Development of a Nursing Dashboard to Support the Advancement of Nurse Sensitive Indicators in the Ambulatory Care Setting

Since the inception of nurse-sensitive indicators (NSIs) in 1998 by the American Nurses’ Association (ANA), improved patient outcomes specific to work done by nurses have been available to leaders and direct quality clinical care. The Collaborative Alliance on Nursing Outcomes (CALNOC) partnered with AAACN to develop ambulatory care-focused NSIs to support the importance of nursing care in the post-acute setting to improve outcomes and the overall continuity of patient care.
The NSIs for hypertension and body mass index (BMI) screening and follow-up look to track patients with identified abnormal blood pressure or BMI noted during a screening who then received follow-up. Per the indicator definition, “follow-up” includes a wide range of responses; none necessarily required by the nurse, but more likely evaluating a care team approach to patient care.
In January 2022, a large integrated health system serving acute, ambulatory, and home care began reporting into the National Database on Nursing Quality Indicators (NDNQI) for ambulatory care NSIs of hypertension and BMI screening and follow-up. The system supports over 200 medical group offices across Illinois and Michigan and enrolled a sample of ten primary care offices. The health system uses Epic as their electronic health record.
Due to the nature of provider documentation in the ambulatory care space, initial stages of reporting proved to be time-consuming, with heavy amounts of manual chart audits in order to extract data. It was also noted that the majority of patient encounters in the sample were visits performed by providers rather than interventions directly from the nurse. All sites enrolled have registered nurses employed and staffing nurse clinics.
The clinical services team began collaborating with healthcare analytics to build out a nursing specific dashboard to run parallel to data being submitted to NDNQI. This dashboard has the same numerator and denominator criteria as the NSI indicator, but it will have the ability to toggle to patients seen in a nurse visit. This optimization allows the organization to monitor overall real time NSI compliance for all patients served (versus only the sample), while also beginning to tie direct care by the nurse to an overall outcome.
The organization is also an accountable care organization (ACO), and the development of the NSI dashboard correlates well with the overall ACO metrics monitored at the practice level. They have developed nurse specific visits and protocols for management of various ambulatory care sensitive conditions, including hypertension education and management. Future state plans include further development of nurse clinics to continue building a foundation of evidence linking direct nursing care in the ambulatory care setting to improved patient outcomes.