Recent Research About Nursing, March 2013
This is part of the March 2013 issue of Sharing Nursing's Knowledge.
Study: APRN-Staffed Clinic Produces Shorter Wait for Diagnoses at Lower Cost for Women with Benign Breast Conditions
A nurse-based approach to diagnosing women with breast conditions is saving money and producing shorter wait times for diagnoses, according to an article in the January issue of Health Affairs.
In 2008, the Virginia Mason Medical Center, a Seattle-based multidisciplinary health care network that logs 800,000 outpatient and 17,000 hospital visits per year, opened a new breast care clinic, with the goal of streamlining the diagnosis and care for women with breast conditions. These include such benign conditions as cysts and fibrocystic breast disease, as well as breast cancer. As part of the clinic’s model, Advanced Practice Registered Nurses (APRNs) take the lead role in diagnosing patients, working with on-site equipment to perform mammography, ultrasound, and magnetic resonance imaging. Patients whose conditions cannot promptly be confirmed as benign meet with breast surgeons for diagnosis and care, if appropriate.
According to a review of patient data by staff at Virginia Mason, including C. Craig Blackmore, MD, MPH, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar (1995-1997), the approach saves both time and money. After opening the clinic, the average time from presentation to final diagnosis for patients with benign conditions dropped from 15.8 days to 3.8 days. In addition, 18 percent fewer surgical consultations were required, and 29 percent fewer imaging studies were performed. Patient satisfaction among women with benign and malignant conditions was high, with 98 percent of patients reporting good or very good results in the three months after the clinic opened.
“The clinic improved efficiency by aligning the skills of the [APRN] with the task of evaluating nonsurgical breast conditions, eliminating unnecessary surgical consultations,” the Virginia Mason authors write. “Patients received clinical and imaging evaluation and core biopsies when appropriate before being seen by a breast surgeon…. The efficiency of this model leads to substantial cost savings for both payers and providers, and it suggests the feasibility of achieving higher care quality at lower cost by rethinking standard clinical pathways for common conditions.”
Regional Differences Emerge in Nursing Workforce Projections
A new analysis of the nation’s current and future workforce of registered nurses (RNs) projects significant regional differences on the horizon.
Researchers led by Peter Buerhaus, PhD, RN, FAAN, a former RWJF faculty fellow in health care finance at The Johns Hopkins University, examined detailed census data on employment status, and developed workforce supply projections by region of the country. They found that the current RN workforce in the Southern and Midwestern regions is younger than in the Northeast and West, suggesting that the Southern and Midwestern regions can expect lower rates of retirement and a larger supply of nurses to replace those who do retire.
As a result, the authors write, “the RN workforce through 2030 is expected to grow faster in the Midwest (17.4 percent per capita growth) and South (10.8 percent) compared to the West and Northeast from 2010 to 2030, which are projected to decline in per-capita RN supply (by 2.5 percent and 6.2 percent, respectively).” The consequence is that by 2030, the supply of RNs per 100,000 residents will range from 1,085 in the Midwest to 700 in the West.
“This information can help guide national and state health workforce planners, employers, educators and others in developing policies and initiatives that may impact nursing supply in their states,” the authors write. The analysis was published in the January-February issue of Nursing Economic$.