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Maternal Child Health Client Outcomes from Public Health Nurse Visits

Maternal Child Health Client Outcomes from Public Health Nurse Visits. The Minnesota Omaha System Users Group Meeting February 1, 2012. Beth Lipton, MPH CPH Epidemiologist beth.lipton@kitsappublichealth.org. Acknowledgements. Suzanne Plemmons, RN, MN, PHCNS-BC Yolanda Fong, RN, MN

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Maternal Child Health Client Outcomes from Public Health Nurse Visits

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  1. Maternal Child Health Client Outcomes from Public Health Nurse Visits The Minnesota Omaha System Users Group Meeting February 1, 2012 • Beth Lipton, MPH CPH • Epidemiologist • beth.lipton@kitsappublichealth.org

  2. Acknowledgements • Suzanne Plemmons, RN, MN, PHCNS-BC • Yolanda Fong, RN, MN • Nancy Acosta, RN, BSN • Linda Terry, RN, ARNP, MSN, IBCLC • and all of the Kitsap Public Health Nursing Staff

  3. Why measure outcomes? • Quantify practice • What do we do and how much of it do we do? • Guide practice, policies, priorities and strategic planning • Improve quality • Track and evaluate progress toward goals • Enhance performance and overall accountability • Develop, focus, and streamline data collection and reporting capacity

  4. How are Kitsap’s data maintained? • All public health nurses enter data into a client record in Nightingale Notes after each encounter • Standardized data collection through set fields and pathways • Demographics • Initial assessment with KBS • New problems entered in subsequent visits • KBS entered on any subsequent visit if there has been a change in any one of the scores

  5. How were Kitsap’s outcomes analyzed? • Nightingale Notes data can be extracted at any time through the Reports function • Data extraction can be customized through selection of reporting pathways and fields and through use of filters • Three reporting pathways are used (Clients, Activity info, Charting info). Data are: • exported into Excel from NN • cleaned and organized • exported in SPSS for analysis

  6. How were Kitsap’s outcomes analyzed?

  7. How were Kitsap’s outcomes analyzed? • Important to define which clients, programs, timeframe, encounters, etc. you include from the start • Important to work with the nurses along the way; when something doesn’t look right, find out why! 40 weeks pregnancy 60 days postpartum eligibility Client’s pregnant status discovered Client visits Client visits Birth of the baby Client closed Client opened Client referred to MSS

  8. Who are our clients? Aug. 9, 2009 - Dec. 31, 2010

  9. How many visits do our clients get? • Only in-person visits were included as nurses do not complete pathways, identify problems, or perform KBS by phone

  10. When are our clients seen? • Only 50% of clients are seen during both pregnancy and postpartum

  11. Are clients with more needs seen more often? • Clients designated a service level, determining overall hours that can be spent with the client • Service level designated during initial risk assessment using criteria developed by the WA Dept. of Health • Level can change if new issues are revealed or develop; level may be different during pregnancy & postpartum

  12. What problems are identified in our clients? • A total of 391 clients had 999 actual problems identified, an average of 2.5 per client overall (n=406) • Of those clients with an actual problem identified, there was a range of 1 to 8 problems • Clients with a service level of ‘A’ had an average of 1.4 actual problems, with a ‘B’ had an average of 1.9, and with a ‘C’ had an average of 3.0

  13. What problems are most common in our clients?

  14. Were there improvements in KBS for our clients? • In all three KBS areas, the average score for all problems combined showed a statistically significant increase from the initial rating to the final rating

  15. Were there differences in KBS improvements across problems? • Caretaking/parenting had statistically significant increases in the areas of Knowledge and Status • Income had statistically significant increases in the areas of Knowledge, Behavior, and Status

  16. Were there differences in KBS improvements across problems? • Mental health had statistically significant increases in the areas of Knowledge, Behavior, and Status • Postpartum had a statistically significant increase in the area of Status • Substance abuse had a statistically significant increase in the area of Knowledge

  17. Conclusions • Use of NN has provided a reliable system by which we can extract meaningful data, although at times not the most simple or efficient system • We are better able to describe our client population with respect to demographics, services provided, and client needs • We found opportunities for quality improvement (data entry, recruitment during pregnancy), for advocacy (visits per client, KBS improvement)

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