Identifying Nurse Care Coordination Interventions Using Electronic Health Records

Monday, 18 November 2013: 10:40 AM

Tae Youn Kim, PhD, RN
School of Nursing, University of California Davis, Sacramento, CA
Karen Marek, PhD, MBA, RN, FAAN
College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ
Amy Coenen, PhD
College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI

Learning Objective 1: The learner will be able to identify the components of nurse care coordination in the home-based environment.

Learning Objective 2: The learner will be able discuss the relationship between nurse care coordination interventions and patient outcomes.

The current health care system fails to meet the needs of most chronically ill older adults. Recently care coordination was identified by the Institute of Medicine as a key area of development in transforming health care. However, there is limited evidence of the effectiveness of such programs in improving patient outcomes. In a recent randomized controlled trial improvements in patient outcomes (i.e., functional status, cognitive status, depressive symptoms, and quality of life) were observed in frail older adults who participated in a care coordination program (2005-2010). Although this program focused on the management of patients’ chronic illness in their day to day life during a one year period, it is not clear what specific components of care coordination, or nursing interventions, actually contributed to the improvement of patient outcomes. Accordingly, this new study was designed to examine the components of the care coordination intervention. A secondary analysis was applied to a de-identified dataset created from electronic health records of nurse care coordinator documentation during home visits. A total of 7,703 visit records (mean 30; range 2-68 visits) of 259 program participants (mean age 79.5; range 60-98 years) were included in this study. Both structured and unstructured text data were the sources of this analysis. Structured data were coded using the Omaha System, a standardized nursing terminology. A total of 645 narrative text notes were manually reviewed by the authors and then assigned to an Omaha nursing intervention code if semantic matches existed. We found that 10 interventions (such as medication coordination and surveillance of signs and symptoms) were most frequently implemented during the care coordination home visits. Although further research is warranted, our analysis reaffirms that there is a need for nurse care coordination for frail older adults across care continuum.