Document Type



The Final Report, ""Evaluation of a Quality Assurance Model for Public Health Nursing,"" details the project conducted over a one-year period. The project was based on the American Nurse Association (ANA) Model for Quality Assurance and assessed standards for an overall Quality Assurance Program. The primary purpose of the study was to analyze baseline outcome criteria for a Quality Assurance Program and to implement and interface evaluation methodologies on Public Health Nursing (PHN) services within the IHS to: 1) identify the amount and kind of quality services provided and the strengths and barriers to that provision of quality services; 2) provide recommendations for improvement in the quality of service; and 3) provide an action plan for implementing changes to improve the quality of PHN care to recipients. The major study focus centered on the components of Peer Review, Utilization Review, and Patient/Consumer Satisfaction. The authors developed survey forms for the study that would allow for comprehensive collection of data while not placing an additional burden on PHNs. Forms were developed for the six categories of Outcome Criteria. Instructions asked nurses to review patient records and complete the form for each category. All exceptions to the forms were to be fully explained and time expended in completing the form was noted. Peer Review forms instructed nurses to review the recorded documents of another nurse and complete the form listing sources of documents reviewed and time expended. The Patient Satisfaction survey focused on service provided and was a combination of multiple choice options and short answers. These forms were distributed to patients by the PHNs for completion. The Utilization Review allowed for the evaluation of five clinical patient records. A space was provided for a summary, based on nursing judgement, to describe the adequacy and appropriateness of PHN services. Space was also provided for describing recommendations and an action plan. A workshop was conducted as well as site visits to the Albuquerque and Oklahoma Areas. Practice case studies were provided to acquaint the participants with the use of the study tools.Study findings demonstrated that most Outcome Criteria standards are being met in a high percentage of instances - in the 60 to 70 percentiles. This is considered outstanding because literature reviewed indicated that when using Outcome Criteria for the first time, findings in the 40 percentile are considered excellent. Patient Satisfaction Surveys indicated extremely high satisfaction with public health nursing services - in the 95 to 99 percentiles. Peer Review and Utilization Review standards also showed a very high positive percentile ranking.Recommendations are as follows: 1) utilize the ANA Model for PHN IHS/Tribal Quality Assurance Program through use of the developed tools; 2) establish attainment percentages as follows: 50% for outcome criteria standards, 75% for peer review standards, and 75% for utilization review standards; and 3) focus increased in-service for PHNs on quality assurance by use of the following handouts, ""What is quality assurance?"" and ""How does one do Quality Assurance?"" In addition, the following activities are recommended: 1) refresh interviewing skills to increase abilities to document client health status outcome; 2) teach health promotion strategies which focus on client functional behaviors; 3) stress team work and team building with clinic, outpatient, and hospital nurses with a focus on who should do what specific activities to increase continuity of care and appropriate timely referrals; 4) use Peer Review primarily for PHN team sharing and participative management at the local level; 5) provide PHNs with sufficient work time to conduct quality assurance activities; and 6) consider diabetes as one would a communicable disease using the epidemiological model for screening and follow-up.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-97).