From Clinical Trial to Health PolicyResearch on Urinary Incontinence in the Adult, Part II
T
HE MOST STRIKING FEATURE of the continence clinical trial is the simplicity of the treatment interventions. When presenting the data, we heard, “. that is just good nursing care you delivered. ” Yes, jurt good nursing care is “supposed” to be performed in all nursing homes everyday. The Omnibus Budget Reconciliation Act of 1987 (PI 100-203, Part 1V.C. 1) requires six to eight toileting prompts per day for residents of nursing homes. Some health care administrators recommended that the nursing home survey/certification process needs to monitor patient problems arising from incontinence. Others advocated using administrative reimbursements for staff development (under Section 112 1, Paragraph H, of the Medicare/Medicaid conditions of participation) to fund inservice training for nurses in the treatment of incontinence. All outside consultants who reviewed the above-mentioned project advocated stricter enforcement of existing nursing standards that require checking and toileting or changing the patient every 2 hours, although it might require increased funding to cover the additional staffing needed to perform and supervise these procedures. Within 1 year of completion, one state changed its policy to recommend continued reimbursement for incontinence even when the resident of long-term care was in a treatment program. All data indicate that the toileting of patients does take more nursing time, and does cost more than changing pads or no treatment at all (Hu et al., 1989; McCormick et al., 1990; Schnelle, Sowell, Ju, & Traughber, 1988), but the long-term benefits and cost savings seem to outweigh the initial investment. In December 1989, the Omnibus Budget Reconciliation Act added a new Title IX to the Public Health Service Act establishing the Agency for Health Care Policy and Research (AHCPR) to enhance the quality, appropriateness, and effectiveness of health care services, and access to such services. Section 911 of the act established within the Agency the Office of the Forum for Quality and Effectiveness in Health Care. Section 912 of the Act directed the Forum to arrange for the development and periodic review and updating of “Clinically relevant guidelines that may be KATHLEEN A. MCCORMICK, Gerontology Raearcb Center
PHD, RN,
National Institutes of Health. NationaL htitute
FAAN
on Aging
4940 Eastwn Aue Baltimre,
MD 21224
This is a US government
work.
There
are no restrictions
its use. 8755-722319
202
l/0704-0002$0.00/O
Jownal
on
used by physicians, educators and health care practitioners to assist in determining how diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically” (The Omnibus Budget Reconciliation Act of 1989). Based on statutory criteria, recommendations from a nursing advisory panel, consultation with the Health Care Financing Administration, studies conducted by the Institute of Medicine, and availability of research data, it was established that urinary incontinence in the adult merited guideline development. The proposed guideline is meant to (1) improve methods of prevention, diagnosis, treatment, and clinical management, thereby benefiting a significant number of individuals; (2) reduce clinically significant variations among providers in making diagnoses and providing treatment, or reduce significant variations in the outcomes of health care services or procedures; and (3) reduce variations in the services and procedures used for diagnosis and treatment (and potentially produce savings in health care expenditures) (Federal Register, October 2, 1990, Notice of Public Meeting on Clinical Practice Guidelines for Urinary Incontinence in the Adult). The panel co-chairs are Kathleen A. McCormick, PhD, RN, and Ananias Diokno, MD. The panel members are researchers, clinicians, consumers, and educators who represent multidisciplinary professions. The attributes associated with the guidelines are available for those interested in more information and background (AHCPR Program Note, 1990; Field & Lohr, 1990).
References Agency for Health Care Policy and Research Program Note. ( 1990). Clinical guideline development. (Available from AHCPR, 18-02 Parklawn Building, Rockville, MD 20857). Federal Register. ( 1990). Public meeting on clinical practice guidelrnesfor uvwwy incontinence in the adult: Vol. 55, No. 191. Field, M., & Lohr, K. (Eds.). (1990). Institute of Medicine, ClinicaL practice guidelines: Dwectionsfor a neu’ program. Washington, DC: National Academy Press. Hu, T., Igou, J., Kaltreider, L.. Yu, L., Rohner, T., Dennis, P., Craighead, E.. Hadley, E., & Ory, M. (1989). A clinical trial of a behavioral therapy to reduce urinary incontinence in nursing homes: Outcomes and implications. Journai of the Amwiran Medical Assonation. 261, 2656-2662. McCormick, K., Cella, M., Scheve, A., & Engel, B. (1990, December). Cost-effectiveness of treating incontinence in severely mobility-impaired long term care residents. Quart&y Review Bulhin. 16. 439-443. Schnelle, J. 1 Sowell, V., Hu, T., & Traughber, B. (1988). Reduction of urinary incontinence in nursing homes: Does it reduce or increase costs! Journa/ of the Amerrcan Geriatrics Society. 36. 34-39.
of Professional Nwsing,
Vol 7, No 4 (July-August),
1991: p 202
T
HE MOST STRIKING FEATURE of the continence clinical trial is the simplicity of the treatment interventions. When presenting the data, we heard, “. that is just good nursing care you delivered. ” Yes, jurt good nursing care is “supposed” to be performed in all nursing homes everyday. The Omnibus Budget Reconciliation Act of 1987 (PI 100-203, Part 1V.C. 1) requires six to eight toileting prompts per day for residents of nursing homes. Some health care administrators recommended that the nursing home survey/certification process needs to monitor patient problems arising from incontinence. Others advocated using administrative reimbursements for staff development (under Section 112 1, Paragraph H, of the Medicare/Medicaid conditions of participation) to fund inservice training for nurses in the treatment of incontinence. All outside consultants who reviewed the above-mentioned project advocated stricter enforcement of existing nursing standards that require checking and toileting or changing the patient every 2 hours, although it might require increased funding to cover the additional staffing needed to perform and supervise these procedures. Within 1 year of completion, one state changed its policy to recommend continued reimbursement for incontinence even when the resident of long-term care was in a treatment program. All data indicate that the toileting of patients does take more nursing time, and does cost more than changing pads or no treatment at all (Hu et al., 1989; McCormick et al., 1990; Schnelle, Sowell, Ju, & Traughber, 1988), but the long-term benefits and cost savings seem to outweigh the initial investment. In December 1989, the Omnibus Budget Reconciliation Act added a new Title IX to the Public Health Service Act establishing the Agency for Health Care Policy and Research (AHCPR) to enhance the quality, appropriateness, and effectiveness of health care services, and access to such services. Section 911 of the act established within the Agency the Office of the Forum for Quality and Effectiveness in Health Care. Section 912 of the Act directed the Forum to arrange for the development and periodic review and updating of “Clinically relevant guidelines that may be KATHLEEN A. MCCORMICK, Gerontology Raearcb Center
PHD, RN,
National Institutes of Health. NationaL htitute
FAAN
on Aging
4940 Eastwn Aue Baltimre,
MD 21224
This is a US government
work.
There
are no restrictions
its use. 8755-722319
202
l/0704-0002$0.00/O
Jownal
on
used by physicians, educators and health care practitioners to assist in determining how diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically” (The Omnibus Budget Reconciliation Act of 1989). Based on statutory criteria, recommendations from a nursing advisory panel, consultation with the Health Care Financing Administration, studies conducted by the Institute of Medicine, and availability of research data, it was established that urinary incontinence in the adult merited guideline development. The proposed guideline is meant to (1) improve methods of prevention, diagnosis, treatment, and clinical management, thereby benefiting a significant number of individuals; (2) reduce clinically significant variations among providers in making diagnoses and providing treatment, or reduce significant variations in the outcomes of health care services or procedures; and (3) reduce variations in the services and procedures used for diagnosis and treatment (and potentially produce savings in health care expenditures) (Federal Register, October 2, 1990, Notice of Public Meeting on Clinical Practice Guidelines for Urinary Incontinence in the Adult). The panel co-chairs are Kathleen A. McCormick, PhD, RN, and Ananias Diokno, MD. The panel members are researchers, clinicians, consumers, and educators who represent multidisciplinary professions. The attributes associated with the guidelines are available for those interested in more information and background (AHCPR Program Note, 1990; Field & Lohr, 1990).
References Agency for Health Care Policy and Research Program Note. ( 1990). Clinical guideline development. (Available from AHCPR, 18-02 Parklawn Building, Rockville, MD 20857). Federal Register. ( 1990). Public meeting on clinical practice guidelrnesfor uvwwy incontinence in the adult: Vol. 55, No. 191. Field, M., & Lohr, K. (Eds.). (1990). Institute of Medicine, ClinicaL practice guidelines: Dwectionsfor a neu’ program. Washington, DC: National Academy Press. Hu, T., Igou, J., Kaltreider, L.. Yu, L., Rohner, T., Dennis, P., Craighead, E.. Hadley, E., & Ory, M. (1989). A clinical trial of a behavioral therapy to reduce urinary incontinence in nursing homes: Outcomes and implications. Journai of the Amwiran Medical Assonation. 261, 2656-2662. McCormick, K., Cella, M., Scheve, A., & Engel, B. (1990, December). Cost-effectiveness of treating incontinence in severely mobility-impaired long term care residents. Quart&y Review Bulhin. 16. 439-443. Schnelle, J. 1 Sowell, V., Hu, T., & Traughber, B. (1988). Reduction of urinary incontinence in nursing homes: Does it reduce or increase costs! Journa/ of the Amerrcan Geriatrics Society. 36. 34-39.
of Professional Nwsing,
Vol 7, No 4 (July-August),
1991: p 202
