Lessons learned from testing the quality cost model of Advanced Practice Nursing (APN) transitional care.
OBJECTIVE
To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research.


METHODS
The Quality Cost Model of APN Transitional Care.


METHODS
Review of published results of seven randomized clinical trials with very low birth-weight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and women with high risk pregnancies in which half of physician prenatal care was substituted with APN care. Ongoing work with the model is linking the process of APN care with the outcomes and costs of care.


RESULTS
APN intervention has consistently resulted in improved patient outcomes and reduced health care costs across groups. Groups with APN providers were rehospitalized for less time at less cost, reflecting early detection and intervention. Optimal number and timing of postdischarge home visits and telephone contacts by the APNs and patterns of rehospitalizations and acute care visits varied by group.


CONCLUSIONS
To keep people well over time, APNs must have depth of knowledge and excellent clinical and interpersonal skills that are the hallmark of specialist practice, an in-depth understanding of systems and how to work within them, and sufficient patient contact to effect positive outcomes at low cost.
Brooten
Dorothy
D
Florida International University, School of Nursing, 3000 NE 151st Street, AC11 Rm. 231A, North Miami, FL 33181, USA. brooten@fiu.edu
Naylor
Mary D
MD
York
Ruth
R
Brown
Linda P
LP
Munro
Barbara Hazard
BH
Hollingsworth
Andrea O
AO
Cohen
Susan M
SM
Finkler
Steven
S
Deatrick
Janet
J
Youngblut
JoAnne M
JM
D002983:Clinical Competence / Q000592:standards; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D016294:Models, Nursing; D009720:Nurse Clinicians / Q000458:organization & administration*; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic