Abstract
AimsA discussion of the implications and opportunities arising from the Commonwealth of Australia health care reform agenda; linking pricing with quality, with particular reference to directions for nursing‐focused health services outcomes research directed to improve the safety and quality of health care practices.BackgroundNational activity‐based funding in Australia is a policy‐focused development. As the relationship between cost and quality becomes apparent, the role of clinicians and their contribution to high quality care has become a pressing issue for leadership, teaching, and research.DesignDiscussion paperData SourcesThis paper is based on seven years' experience as a member of a Commonwealth of Australia statutory committee—the Clinical Advisory Committee of the Independent Hospital Pricing Authority—and is supported by relevant literature and theory.Implications for NursingTo date, unravelling the linkage, especially causal relationships, between direct care nursing and patient safety outcomes has not been well established. New activity‐based funding data elements developed for national implementation in Australia provide accessible and meaningful standardised data for measurement of never events, hospital‐acquired complications, and preventable readmissions.
Highlights
For this category of research whilst showing the importance of nursing resource deployment to support the safety and quality of health care provision, and alerting policy officials at all levels about the need for appropriate professional nurse staffing levels to manage patient‐ related safety and quality outcomes, nursing researchers have argued that more attention be directed towards peering into the “black box”—that being the development of empirical understandings regarding the impact of direct care nursing interventions on patient outcomes, and not limited to structural variables of nurse characteristics and nurse staffing (Heslop & Lu, 2014; Kim, Lyder, McNeese‐Smith, Leach, & Needleman, 2015)
I have suggested an operational solution for the potential use and transfer of rich Activity Based Funding (ABF) data that are well‐developed and validated to better quantify nurse‐related quality of care outcome measures, there remain complex methodological challenges associated with applying this evidence to nursing‐focused health services outcomes research
Use of the ABF classification scheme will help overcome methodological shortfalls associated with definitions and operationalization of patient safety and quality variables
Summary
The attribution of nursing care interventions to specific patient‐ related outcomes is difficult to isolate. Investigating how nursing care interventions contribute to safety and quality health care outcomes is often referred to as the “black box” of nursing‐focused health services outcomes research. Research into the impact of nursing interventions on patient outcomes, such as hospital‐acquired complications, remains immature. Activity‐based funding data provide safety and quality measures relevant to nursing‐focused health services outcomes research. Building clinical‐decision support, based on the Australian Commission for Safety and Quality in Healthcare hospital‐acquired complication outcome measures, may assist nurses engage with quality improvement as nurses are likely to act on data relevant to their practice. The Australian Commission for Safety and Quality in Healthcare hospital‐acquired complication outcome measures have enhanced data specifications, useful to support development of nursing‐ focused health services outcomes research. In European hospitals today, ABF is the most common mechanism for reimbursing hospitals, though most classifications there, unlike the Australian ABF model, do not discriminate between diagnoses present on admission (comorbidities) and those occurring during the hospital stay (complications) (Or, 2014)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
