Children with chronic health issues need care from different care providers, which makes care coordination (CC) more complex. Ineffective CC results in communication gaps, treatment delays, medication discrepancies, missed appointments, and overall decreased quality of provided services. Nurse practitioners can supervise CC and ensure proper communication between the medical staff and the patients, their families, and the entire community. Ruggiero et al. (2019) implemented a quantitative study to quantify the outcomes and evaluate the effectiveness of a quality improvement (QI) project on care coordination implemented by NPs in the pediatric ambulatory setting.
The setting of the project was two pediatric ambulatory infusion clinics in an urban tertiary care facility. The two clinics have about eight thousand visits every year, with the provision of such services as transfusions, infusion therapies, endocrine and allergy testing, as well as other types of tests required in treating chronic conditions. Ruggiero et al. (2019) noted that the sample population included patients who had received infusion therapies in the clinics. However, the researchers do not provide descriptive demographics or even the number of patients involved in the project. Although the focus of this study was on the provided services and NPs’ functioning, it is important to understand the overall number of patients who were involved, some of their characteristics (mean age, health condition, and so on), and the drop-out rate. The sampling method is not explicitly described either, so it is difficult to estimate whether it was random or based on another sampling tool. The absence of this information is a serious issue undermining the generalizability, reliability, and validity of the project.
A care coordination measurement tool (CCMT) was utilized to evaluate the variable. Ruggiero et al. (2019) reported that this instrument had been used in two other studies and found valid. The use of CCMT is appropriate for addressing the aims of the study, but Ruggiero et al. (2019) utilized a modified version of the tool. The validation of the new version was confined to the involvement of several nurse practitioners and nurse researchers as well as ten patients, which is not sufficient and can be associated with obtaining preliminary data for more profound studies. The reliability of this tool, as noted by Ruggiero et al. (2019), was implemented with the help of chart reviews conducted by two infusion nurses and one expert clinician. The agreement rate among these experts was 80%, which is rather high but is quite insufficient as the number of raters was only three people.
Descriptive statistics analysis employed in this study is relevant to its goals and purpose. Since the researchers were interested in the identification of CC services provided to patients, the collection of data based on CCMT was appropriate. Ruggiero et al. (2019) stated that 259 care coordination interactions delivered in 166 encounters were traced. The authors did not highlight the exact statistical instruments they employed in their research, which is a considerable limitation.
As mentioned above, the researchers did not mention any demographic details regarding the patients. The only thing that Ruggiero et al. (2019) explicitly mentioned was the setting, which was two ambulatory clinics in a local tertiary care facility. The generalizability of such data is low as the patients of a single hospital took part in the study. Moreover, the gender, age, ethnicity, or health status of the participants were not known, so the results of CCMT can be very different in other settings and with diverse populations.
The researchers found that approximately 15% of the time, nurses addressed medical discrepancies. Almost 70% of the time was devoted to addressing families’ concerns, needs, and questions (Ruggiero et al., 2019). It was reported that over 38% of delays in treatment, almost 10% of other specialist visits, and over 8% of negative effects due to medical error were prevented.
The article in question does not contain a separate section on validity and reliability, which is a significant limitation. At that, the researchers addressed the reliability aspects when the CCMT modifications were discussed (Ruggiero et al., 2019). As mentioned above, the reliability evaluation procedures were based on the analysis of data received from a limited sample, and the number of raters was also inappropriate for proper validation.
The authors highlighted two of the major limitations of their research, which included the focus on a single facility and the use of self-reports. Ruggiero et al. (2019) noted that the findings could not be generalizable to care coordination in other clinical settings because only two clinics were involved. However, the authors did not mention the limitations related to the sample size. The use of self-reports is mentioned in the article as a weakness as such surveys can be underreported or exaggerated. As to the future studies, the authors stated that the cost-effectiveness of CC could be estimated.
This study has a significant value for nursing practice as it sheds light on care coordination implications in the tertiary care setting. However, due to the lack of transparency and gaps related to the used methodology, this study cannot inform projects and studies properly. The research under analysis can serve as a preliminary project on the evaluation of CC in a particular setting. It is possible to use the CCMT in other settings, but a larger sample and appropriate description of all relevant details should be ensured.
Reference
Ruggiero, K., Pratt, P., & Antonelli, R. (2019). Improving outcomes through care coordination: Measuring care coordination of nurse practitioners.Journal of the American Association of Nurse Practitioners, 31(8), 476-481.