Perceptions of patients' post coronary artery bypass grafting surgery related to health related quality of life and satisfaction when nurse practitioners are active participants in care

Abstract

<p>The issue of quality health care has a renewed focus since the Institute of Medicine's 2000 report and has become a primary concern for patients, providers, and payors. Quality needs to be addressed from the perspective of the patient, incorporating patient-centered preferences in all areas where care is received; with special attention for high frequency, high cost, high-risk populations that evaluates all types of providers. The primary aim of this study is to describe patient perceptions of health related quality of life (HRQOL) and satisfaction for patients hospitalized for coronary artery bypass grafting (CABG) surgery when Nurse Practitioners (NP) are active participants in care. Secondary aims of the study were to: describe the outcomes: adverse events (pulmonary, urinary tract, and wound infections); cost of care; mortality; and hospital re-admissions; and the role of the Nurse Practitioner for patients having CABG surgery. The Quality Health Outcomes Model was used as the foundation for the research. A prospective descriptive multi-site study using a criterion-based sample to select individuals having CABG surgery in mid to large size, non-Magnet community hospitals in northeastern, central, or southeastern Pennsylvania was used. Data was collected from four sources: two surveys, the Short Form-36, version 2 for HRQOL and the Patient Judgment System for patient satisfaction; a Chart Review Tool; and a NP survey. Participants were enrolled (N = 91) at two hospitals, with one NP at each facility. Primary data analysis was descriptive with secondary analyses performed to identify the presence of relationships among the study variables. Findings indicated participants had high satisfaction with all aspects of hospitalization and HRQOL mental health; and low scores for HRQOL physical role and physical component score. Mortality and cost of care were lower than State averages, while adverse events and re-admissions were higher than State averages. NPs were actively involved in patient care and spent 80% of their time in direct patient care activities. Implications include the need for continued research, using quasi-experimental designs to identify a cause and effect relationship between the use of NPs and selected patient outcomes.</p>