Economic evaluation of nursing practices: a review of literature

Research status and hotspots of economic evaluation in nursing by co-word clustering analysis

Objective

The aim of this study is to discover research status and hotspots of economic evaluation (EE) in nursing area using co-word cluster analysis.

Methods

Medical Subject Heading (MeSH) term “cost–benefit analysis” was searched in PubMed and nursing journals were limited by the function of filter. The information of author, country, year, journal, and keywords of collected paper was extracted and exported to Bicomb 2.0 system, where high-frequency terms and other data could be further mined. SPSS 19.0 was used for cluster analysis to generate dendrogram.

Results

In all, 3,020 articles were found and 10,573 MeSH terms were detected; among them, 1,909 were MeSH major topics and generated 42 high-frequency terms. The consequence of dendrogram showed seven clusters, representing seven research hotspots: skin administration, infection prevention, education program, nurse education and management, EE research, neoplasm patient, and extension of nurse function.

Conclusions

Nursing EE research involved multiple aspects in nursing area, which is an important indicator for decision-making. Although the number of papers is increasing, the quality of study is not promising. Therefore, further study may be required to detect nurses’ knowledge of economic analysis method and their attitude to apply it into nursing research. More nursing economics course could carry out in nursing school or hospitals.

Quantity and Quality of Economic Evaluations in U.S. Nursing Research, 1997-2015: A Systematic Review

BACKGROUND

The United States has a complex healthcare system that is undergoing substantial reformations. There is a need for high-quality, economic evaluations of nursing practice. An updated review of completed economic evaluations relevant to the field of nursing within the U.S. healthcare system is timely and needed.

OBJECTIVES

The purpose of this study was to evaluate and describe the quantity and quality of economic evaluations in nursing-relevant research performed in the United States between 1997 and 2015.

METHODS

Four databases were searched. Titles, abstracts, and full-text content were reviewed to identify studies that analyzed both costs and outcomes, relevant to nursing, performed in the United States, and used the quality-adjusted life year to measure effectiveness. For included studies, data were extracted from full-text articles using criteria from U.S. Public Health Service's Panel on Cost-Effectiveness in Health and Medicine.

RESULTS

Twenty-eight studies met the inclusion criteria. Most (n = 25, 89%) were published in the last decade of the analysis, from 2006 to 2015. Assessment of quality, based on selected items from the panel guidelines, found that the evaluations did not consistently use the recommended societal perspective, use multiple resource utilization categories, use constant dollars, discount future costs and outcomes, use a lifetime horizon, or include an indication of uncertainty in results. The only resource utilization category consistently included across studies was healthcare resources.

DISCUSSION

Only 28 nursing-related studies meeting the inclusion criteria were identified as meeting robust health economic evaluation methodological criteria, and most did not include all important guideline items. Despite increases in absolute numbers of published studies over the past decade, economic evaluation has been underutilized in U.S. nursing-relevant research in the past two decades.

Development and evaluation of a home enteral nutrition team

The organisation of services to support the increasing number of people receiving enteral tube feeding (ETF) at home varies across regions. There is evidence that multi-disciplinary primary care teams focussed on home enteral nutrition (HEN) can provide cost-effective care. This paper describes the development and evaluation of a HEN Team in one UK city. A HEN Team comprising dietetians, nurses and a speech and language therapist was developed with the aim of delivering a quality service for people with gastrostomy tubes living at home. Team objectives were set and an underpinning framework of organisation developed including a care pathway and a schedule of training. Impact on patient outcomes was assessed in a pre-post test evaluation design. Patients and carers reported improved support in managing their ETF. Cost savings were realised through: (1) prevention of hospital admission and related transport for ETF related issues; (2) effective management and reduction of waste of feed and thickener; (3) balloon gastrostomy tube replacement by the HEN Team in the patient's home, and optimisation of nutritional status. This service evaluation demonstrated that the establishment of a dedicated multi-professional HEN Team focussed on achievement of key objectives improved patient experience and, although calculation of cost savings were estimates, provided evidence of cost-effectiveness.