Evaluating the use of monthly patient engagement metrics as a nursing-sensitive quality indicator

Abstract

Nursing-sensitive indicators reflect structures of care and care processes that influence patient outcomes. This study seeks to determine if monthly reporting of patient engagement to nurses improves rates of patients initiating treatment. Retrospective cohort. The electronic medical record database was queried to identify all new patients seen between October 1, 2008 and September 30, 2010. Only those patients assigned to a primary nurse employed during the entire study period were examined. The patient engagement (PtE) metric was defined as the % of new patients seen who underwent a treatment cycle within a fixed time period following date of first visit. This metric was reported monthly to the nursing staff beginning October 2009. Primary effectiveness was evaluated by comparing rates of PtE before and after implementation of metrics reporting. Secondary endpoints were rates of PtE by individual nurses and patient age. Chi square and logistic regression analysis were employed for data analysis. 3786 patient records were selected for further study (1922 patients prior to use of metrics and 1864 patients after use of metrics). There was a significant difference in engagement between primary nurses. In addition, age had a consistent negative correlation with engagement at 4, 6 and 8 months (OR = 0.95, P<.001). When controlling for primary nurse and patient's age, there was a significant and sustained increase in PtE related to nursing staff exposure to this metric. Significance was found at 4 months (42.5% to 47.2%; P=0.004), 6months (50% to 54.5%; P=0.006) and 8 months (52.9% to 57.5%; P=0.003). Interestingly, prior to use of metrics, there was no significant temporal change in PtE. Patient engagement is significantly improved by providing nurses with key outcome data. This analysis highlights the importance of reporting this data to nurses to improve processes of care and validates the inclusion of PtE in a quality dashboard for nursing care.