Changes in Outcomes From Admission to Discharge: Lessons Learned From the Canadian HOBIC Data

Purpose:
The study objective was to examine changes in HOBIC outcomes scores (i.e., pain; fatigue; dypsnea; nausea) from admission to discharge on over 24,000 medical and surgical patients in acute care settings in Ontario, Canada using data collected in the secondary dataset of HOBIC outcomes.

Background/Significance:
The health care system in Canada has undergone change in the past few years in an effort to regionalize and promote an integrated approach to health care service delivery. One of the challenges that some nurse executives encounter pertains to the availability of adequate data that links health outcomes to patient care delivery. Data is needed that evaluates the impact of changes in structure, staff mix, and patient care processes on patient and system.

Methods:
The Ontario Ministry of Health and Long-Term Care(MOHLTC)is facilitating the development of a systematic approach for collecting outcomes data through the Health Outcomes for Better Information and Care (HOBIC) initiative. A number of settings have implemented HOBIC data collection, in a dataset currently housed at ICES. HOBIC is the province-wide, standardized collection of data on the patient outcomes of pain; fatigue; dypsnea; nausea; falls; pressure ulcers; therapeutic self-care; and activities of daily living. Data were analyzed using SAS and changes in HOBIC scores on each of the outcome variables from admission to discharge were computed.

Results:
This paper presents the first analysis of data from the HOBIC dataset with a focus on determining how the information contained in the HOBIC database can be utilized by different hospital sites. Statistically significant changes in HOBIC scores between admission and discharge were found. A consistent pattern in the changes scores was noted across all measures in the appropriate direction. The potential of the HOBIC data for comparative purposes across specific sites and/or within sectors for health care leaders who are planning and implementing changes in models of care will be discussed. Further explorations of the data will be described.

Conclusions and Implications for Practice:
Data evaluating patient and system outcomes is critical for the healthcare industry to maintain quality and safe patient care. This paper presents the first analysis of data from the HOBIC dataset in Canada.