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Structure and Process Variables Affecting Outcomes for Heart Failure Clients

Van Doren, Elaine S. PhD, RN; Bowman, Joan MPA, RN, CCM; Landstrom, Gay L. MS, RN; Graves, Susan Y. MSN, RN


This study focused on case management by examining the relationships between congestive heart failure patient outcomes and nurse structure and process variables. A correlational design with retrospective analysis of data from 175 randomly selected acute care patients was used. The amount of education provided by the nurses on the unit was positively correlated with the degree of pathway completion (r= .32, p = .000) and negatively correlated with the readmissions (r = − .27, p = .000). The degree of completion of the clinical pathway had no effect on length of stay (LOS) but was negatively correlated to readmission rate (r =−.53, p = .000) and positively correlated to hospital days (r = .21, p = .000). Case Management was positively correlated with LOS (r = .41, p = .000) but negatively correlated with hospital days and readmissions, (r = −22, p = .000; r = −.29, p = .000, respectively). No relationships were found between RN hours and LOS or readmissions. The implications of these findings for case managers and nurse administrators are discussed.

Elaine S. Van Doren, PhD, RN, is a faculty member of the University of Michigan, teaching the undergraduate program and serving as liaison for the RN Studies Program in Southwest Michigan. Her background is in administration of acute and managed care.

Joan Bowman, MPA, RN, CCM, serves as the Case Management Program Specialist at Michigan State University, College of Nursing and Health Team. Formerly, she was the Provider Network Manager for Westshore Health Network, a physician hospital organization in West Michigan. Her background includes case management and nursing in acute, primary, home health, and managed care settings.

Gay L. Landstrom, MS, RN, received her Bachelor’s degree from Rush University and her Master’s degree in Nursing Administration from the University of Illinois at Chicago. She currently serves as Vice President of Patient Care Services for Mercy General Health Partners, in Muskegon, Michigan.

Susan Y. Graves, RN, MSN, received her Masters of Nursing in Administration of Patient Care Services from the University of Michigan. She is employed as a Case Manager for Mercy General Health Partners, Muskegon, Michigan. Her areas of interest include case management, management of the diabetic population, and home care.

Address correspondence and reprint requests to Gay L. Landstrom, MS, RN, 1500 E. Sherman Blvd., Muskegon, MI 49443 ( and

© 2004 Lippincott Williams & Wilkins, Inc.