HEALTHCARE SYSTEMS RESEARCH ACROSS THE CONTINUUM OF CARE

Ambulatory patient encounters currently outweigh acute care patient encounters by several orders of magnitude. With a shifting focus from inpatient to preventive and non-acute care, the difference between one billion ambulatory care encounters versus eight million acute care encounters (Ong, 2011) is expected to widen. Between 2010 and 2020, the nursing workforce employed in ambulatory care settings is predicted to increase by 32.7% or one million RNs (United States Department of Labor. Bureau of Labor Statistics, 2012). Despite this growth, research to support the practice of outpatient and community care providers is not keeping pace. According to the Institute of Medicine, effective workforce planning and policy development require better data collection with an improved information infrastructure (IOM, 2011).

Theory: The Systems Research Organizing Model (SROM) (Brewer, Verran & Stichler, 2008), used as the framework for systems research across the continuum of care, is based on Donabedian’s Structure, Process, Outcomes framework (Donabedian, 1966) and the Quality Health Outcomes Model ⁽Mitchell, Ferketich & Jennings, 1998)^. The model acknowledges the complex interrelationship between elements within a system. Applied to the need for additional research beyond the acute care setting, the provider or nurse is represented in the position of the client, understood as the consumer of research within the SROM concepts. The healthcare system provides the context in which one billion patient encounters occur each year. The action focus lies in the development of a body of evidence to guide education, policy and practice for non-acute patient care. The outcome concept focuses on increasing system level research able to meet the demand for scientific evidence across the continuum of care.

Aim: Identify areas of research with an insufficient evidence base to support nursing practice in outpatient and community-based care settings.

Method: Review of the literature around issues impacting nurses in ambulatory care, primary care, and community-based care.

Findings: Researchers identified four focus areas lacking robust evidence to sustain nursing education and practice for quality outpatient and community-based care delivery.

• Practice environment characteristics contributions to the relationship between Nurse Practitioner autonomy and patient outcomes in ambulatory care
• Primary care Pediatric Nurse Practitioner’s role perceptions and barriers to performing mental health screening
• The effect of practice climate on the certified nurse midwife professional psychological well-being and the implications for patient and organizational outcomes
• Evaluation of rural care coordination models for population health, quality, and cost outcomes

Conclusion: The mismatch between supply and demand for evidence-based knowledge in non-acute care settings calls for more research to support the delivery of high-quality nursing care across the care continuum.