title: Structure and process variables affecting outcomes for heart failure clients.
abstract: This study focused on case management by examining the relationships between congestive heart failure patient outcomes and nurse structure and process variables. A correlational design with retrospective analysis of data from 175 randomly selected acute care patients was used. The amount of education provided by the nurses on the unit was positively correlated with the degree of pathway completion (r=.32, p =.000) and negatively correlated with the readmissions (r = -.27, p =.000). The degree of completion of the clinical pathway had no effect on length of stay (LOS) but was negatively correlated to readmission rate (r =-.53, p =.000) and positively correlated to hospital days (r =.21, p =.000). Case Management was positively correlated with LOS (r =.41, p =.000) but negatively correlated with hospital days and readmissions, (r = -22, p =.000; r = -.29, p =.000, respectively). No relationships were found between RN hours and LOS or readmissions. The implications of these findings for case managers and nurse administrators are discussed.
authors.affiliation: University of Michigan, USA.
authors.forename: Elaine S
authors.initials: ES
authors.lastname: Van Doren
authors.forename: Joan
authors.initials: J
authors.lastname: Bowman
authors.forename: Gay L
authors.initials: GL
authors.lastname: Landstrom
authors.forename: Susan Y
authors.initials: SY
authors.lastname: Graves
mesh_terms: D000208:Acute Disease; D019090:Case Management / Q000458:organization & administration*; D019091:Critical Pathways / Q000458:organization & administration*; D006333:Heart Failure; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D017146:Models, Organizational; D024802:Nurse's Role; D009730:Nursing Assessment / Q000458:organization & administration; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000458:organization & administration; D010359:Patient Readmission / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration; D012189:Retrospective Studies; D016526:Workload