CentraState Healthcare Foundation

To develop precision health (PH) competencies and evaluate their comprehensiveness and fit into nursing practice. A modified e-Delphi technique was used to gather perceptions and achieve consensus on the inaugural set of PH domains, competency statements and sub-competencies developed by a workgroup formed under the aegis of the American Nurses Association (ANA). A set of PH competencies and sub-competencies was developed by the ANA workgroup, beginning with a literature review, followed by a multi-step work process of the group over 3 years (2022-2025). Then, a modified e-Delphi technique was conducted via a four-point Likert scale Qualtrics survey, using a purposive sample of PH experts. The respondents were asked to agree or disagree with each competency or sub-competency statement and suggest modifications. The threshold of concordance was set at 80%. The ANA workgroup reached consensus on six domains, six competency statements and 43 sub-competency statements to represent PH in nursing practice in its entirety. Forty experts in the field evaluated and offered revisions to the final 44 sub-competencies that represent the knowledge and skills necessary for PH in general nursing practice. A majority of the competency statements obtained favourable agreement from the expert panel, and a typical pattern of convergence was observed over two rounds of evaluation. The development of PH competencies is the essential first step in the attempt to integrate PH into nursing practice. The competency statements will inform nursing curricula, clinical practice guidelines, funding opportunities and role expectations in all healthcare settings. This work sets the stage for subsequent interprofessional practice initiatives and research exploring how these competencies influence patient outcomes, workforce readiness and the practical integration of advanced technologies into precise care.

Study Design Retrospective cohort. Background Patient-classification subgroupings may be important prognostic factors explaining outcomes. Objectives To determine effects of adding classification variables (McKenzie syndrome and pain patterns, including centralization and directional preference; Symptom Checklist Back Pain Prediction Model [SCL BPPM]; and the Fear-Avoidance Beliefs Questionnaire subscales of work and physical activity) to a baseline risk-adjusted model predicting functional status (FS) outcomes. Methods Consecutive patients completed a battery of questionnaires that gathered information on 11 risk-adjustment variables. Physical therapists trained in Mechanical Diagnosis and Therapy methods classified each patient by McKenzie syndromes and pain pattern. Functional status was assessed at discharge by patient-reported outcomes. Only patients with complete data were included. Risk of selection bias was assessed. Prediction of discharge FS was assessed using linear stepwise regression models, allowing 13 variables to enter the model. Significant variables were retained in subsequent models. Model power (R(2)) and beta coefficients for model variables were estimated. Results Two thousand sixty-six patients with lumbar impairments were evaluated. Of those, 994 (48%), 10 (<1%), and 601 (29%) were excluded due to incomplete psychosocial data, McKenzie classification data, and missing FS at discharge, respectively. The final sample for analyses was 723 (35%). Overall R(2) for the baseline prediction FS model was 0.40. Adding classification variables to the baseline model did not result in significant increases in R(2). McKenzie syndrome or pain pattern explained 2.8% and 3.0% of the variance, respectively. When pain pattern and SCL BPPM were added simultaneously, overall model R(2) increased to 0.44. Although none of these increases in R(2) were significant, some classification variables were stronger predictors compared with some other variables included in the baseline model. Conclusion The small added prognostic capabilities identified when combining McKenzie or pain-pattern classifications with the SCL BPPM classification did not significantly improve prediction of FS outcomes in this study. Additional research is warranted to investigate the importance of classification variables compared with those used in the baseline model to maximize predictive power. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2016;46(9):726-741. Epub 31 Jul 2016. doi:10.2519/jospt.2016.6266.

Laurie A. Huryk is manager of Clinical Information Systems, Family Practice of Central Jersey and Family Medicine Residency Program, CentraState Medical Center in Freehold, N.J. The marriage of information technology and healthcare creates informatics nurse specialists. The author has disclosed that she has no financial relationships related to this article.

In the interest of full disclosure, Dr Dennis Hart is a director of Focus on Therapeutic Outcomes, Inc (FOTO), which develops outcome measures and services for physical therapy and rehabilitation . The work by Costa et al1 represents a step forward in the assessment of treatments that are helpful for patients with lumbar spine impairments. The strength of their study lies in their design, which has been nicely reviewed by Fritz.2 However, we would like to direct attention to a psychometric matter that appears to have been overlooked by Fritz, the editors and reviewers, and the authors. Costa et al used the Patient-Specific Functional Scale (PSFS)3,4 to assess change in “activity” in their sample. Using aggregated PSFS scores to assess change in groups of patients represents a major conceptual and psychometric error, which makes interpretation of results difficult. In the present study, the authors also used the Roland-Morris Disability Questionnaire5 to assess “activity,” which provided results similar to those obtained using the aggregated PSFS scores, so our discussion is entirely related to the psychometric appropriateness of using aggregated PSFS scores to assess change in function in groups of patients, not the ultimate results of the study. If one starts with the assumption that the reported purpose of the PSFS is to assess functional ability and its change in …

Spine: March 1, 2003 - Volume 28 - Issue 5 - p 520 doi: 10.1097/01.BRS.0000049108.56687.F3