title: Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service.
abstract: Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia.
  
  
  
  Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings.
  
  
  
  Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction.
  
  
  
  This study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands.
authors.affiliation: Central Queensland University, Building 18 Rockhampton, Bruce Highway, Rockhampton, Q, 4702, Australia. t.dwyer@cqu.edu.au.
authors.forename: Trudy
authors.initials: T
authors.lastname: Dwyer
authors.affiliation: School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Q, 4556, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Craswell
authors.affiliation: Central Queensland University, Building 18 Rockhampton, Bruce Highway, Rockhampton, Q, 4702, Australia.
authors.forename: Dolene
authors.initials: D
authors.lastname: Rossi
authors.affiliation: Central Queensland Hospital and Health Service, Queensland Health, Rockhampton, Q, 4770, Australia.
authors.forename: Darren
authors.initials: D
authors.lastname: Holzberger
mesh_terms: D000368:Aged; D003299:Cooperative Behavior; D058006:General Practice / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000592:standards*; D006707:Homes for the Aged / Q000592:standards; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D009722:Nurse Practitioners / Q000592:standards*; D009735:Nursing Homes / Q000592:standards; D011787:Quality of Health Care; D011793:Queensland; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities
keywords: Aged care facility; Donabedian; Geriatrics; Health service evaluation; Nurse practitioner