• Comparison of a Collaborative Nurse System and a Tertiary Medical System of Perinatal Care for Rural Women

      Edenfield, Sandra M; Department of Physiological and Technological Nursing (1997-04)
      The study was a retrospective program evaluation, using a matched comparison design, to determine differences in the quality of care provided to patients from twelve rural east central Georgia counties. The 377 subjects were poor, predominantly African-American, Medicaid-insured women who received perinatal care in a collaborative nurse system of care and a tertiary medical system of care. Matching factors were race, age group, gravidity, entry into care, and medical risks at entry into care. Components of existing data sets were combined into a data base. Brooten’s (1986) cost quality evaluation model guided the selection of the dependent variables. The matched design created confounding that must be considered in interpreting the findings; some women with unique constellations of risks were unable to be matched to controls, and more than half of the 131 matched sets were not straight-forward and had to be adjudicated by and expert panel. The distribution of birth weight in the two groups was not different . low birth weight rates in the two groups were 14.5 and 14.2 for the Jefferson County and the tertiary groups, respectively ; very low birth weight rates were .76 and 3.25, respectively. One neonatal death occurred in the Jefferson County group and four in the tertiary group. There were 3 sexually transmitted diseases at delivery in the Jefferson County group, compared to 28 in the tertiary group. Infant stays in the intermediate and/or intensive care nurseries required 103 hospital days in the Jefferson County group and 493 days in the tertiary group. Twenty-one of 65 (32%) matched sets with ill infants had more than one infant with possible morbidity or death. The differences in very low birth weight infants, neonatal death outcomes, infant stays in intermediate and intensive care nurseries, and sexually transmitted diseases at delivery give support for further evaluation of the effectiveness of utilizing a model of comprehensive perinatal nursing in a community-tertiary partnership. This collaborative system may deliver care that achieves uniquely improved health outcomes for rural women.
    • Enabling Assessments to Better Inform Goal Setting and Treatment Planning for Patients with Elbow, Wrist, and Hand Impairments

      Hughes, Jason; Department of Occupational Therapy (11/7/2018)
      Musculoskeletal disorders, including elbow, wrist, and hand impairments, are the second most common disability worldwide and place a large burden on the health care system. Due to this prevalence and cost, accurate and precise assessment is critical to ensure that patient treatment is optimal (i.e. efficient and productive). Our first objective was to examine the item-level characteristics of the Elbow, Wrist, and Hand Computer Adaptive Test (EWH CAT) using Rasch analysis, including item difficulty measures, person ability measures, item fit, and item-person match. A unique feature of Rasch analysis is its ability to plot person ability and item difficulty on the same continuum. Awareness of this relationship helped us discern that while our items matched our sample relatively well (i.e. sample mean .13 logits above the item mean) there were slight ceiling and floor effects indicating that the addition of some harder and easier items might increase the breadth of abilities in our sample that could be accurately measured. After identifying the item-level properties of the EWH CAT, our second objective was to develop a data collection form to assist clinicians in goal setting and treatment planning. Using the Winsteps Rasch analysis program, a keyform was generated. Based on this keyform, a data collection form was created that could be used to illustrate how patient responses to specific items (i.e. difficulty indicated) differ from admission and discharge, thus helping to guide clinicians in goal setting and treatment planning. Our third objective was to identify factors that increase the probability of favorable outcomes for patients with elbow, wrist, and hand diagnoses. Seven variables were found to be associated with the likelihood of a poorer outcome: being female, having greater than three comorbidities, having a history of surgery, acuity of > 22 days, exercising less than 3 times a week, no medication use, and payer source. Four variables were significantly associated with a greater probability of a good outcome: no history of surgery, no medication use, shorter acuity, and payer source. This knowledge might indicate when a treatment approach different from traditional rehabilitation may be required and/or additional consults may be necessary.