Skip to Main Content
 

Global Search Box

 
 
 
 

Files

File List


Dissertation Revised-T-no lines.pdf (2.22 MB)

ETD Abstract Container

Abstract Header

A Pilot Study to Evaluate Use of a Psychiatric Advanced Practice Nurse to Improve Hospital to Home Transition Outcomes

Moore, Tammy Lynn
http://rave.ohiolink.edu/etdc/view?acc_num=osu1447147466

Abstract Details

2015, Doctor of Philosophy, Ohio State University, Nursing.
Abstract Problem: Transitioning patients diagnosed with a mental health disorder from inpatient care to outpatient services is a vulnerable time period for treatment adherence, safety planning, and mental health outcomes. Lack of community linkage support, mental health stigma, and medical co-morbidity contribute to the patient’s inability to safely and effectively transition to a healthy life. Evidence demonstrates that the role of the Advanced Practice Registered Nurse (APRN) in transitioning care for medically complex clients from inpatient to outpatient services improves treatment adherence and reduces the need for hospital readmission. However, a gap in science exists with how the role of the psychiatric APRN can improve mental health patient transition. Methods: A two- group randomized, controlled pilot trial assessed the feasibility, acceptability and preliminary effects of utilizing a psychiatric APRN to bridge adult inpatient to outpatient care for 30 days post-discharge via face to face and telephone communication appointments. Following consent, 48 participants, participated in the study and were randomly assigned to either the intervention or treatment as usual group. Outcome measures included: (a) first outpatient appointment adherence, (b) 30-day hospital readmission, (c) direct and indirect costs related to hospitalization, and (d) participant quality of life. Findings: The APRN Bridge program is feasible to administer in settings that have inpatient care and APRNs who are available to follow patients post-discharge. Analysis of acceptability of the intervention when delivered through telephone follow-up identified limitations and is an area for future technology considerations. A clinically significant (not statistically significant) higher proportion of the intervention group attended their first outpatient appointment. Thirty-day hospital readmissions and costs were significantly higher for the intervention group than the treatment as usual group. However, participants who had a 80% or greater compliance with the phone intervention showed a 6% lower rate of readmission than the entire intervention group and an 8% stronger first appointment adherence compared to those participants who had a less than 80% phone intervention compliance. Baseline quality of life indicators were higher for the treatment as usual group in all domains except physical. The post mean quality of life scores for the intervention group were lower in all categories compared to the treatment as usual group. Conclusions: The APRN Bridge Model may be a feasible consideration for this patient population but will require a new intervention than telephone communication. The intervention participants had more medical co-morbidities and lower quality of life than the treatment as usual group and this may have impacted readmission need and status. Considerations to broaden the “bridge” protocol and improve cost effectiveness may include the addition of a Nurse Navigator role to manage the day to day safety follow up, utilization of a licensed independent social worker to manage social needs and the inclusion of the APRN to coordinate medication management and chronic medical needs assessment.
Bernadette Melnyk (Committee Chair)
104 p.
Nursing
Consultation liaison; Treatment assessment and planning; Depression

Recommended Citations

Citations

  • Moore, T. L. (2015). A Pilot Study to Evaluate Use of a Psychiatric Advanced Practice Nurse to Improve Hospital to Home Transition Outcomes [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1447147466

    APA Style (7th edition)

  • Moore, Tammy. A Pilot Study to Evaluate Use of a Psychiatric Advanced Practice Nurse to Improve Hospital to Home Transition Outcomes. 2015. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1447147466.

    MLA Style (8th edition)

  • Moore, Tammy. "A Pilot Study to Evaluate Use of a Psychiatric Advanced Practice Nurse to Improve Hospital to Home Transition Outcomes." Doctoral dissertation, Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1447147466

    Chicago Manual of Style (17th edition)

osu1447147466
727
© 2015, all rights reserved.
This open access ETD is published by The Ohio State University and OhioLINK.