Publications by authors named "Elizabeth Klements"

3 Publications

  • Page 1 of 1

Competency-based Professional Advancement Model for Advanced Practice RNs.

J Nurs Adm 2019 Feb;49(2):66-72

Author Affiliations: Nurse Practitioner (Dr Paul), Center for Motility and Functional Gastrointestinal Disorders; Clinical Nurse Specialist (Ms Abecassis), Medical Intensive Care; Clinical Nurse Specialist (Ms Freiberger), Pulmonary/Pediatric Transplant Center; Clinical Nurse Specialist (Ms Hamilton), Medical Surgical Intensive Care; Nurse Practitioner (Ms Kelly), Urology and Urodynamics; Clinical Nurse Specialist (Ms Klements), Asthma and Medicine Patient Services; Nurse Practitioner (Dr LaGrasta), Cardiovascular Surgical Services; Nurse Practitioner (Mss Lemire, O'Donnell, and Phinney), General Surgery; Nurse Practitioner (Ms Patisteas), Orthopedic Surgery; Professional Development Specialist (Ms Conwell), Clinical Education and Informatics; Nurse Practitioner (Dr Saia), Cardiology; Nurse Practitioner (Ms Whelan), Cardiac Intensive Care; Senior VP, Patient Care Operations and Chief Nursing Officer (Dr Wood); and Nurse Practitioner (Ms O'Brien), Cardiology: Boston Children's Hospital, Massachusetts.

The process of developing a 3-tiered advanced practice RN (APRN) competency-based professional advancement model at Boston Children's Hospital is described. The model recognizes the contributions of entry-level and expert APRNs to advanced clinical practice and outcomes, impact, and leadership, while incorporating the tenets of Patricia Benner's Novice to Expert Model and the American Association of Critical- Care Nurses Synergy Model of Care.
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February 2019

Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma.

MMWR Suppl 2016 Feb 12;65(1):11-20. Epub 2016 Feb 12.

Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.

Black and Hispanic children are hospitalized with complications of asthma at much higher rates than white children. The Boston Children's Hospital Community Asthma Initiative (CAI) provides asthma case management and home visits for children from low-income neighborhoods in Boston, Massachusetts, to address racial/ethnic health disparities in pediatric asthma outcomes. CAI objectives were to evaluate 1) case management data by parent/guardian report for health outcomes and 2) hospital administrative data for comparison between intervention and comparison groups. Data from parent/guardian reports indicate that CAI decreased the number of children with any (one or more) asthma-related hospitalizations (decrease of 79% at 12 months) and any asthma-related emergency department visits (decrease of 56% at 12 months) among children served, most of whom were non-Hispanic black or Hispanic. Hospital administrative data also indicate that the number of asthma-related hospitalizations per child significantly decreased among CAI participants compared with a comparison group. The CAI model has been replicated in other cities and states with adaptations to local cultural and systems variations. Health outcome and cost data have been used to contribute to a business case to educate legislators and insurers about outcomes and costs for this enhanced approach to care. Strong partnerships with public health, community, and housing agencies have allowed CAI to leverage its outcomes to expand systemic changes locally and statewide to reduce asthma morbidity.
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February 2016

Community asthma initiative: evaluation of a quality improvement program for comprehensive asthma care.

Pediatrics 2012 Mar 20;129(3):465-72. Epub 2012 Feb 20.

Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, Boston, MA 02115, USA.

Objectives: The objective of this study was to assess the cost-effectiveness of a quality improvement (QI) program in reducing asthma emergency department (ED) visits, hospitalizations, limitation of physical activity, patient missed school, and parent missed work.

Methods: Urban, low-income patients with asthma from 4 zip codes were identified through logs of ED visits or hospitalizations, and offered enhanced care including nurse case management and home visits. QI evaluation focused on parent-completed interviews at enrollment, and at 6- and 12-month contacts. Hospital administrative data were used to assess ED visits and hospitalizations at enrollment, and 1 and 2 years after enrollment. Hospital costs of the program were compared with the hospital costs of a neighboring community with similar demographics.

Results: The program provided services to 283 children. Participants were 55.1% male; 39.6% African American, 52.3% Latino; 72.7% had Medicaid; 70.8% had a household income <$25 000. Twelve-month data show a significant decrease in any (≥1) asthma ED visits (68.0%) and hospitalizations (84.8%), and any days of limitation of physical activity (42.6%), patient missed school (41.0%), and parent missed work (49.7%) (all P < .0001). Patients with greatest functional impairment from ED visits, limitation of activity, and missed school were more likely to have any nurse home visit and greater number of home visits. There was a significant reduction in hospital costs compared with the comparison community (P < .0001), and a return on investment of 1.46.

Conclusions: The program showed improved health outcomes and cost-effectiveness and generated information to guide advocacy efforts to finance comprehensive asthma care.
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March 2012