2-The effectiness of CNS

Keywords ambulatory care, clinical nurse specialist, cost-effectiveness, economic evaluation, health services research, nurse specialist, nursing, outpatient care, systematic reviews Correspondence Dr Kelley Kilpatrick Hopital Maisonneuve-Rosemont Montreal, Quebec H1T 2M4 Canada E-mail: kelley.kilpatrick@umontreal.ca Accepted for publication: 27 May 2014 doi:10.1111/jep.12219
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Journal Байду номын сангаасf Evaluation in Clinical Practice ISSN 1365-2753
S Y S T E M AT I C R E V I E W
The effectiveness and cost-effectiveness of clinical nurse specialists in outpatient roles: a systematic review
1 Affiliate Faculty, 2Co-Director, 3Knowledge Exchange Specialist, 4Professor Emeritus, Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada 5 Assistant Professor, Faculty of Nursing, Université de Montreal, Montreal, Quebec, Canada 6 Researcher, Hôpital Maisonneuve-Rosemont Research Centre, Montreal, Quebec, Canada 7 Associate Professor, 8Assistant Professor, 9Knowledge Exchange Specialist, 10Professor Emeritus, School of Nursing, McMaster University, Hamilton, Ontario, Canada 11 Associate Professor, Department of Oncology, McMaster University, Hamilton, Ontario, Canada 12 Professor Emeritus, Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada 13 Associate Professor, Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada 14 Director, KJ Research, Rosemere, Quebec, Canada 15 Associate Professor, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada 16 Postdoctoral Fellow, Health Interventions Research Centre, Ryerson University, Toronto, Ontario, Canada 17 Canada Research Chair, Health Services and Systems Research, University of Calgary, Calgary, Alberta, Canada 18 Associate Professor, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
Abstract
Rationale, aims and objectives Increasing numbers of clinical nurse specialists (CNSs) are working in outpatient settings. The objective of this paper is to describe a systematic review of randomized controlled trials (RCTs) evaluating the cost-effectiveness of CNSs delivering outpatient care in alternative or complementary provider roles. Methods We searched CINAHL, MEDLINE, EMBASE and seven other electronic databases, 1980 to July 2012 and hand-searched bibliographies and key journals. RCTs that evaluated formally trained CNSs and health system outcomes were included. Study quality was assessed using the Cochrane risk of bias tool and the Quality of Health Economic Studies instrument. We used the Grading of Recommendations Assessment, Development and Evaluation to assess quality of evidence for individual outcomes. Results Eleven RCTs, four evaluating alternative provider (n = 683 participants) and seven evaluating complementary provider roles (n = 1464 participants), were identified. Results of the alternative provider RCTs (low-to-moderate quality evidence) were fairly consistent across study populations with similar patient outcomes to usual care, some evidence of reduced resource use and costs, and two economic analyses (one fair and one high quality) favouring CNS care. Results of the complementary provider RCTs (low-to-moderate quality evidence) were also fairly consistent across study populations with similar or improved patient outcomes and mostly similar health system outcomes when compared with usual care; however, the economic analyses were weak. Conclusions Low-to-moderate quality evidence supports the effectiveness and two fairto-high quality economic analyses support the cost-effectiveness of outpatient alternative provider CNSs. Low-to-moderate quality evidence supports the effectiveness of outpatient complementary provider CNSs; however, robust economic evaluations are needed to address cost-effectiveness. specialty-based knowledge [2,3], CNSs provide leadership, administrative, research and educational supports to health care teams, organizations and health care systems [4]. Their substantive areas of practice include the management and care of complex and
Introduction
The clinical nurse specialist (CNS) is an internationally recognized advanced practice nursing role introduced in the 1960s [1]. With
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Journal of Evaluation in Clinical Practice 20 (2014) 1106–1123 © 2014 John Wiley & Sons, Ltd.