The first articles from the Health Outcomes for Better Information and Care (HOBIC) project have been published in the Canadian Journal of Nursing Leadership.
Dr. Linda McGillis Hall, BScN 9T3, PhD 9T9, Bloomberg Nursing professor and associate dean, research and external relations, and adjunct scientist at the Institute for Clinical Evaluative Sciences (ICES) examined nurse manager experiences and perspectives on the implementation and integration of the of the program; and Dr. Lianne Jeffs, BScN 9T2, MSc 9T8, director, nursing research at St. Michael’s Hospital, explored staff nurse perceptions related to collecting and using HOBIC measures in clinical practice to improve patient care outcomes.
In 1998, an expert panel commissioned the Nursing and Health Outcomes Project – a critical appraisal of research to identify patient outcomes that are influenced by nursing. A study then demonstrated that nurses across acute and chronic care hospitals, nursing homes and home care were receptive to assessing these outcomes. Based on these results, a recommendation was made to the Ontario Ministry of Health and Long-Term Care to implement the assessment and collection of these outcomes.
HOBIC is the collection of standardized information reflective of nursing in 201 participating healthcare settings across Ontario, 62 in acute and/or complex continuing care, 123 long-term care homes and 16 homecare sites. The outcomes assessed are: functional status, therapeutic self-care, symptom management (pain, nausea, dyspnoea, fatigue) and selected patient safety outcomes (pressure ulcers, falls).
With the implementation of HOBIC, nurses can access real-time data about patients for the first time. They could then use this information to examine the impact of their practice on patients’ status and assess patients’ readiness for discharge.
“We integrated the Health Outcomes for Better Information and Care measures as we implemented electronic clinical documentation in 2009,” says Ella Ferris, executive vice president and chief nursing executive, St. Michael’s Hospital. “HOBIC information can be used on a daily basis by nurses to monitor the impact of their care on patient outcomes and to inform appropriate discharge planning. In addition, managers and decision makers can use HOBIC data at the unit and institution level to inform quality improvement initiatives, performance monitoring and resource allocation.”
McGillis Hall’s survey demonstrated interest and commitment to HOBIC from many nurse leaders in Ontario and highlighted the value that such a program provides for staff nurses in planning and delivering evidence-based patient care. Nurse leaders in Ontario are keenly aware of the significant potential that HOBIC data can provide for high-quality patient care and identified key factors that need to be considered during the implementation of such a program. The information provided by nurse leaders will serve to inform policy makers and system leaders as HOBIC implementation continues in the future.
Even though HOBIC is designed to help organizations and nurses plan and evaluate care by comparing patient outcomes with historical data on similar cases, fewer than 15 per cent of patients in a 2010 study were found to have complete admission and discharge data sets. This low utilization rate of HOBIC measures prompted Jeffs’ qualitative study to gain nurses’ perceptions related to collecting and using HOBIC measures in practice. A third article authored by McGillis Hall and colleagues using the HOBIC data to examine changes in health outcomes from admission to discharge in acute care patients is forthcoming in the Journal of Nursing Care Quality.
“The use of health outcomes data to improve clinical decision-making at the point of care, as well as to guide service delivery, is critically important to high quality care and better patient outcomes,” says Bloomberg Nursing Dean Sioban Nelson. “As the repository of clinical datasets continues to grow, provincially and nationally, we need more nurse researchers to be working with clinical data and providing that link to practising nurses and decision-makers alike. This is why the Bloomberg Faculty has been an enthusiastic foundation member of the ICES-on-Campus initiative here at the University of Toronto.”
ICES houses the HOBIC database. Since its inception in 1992, ICES has played a key role in providing unique scientific insights to help policymakers, managers, planners, practitioners and other researchers shape the future direction of the Ontario health care system. ICES satellite sites were created to expand its capacity to generate high quality health services research at a province-wide basis. HOBIC emerged from collaboration with the ICES site at the University of Toronto.