Paper
Friday, July 23, 2004
When Outcomes Conflict: Evaluating the Effectiveness of a Post-Discharge Follow-Up Telephone Program for Surgical Orthopaedic Patients
Marilyn J. Hodgins, RN, PhD1, Louiselle L. Ouellet, RN, MSN1, Shelley Knorr, RN, BN2, Sandra Pond, RN, BN2, and Geri Geldart, RN, BN, MHSA3. (1) Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada, (2) Unit 4NE, Dr. E. Chalmers Hospital, Fredericton, NB, Canada, (3) River Valley Health Authority, Fredericton, NB, Canada
| Learning Objective #1: Identify the different types of clinical outcome measures |
| Learning Objective #2: Gain an appreciation of the difficulty of clinical decision-making when research generates conflicting results |
Problem: Numerous studies have examined telephone follow-up as a strategy for easing patients’ transition from hospital to home. Despite this, limitations in study designs and the use of diverse outcome measures have complicated efforts to evaluate the effectiveness of this intervention. Theoretical Underpinnings: For the purposes of this quasi-experimental study, post-discharge recovery was conceptualized as a multi-dimensional (physical, psychological, and social) entity influenced by multiple personal, situational, and mediating factors. Outcome measures reflected Hegyvary’s (1991) schema of clinical, functional, financial, and perceptual outcomes. Study: The sample consisted of 438 adults admitted to a regional, referral hospital for orthopaedic surgery. Participants were randomly assigned to receive routine discharge care plus / minus a follow-up telephone call 24 to 72 hours post-discharge. During the third week post-discharge, a structured telephone interview was completed. Separate hierarchical regression analyses were conducted to determine the proportion of variance in the outcome measures explained by 12 variables: 4 personal (gender, age, education, prior health status), 5 situational (elective versus emergent surgery, arthroplasty versus other surgery, length of stay, distance from hospital, and season), 2 mediating (perceived readiness for discharge and help available post-discharge) and 1 intervention (treatment group). Conclusions: Results suggest that interpretations of the effectiveness of a telephone follow-up program vary significantly depending on the outcome(s) measured. In this study, telephone follow-up was interpreted as most effective when evaluated using perceptual outcomes. Implications: This study highlights the need for collaboration between nurse clinicians and researchers to define relevant outcome measures and to determine their relative weighting for clinical decision-making.
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Sigma Theta Tau International
July 22-24, 2004