In a prior blog (Direct speaking about INdirect outcomes: HCAHPS as a measurement*), I argued that HCAHPS questions were indirect measures of outcomes. Indirect measures are weaker than direct measures because they are influenced by tons of variables that have nothing to do with the outcome of interest. But wait!! There’s more! HCAPS can sometimes be a DIRECT measure; it all depends on what you want to know.
(If you know this, then you are way ahead of many when it comes to measuring outcomes accurately!!)
KEY POINTS:
- If your research question is what do patients remember about hospitalization then HCAHPS is a DIRECT measure of what patients remember.
- However if your research question is what did hospital staff actually do then HCHAPS is an INDIRECT* measure of what staff did.
What is HCAHPS? HCAHPS (pronounced “H-caps”) questions are patient perceptions of what happened, which may or may not be what actually happened. Patients are asked to remember their care that happened in the past, and memories may be less than accurate. (See this link for more on what HCAHPS is: http://www.hcahpsonline.org/Files/HCAHPS_Fact_Sheet_June_2015.pdf )
Example: HCAHPS question #16 is, “Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?” Whether the patient answers yes or 
no, the response tells us only how the patient remembers it.
Why is this important?
- Because if you want to know whether or not RNs actually taught inpatients about their medications, then for the most direct & accurate measure you will have to observe RNs .
- However, if you want to know whether patients remember RNs teaching them about discharge medications, then HCAHPS question #16 is one of the most direct & accurate measure of what they remember.
*FOR MORE INFORMATION on why you want to use DIRECT measures 
see https://discoveringyourinnerscientist.com/2016/11/04/direct-speaking-about-idirect-outcomes-hcahps-as-a-measurement/
CRITICAL THINKING: Pick any HCAHPS question at this link and write a research question that for which it would be a DIRECT outcome measure: 
(http://www.hcahpsonline.org/files/March%202016_Survey%20Instruments_English_Mail.pdf)
For your current project, how are you DIRECTLY measuring outcomes?
measures
Is pain experience as diverse as our populations? This week I came across an interesting meta-analysis.
(RCTs) or experimental studies is the strongest type of MA. MA based on descriptive or non-experimental studies is a little less strong, because it just describes things as they seem to be; & it cannot show that one thing causes another.
your practice? Or should it? How can you use the findings with your patients? Should each patient be treated as a completely unique individual? Or what are the pros & cons of using this MA to give us a starting point with groups of patients? [To dialogue about this, comment below.]
library using reference above. It is available electronically pre-publication. Also check out my 
Evidence-based practice = best available evidence + expert clinical judgment + patient & family values/preferences.
practice journals that are beginning to grow–these take best information from the research report all the way through clinical recommendations. For research reports per se, 
database; & there when you find information that fits using your key search terms, you can also look for related articles & get full-text through interlibrary loan or online. Another strategy is take the article that fits your clinical issue to your librarian, and ask for help in finding more research on the identical clinical issue.
Chipmunks” cartoon: “Everyone with a nose knows the nose knows everything.” 
• A health system that began seeking input from patients and families 
level.
