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Marie T Nolan and Victoria Mock (Pp 248; £23.00). California: Sage Publications, 2000. 0 7619 1505 2
Over the past 20 or more years most western health care systems have been looking for ways to address patient and population outcomes rather than merely structure and process issues. The challenges, though, are many, including problems with the validity and reliability of measures and indicators. For health care providers the greatest challenge is probably to make the assessment of patient outcomes both meaningful and to result in improvements in clinical practice.
This book aims to offer a practical primer to “advance practice nurses everywhere” to measure and improve patient outcomes. The authors are eminently qualified to offer this perspective as professors of nursing research at Johns Hopkins University in the USA with a wide range of research experience in patient outcomes between them.
The book is divided into two parts. Part I covers basic methodological issues such as the validity and reliability of tools, statistical methods, and provides a step by step guide to using SPSS, as well as to the graphical presentation of data. Part II presents case studies in “patient outcomes management” from acute care, maternal and child care, and primary care.
There is no doubting the enthusiasm generated by the authors. The book is explicitly aimed at nurses, but could equally apply to any health care professional as well as to non-clinical audit or quality assurance assistants. The level of detail in the chapters on SPSS and statistics would be particularly useful to a newcomer who needs to grasp the basics without access to formal support. The case studies emphasise the importance of multidisciplinary team involvement and the improvements in care that have resulted from the exercise.
The main limitation of the book is the exclusively US orientation. As well as confusing terminology and the predominance of “managed care” approaches, the assumed level of resources to support such activities is not generalisable. Several of the case studies are clearly research studies, some with design problems that would have been better addressed in larger more formal trials. Most actually did not result in significant changes in local practice, reflecting the “wouldn't it be interesting to know” nature of the study questions, which has been one of the problems with clinical audit initiatives in the UK. The broader issue of the best way of providing routine clinical information systems for providers, to enable continuous monitoring of processes and outcomes, is not addressed at all.
This book will no doubt be of great value to nurses and other health care professionals in the USA. New health services researchers (clinical and otherwise) from elsewhere would find the practical chapters useful if they can understand the US terminology. They may also find the book inspirational. However, the lack of impact of the case studies and the absence of a broader context limit the book's usefulness outside the USA.
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