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About C-HOBIC
The Canadian Health Outcomes for Better Information and Care (C-HOBIC) project has begun implementation of the collection of standardized patient outcome data related to nursing care in electronic health records (EHRs) in Saskatchewan and Manitoba.
C-HOBIC introduces a systematic, structured language to admission and discharge assessments of patients receiving acute care, complex continuing care, long-term care or home care. This language can be abstracted into provincial databases or EHRs. C-HOBIC builds on the Ontario HOBIC (Health Outcomes for Better Information and Care) program (www.health.gov.on.ca/hobic).
Objectives
The objectives of the C-HOBIC project were to:
- standardize the language concepts used by HOBIC to the International Classification for Nursing Practice (ICNP);
- capture patient outcome data related to nursing care across four sectors of the health system: acute care, complex continuing care, long-term care and home care; and
- store the captured and standardized data in relevant, secure jurisdictional data repositories or databases in preparation for entry into provincial EHRs.
Methodology and Deliverables
C-HOBIC used the methodology developed in Ontario through the Nursing and Health Outcomes Project and the HOBIC program to implement the collection of outcome data in Saskatchewan and Manitoba. The outcomes have a concept definition, a valid and reliable measure, and empirical evidence linking them to nursing inputs or interventions. They are:
- functional status
- therapeutic self-care (readiness for discharge)
- symptom management (pain, nausea, fatigue, dyspnea)
- safety (falls, pressure ulcers)
- patient satisfaction with nursing care
Nurses were trained to assess and document patient outcomes at the point of care using a standardized methodology. Outcomes were assessed and documented on admission and discharge for patients receiving acute care, and on admission, quarterly (if condition changes) and discharge for patients receiving complex continuing care, long-term care and home care. Deliverables included:
- mapping of the structured language used in C-HOBIC to the ICNP (the standardized clinical reference terminology of nursing) to demonstrate the value of mapping current information and to prepare outcomes for inclusion in the EHR; and
- an evaluation of C-HOBIC that examined the use and satisfaction of C-HOBIC information by nurses, and how their practice changed as a result of using C-HOBIC information.
Benefits
In addition to providing real-time information to nurses about how patients are benefiting from care, the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organization is managing outcomes – in other words, how well they are preparing patients for discharge. Furthermore, at an aggregate level, this information will be useful to researchers and policy-makers in examining how well the system is performing in meeting the health-care needs of people.
This project contributes to many of the priorities for health-care renewal in Canada:
- patient safety
- outcomes related to home care
- increased use of information technology
- accountability
Outcomes
C-HOBIC is being implemented so far in Ontario in acute and long-term care, in Manitoba in long-term and home care, and in Saskatchewan in long-term care. Evaluation findings are most positive in care sectors that have been involved in the initiative the longest and have focused resources on assisting clinicians to use the C-HOBIC information to improve their practice.
User feedback during the project illustrates that while adoption of EHRs is not complete and could take up to a year after implementation, the incorporation of C-HOBIC data and reports is seen to be beneficial and will foster adoption among non-users.
The C-HOBIC Toolkit provides a variety of information and resources from the C-HOBIC project.
Page updated January 2010
“[C-HOBIC] allows the nurse to understand patients’ ‘ways of knowing’ with regard to medical history and medications. It is a quick way for the nurse to assess the patient’s educational needs and lets the nurse know about family/friends the patient relies on.”
“C-HOBIC can elicit information not normally attained. It keeps the nursing unit updated regarding recent treatments, etc., prior to the patient’s admission.”
“Have a meeting where you’ve actually seen a result and then everybody believes it; you use a report at a meeting and the family says, ‘Wow,’ [because] they’ve seen the progress made. [The nurses say] this is great.”
