Paper
Saturday, November 3, 2007
83
Theory Driven Quality Measurement : Evidence-Based Outcomes for Nurse Practitioners
Stephen J. Aragon, PhD, MHA, BS, School of Health Sciences- Department of Nursing, Winston-Salem State University, Winston-Salem, NC, USA and Stephanie Pickett, MSN, BSN, The School of Health Sciences, Department of Nursing, Winston-Salem State University, Winston-Salem, NC, USA.
PURPOSE: The purpose of this investigation was to test the robustness of nurse practitioner care across multiple national random samples patients. METHODS: A four-factor multigroup structural equation modeling design was employed, with randomly selected test (N = 300) and cross-validation (N = 300) samples of nurse practitioner medical practice patients. Equality constraints were established to test the invariance of effects across groups. The model was compared with its unconstrained counterpart to further test its trustworthiness. An additional 5000 nonparametric bootstrapped samples for each group were generated to further cross-validate and assess the stability of effect estimates. RESULTS: The model fit well. When nurse practitioner patient-centeredness increased by one unit, the predicted values for satisfaction with waiting time, nursing service, and overall service increased. Patient-centered nurse practitioner care behaviors increased patients’ overall rating of care and likelihood of recommending the practice to others. This pattern of effects held across the test and cross-validation groups. The hypothesized model was sustained when compared with its competing counterpart. CONCLUSIONS: Evidence supported the factor and structural validity of the model. This study offers a plausible four-factor model for the measurement and improvement of patient-centeredness, and concomitantly, satisfaction with nursing service, waiting time, and overall service. In addition to quality improvement and evidence-based outcome measurement, the model has implications for patient-centeredness, patient trust, the patient-provider relationship, and nursing education.