention inpatient and day patient team care in rheumatoid arthritis
Journal of Advanced Nursing, 2003Co-Authors: Gerhardus J Tijhuis, J M W Hazes, F C Breedveld, Aeilko H Zwinderman, P Theodora Vliet M VlielandAbstract:Two-year follow-up of a randomized controlled trial of a Clinical Nurse Specialist intervention, inpatient, and day patient team care in rheumatoid arthritis Aim. To compare the long-term effectiveness of care delivered by a Clinical Nurse Specialist (CNS) with inpatient team care and day patient team care in patients with rheumatoid arthritis and increasing functional limitations. Background. The role of CNSs in the management of patients with rheumatoid arthritis (RA) is evolving, and their effectiveness in comparison with care provided by a rheumatologist alone has been established. However, long-term controlled studies showing how the effectiveness of CNSs compares with that of other forms of co-ordinated care, such as multidisciplinary team care, are lacking. Methods. Two hundred and ten patients rheumatoid arthritis patients were randomized to care delivered by a CNS in a rheumatology outpatient clinic (12 weeks), inpatient team care (2 weeks) and day patient team care (3 weeks). Clinical assessments recorded on study entry, weeks 12, 26, 52, 78 and 104 comprised the health assessment questionnaire (HAQ) and MacMaster Toronto Arthritis (MACTAR) patient preference interview as primary outcome measures. Grip strength, walk test, RAND-36, Rheumatoid Arthritis Quality of Life questionnaire and disease activity score (DAS) were applied as secondary outcome measures. Results. No significant differences in medical treatment, use of services of other health professionals, introduction of adaptive equipment or number of hospitalizations were observed between the three treatment groups during 2 year follow-up, except that visits to Nurse Specialists were more frequent and home help was less frequent in the CNS group. A comparison of Clinical outcomes among the three groups and a comparison between the Nurse Specialist and inpatient and day patient care groups together did not show any significant differences. Within all three groups functional status, quality of life and disease activity improved significantly (P < 0.05). In general, the results obtained after 12 weeks remained stable until 104 weeks after the start of the study. Conclusion. Care provided by a CNS in an outpatient rheumatology clinic has a similar long-term Clinical outcome to inpatient and day patient team care in patients with rheumatoid arthritis. A CNS intervention appears to be an effective innovation in the care for patients with rheumatoid arthritis.
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a randomized comparison of care provided by a Clinical Nurse Specialist an inpatient team and a day patient team in rheumatoid arthritis
Arthritis & Rheumatism, 2002Co-Authors: Gerhardus J Tijhuis, J M W Hazes, F C Breedveld, Aeilko H Zwinderman, Wilbert B Van Den Hout, T Vliet P M VlielandAbstract:Objectives To compare in a randomized, controlled trial the Clinical effectiveness of care delivered by a Clinical Nurse Specialist, inpatient team care, and day patient team care in patients with rheumatoid arthritis (RA) who have increasing functional limitations. Methods Between December 1996 and January 1999, 210 patients with RA were recruited in the outpatient clinic of the rheumatology department of 6 academic and nonacademic hospitals. Clinical assessments recorded on study entry and weeks 6, 12, 26, and 52 included the Health Assessment Questionnaire (HAQ) and the McMaster Toronto Arthritis Patient Preference Disability Questionnaire as primary outcome measures, and the RAND-36 Item Health Survey, the Rheumatoid Arthritis Quality of Life questionnaire, the Health Utility Rating Scale, and the Disease Activity Score as secondary outcome measures. Patient satisfaction with care was measured on a visual analog scale in week 6 in all 3 groups and again in week 12 in the Nurse Specialist group. Results Within all 3 groups, functional status, quality of life, health utility, and disease activity improved significantly over time (P < 0.05). However, a comparison of Clinical outcome among the 3 groups and a comparison between the Nurse Specialist group and the inpatient and day patient care groups together did not show any sustained significant differences. Subgroup analysis showed that age had a significant impact on differences between the 3 treatment groups with respect to functional outcome as measured with the HAQ (P < 0.001). With increasing age, the most favorable outcome shifted from care provided by a Clinical Nurse Specialist and inpatient care to day patient care. Patients' satisfaction with care was significantly lower in the Nurse Specialist group than in the inpatient and day patient care groups (P < 0.001). Conclusion Care provided by a Clinical Nurse Specialist appears to have a similar Clinical outcome in comparison with inpatient and day patient team care. Although all patients were highly satisfied with multidisciplinary care, patients who received care provided by a Clinical Nurse Specialist were slightly less satisfied than those who received inpatient or day patient team care. Age appeared to be the only factor related to differences in functional outcome between the 3 treatment groups. The choice of management strategy may, apart from age, further be dependent on the availability of facilities, the preferences of patients and health care providers, and economic considerations.