The Difference Nurses Are Making to Improve Quality of Care to Older Adults through the Interdisciplinary Nursing Quality Research Initiative
I have had the opportunity to be part of the Interdisciplinary Nursing Quality Research Initiative (INQRI) and, in my geriatric-centric focus, have encouraged the group to look across all the studies and consider specifically the impact of this work on care of older adults. Although many of the investigators come from acute care backgrounds and focus, the issues addressed and work being done will have a major impact on care of older adults. So who supports the INQRI, and why was it developed? The Robert Wood Johnson Foundation (RWJF), well known for the commitment it has to enhancing health care quality for all patients, developed and supports the INQRI. The Foundation’s current goals include transforming the way care is delivered at the bedside, reducing the shortage of nurses, and advancing the science to improve health care quality. To address the gaps in what was known about nursing’s effect on quality and to explore the many contributions nurses are making to keep patients safer and healthier, the RWJF created the INQRI. As its name suggests, the program supports teams of nurse scholars and scholars from other disciplines to address gaps in knowledge about the relationship between nursing and health care quality. This program is led by Mary Naylor, a nurse and health services researcher, and Mark Pauly, a health care economist, both at the University of Pennsylvania, in partnership with Lori Melichar and colleagues at the RWJF.
Grantees
The first round of grantees began work in August 2006 and completed their work in fall 2008. Their research focuses on measurement. The 9 research projects covered 3major areas: 1) investigating the
link between the work of nurses and the quality of care provided in hospitals; 2) producing and validating measures that capture nurses’ contributions to quality care in hospitals; and 3) evaluating the
impact of innovative nurse-led initiatives on patient outcomes. Twelve additional projects received INQRI grants in September 2007 and grantees completed their work in August 2009. These teams addressed interventions to prevent falls, evidence-based nursing and chronic disease, pediatric nursing care, nurse workforce and hospital performance, and how to improve hospital discharge. Grants were awarded to 8 additional teams in September 2008 and could be, as noted, across all levels of care. Five new teams received funding in September 2009. These researchers are addressing the value of nursing in achieving
efficient, high-quality patient care. Currently, there is a call for proposals focused on dissemination and implementation of innovative care approaches implemented by interdisciplinary teams to improve patient outcomes.
Translating the Research
Ultimately, the goal of the INQRI work is that this investigator-initiated research will result in robust results that can be shared with policymakers, hospital administrators, and others who determine how nursing resources will be distributed to improve the quality and outcomes of patient care. To increase the probability that the findings of studies supported by the INQRI program are placed in the hands of and used by influential decision makers, INQRI is engaging key stakeholders on an ongoing basis to provide feedback and practical guidance to researcher teams. In addition to providing communications assistance to researchers to ensure that their work reaches a broad and diverse audience, the INQRI leadership team will produce syntheses that place the work of INQRI grantees in the context of similar research by others in the nursing and other health care fields. In the Journal, we have pulled together the work from several of the INQRI projects that address care of older adults. I am thrilled to share these with our readership, because I believe they provide some very useful information for those of us to use in the field. The work by Bobay and colleagues in this issue, for example, provides a critical foundation for intervention work to improve discharge success following acute care admissions for older adults. Clearly, there is a need to review how discharge education is being done, particularly among those aged 85 years and older. In addition to what we have published in the Journal, the following projects are potentially relevant to older adults, and I encourage you all to monitor for publications on these projects in the near future and to reflect on and apply findings to how we can specifically address and improve the care provided to older adults across the entire health care continuum.
Cohort 1
Linking Blood Stream Infection Rates to Intensive Care
Johns Hopkins University
David Thompson and Jill Marsteller
The goal of this study was to implement a comprehensive safety program including an evidence-based intervention to reduce centralline-associated bloodstream infections while examining the context of nursing care delivery on patient outcomes. This interdisciplinary research team used the expertise of nurses to develop and deliver a quality improvement initiative that reflects the positive clinical contributions of nurses in the critical care setting. This study is likely to inform other nurse-led medical error reduction interventions and contribute to the quality improvement literature and the science of rigorously evaluated evidence-based interdisciplinary nursing practice.
Nurse-Sensitive Measurement of Hospital Care Coordination
Emory University
Gerri Lamb and Francois Sainfort
An interdisciplinary team of nurse scientists and system engineers developed a new tool to capture what nurses do when they coordinate care for hospitalized patients. The tool, the first of its kind, will enable nurses and hospitals to document this important nursing work and will lead to a better understanding of how to improve care coordination and the quality of patient care in hospitals.
Improving the NQF Failure to Rescue Metric
Mayo Clinic
Marcelline Harris and Jack Needleman
Led by scholars in nursing and health services research and informatics, the goal of this interdisciplinary team was to refine one of the most controversial measures of nursing-sensitive quality of care: failure to rescue. Refinement of this measure is expected to result in a measure of the quality of nursing care that is more likely to be used for quality improvement, public accountability, and pay for performance.
Quality Care on Acute Inpatient Units
University of California
Mary Blegen and Tom Vaughn
The goal of this interdisciplinary project led by a nurse scholar was to test the power of the National Quality Forum–endorsed measures to advance quality nursing research and design, test other measures as potential indicators of nursing quality, and determine the impact of nurse staffing on these indicators in specific types of patient care units. Findings from this study are likely to inform the decisions of policy makers and others who are considering alternative proposals to ease the effects of current and future nursing shortages.
Developing and Testing Nursing Quality Measures with Consumers and Patients
Baruch College
Shoshanna Sofaer and Jean Johnson
Led by scholars in health policy and public policy and nursing, the goal of this project was to develop nursing-sensitive quality measures that patients and other decision makers will find important and
useful. In addition to existing nursing quality measures, the project also worked on new measures in an area that both patients and professionals often point to as critical: the coordination of their care.
Measuring Nursing Care Quality Related to Pain Management
University of Utah
Susan Beck and Patricia Berry
The purpose of this study was to develop and test a questionnaire that can be used to measure
opinions of patients about how their nurses manage their pain. Many patients in the hospital report significant pain, which can cause distress and limit their ability to carry out their usual activities. The information from this project will provide researchers with an understanding of how patients with pain understand and interpret questions related to the quality of their nursing care. This measure is likely to prove salient to consumers interested in selecting hospitals that can best address their care needs, as well as to hospital administrators and policy makers interested in improving the quality of nursing-related care.
Validating NQF Nursing-Sensitive Performance Measures
University of Pennsylvania
Sean Clarke and Doug Sloane
Led by a nurse scholar, the goal of this interdisciplinary team was to analyze and validate measures from the National Quality Forum nursing sensitive measure set using data collected from approximately 600 acute care hospitals in 3 states, as well as Medicare hospital performance measures, in 2005–2006. This validation study will be the foundation for blending new types of data on hospital quality in studies to help understand how staffing levels and the ways nursing services are organized influence the care patients receive and, ultimately, patient outcomes. The project also provided the first predictive validation for the National Quality Forum nursing measures against an external data set.
Lessons Learned from State Rollout of the National Quality Forum (NQF) Nursing Sensitive Measures
Massachusetts Hospital Research and Education
Association, Inc.
Pat Noga and Barry Kitch
Led by a teamof health services researchers, the goal of this interdisciplinary team was to evaluate
2 statewide implementations of the NQF Nursing-Sensitive Measures created to provide hospitals and the public with comparative measures of nursing quality. The 2 statewide implementations were a voluntary effort in Massachusetts hospitals and a government-mandated effort in Maine hospitals. This study has the potential to inform policy makers and advocates in oth
The Difference Nurses Are Making to Improve Quality of Care to Older Adults through the Interdisciplinary Nursing Quality Research Initiative
I have had the opportunity to be part of the Interdisciplinary Nursing Quality Research Initiative (INQRI) and, in my geriatric-centric focus, have encouraged the group to look across all the studies and consider specifically the impact of this work on care of older adults. Although many of the investigators come from acute care backgrounds and focus, the issues addressed and work being done will have a major impact on care of older adults. So who supports the INQRI, and why was it developed? The Robert Wood Johnson Foundation (RWJF), well known for the commitment it has to enhancing health care quality for all patients, developed and supports the INQRI. The Foundation’s current goals include transforming the way care is delivered at the bedside, reducing the shortage of nurses, and advancing the science to improve health care quality. To address the gaps in what was known about nursing’s effect on quality and to explore the many contributions nurses are making to keep patients safer and healthier, the RWJF created the INQRI. As its name suggests, the program supports teams of nurse scholars and scholars from other disciplines to address gaps in knowledge about the relationship between nursing and health care quality. This program is led by Mary Naylor, a nurse and health services researcher, and Mark Pauly, a health care economist, both at the University of Pennsylvania, in partnership with Lori Melichar and colleagues at the RWJF.
Grantees
The first round of grantees began work in August 2006 and completed their work in fall 2008. Their research focuses on measurement. The 9 research projects covered 3major areas: 1) investigating the
link between the work of nurses and the quality of care provided in hospitals; 2) producing and validating measures that capture nurses’ contributions to quality care in hospitals; and 3) evaluating the
impact of innovative nurse-led initiatives on patient outcomes. Twelve additional projects received INQRI grants in September 2007 and grantees completed their work in August 2009. These teams addressed interventions to prevent falls, evidence-based nursing and chronic disease, pediatric nursing care, nurse workforce and hospital performance, and how to improve hospital discharge. Grants were awarded to 8 additional teams in September 2008 and could be, as noted, across all levels of care. Five new teams received funding in September 2009. These researchers are addressing the value of nursing in achieving
efficient, high-quality patient care. Currently, there is a call for proposals focused on dissemination and implementation of innovative care approaches implemented by interdisciplinary teams to improve patient outcomes.
Translating the Research
Ultimately, the goal of the INQRI work is that this investigator-initiated research will result in robust results that can be shared with policymakers, hospital administrators, and others who determine how nursing resources will be distributed to improve the quality and outcomes of patient care. To increase the probability that the findings of studies supported by the INQRI program are placed in the hands of and used by influential decision makers, INQRI is engaging key stakeholders on an ongoing basis to provide feedback and practical guidance to researcher teams. In addition to providing communications assistance to researchers to ensure that their work reaches a broad and diverse audience, the INQRI leadership team will produce syntheses that place the work of INQRI grantees in the context of similar research by others in the nursing and other health care fields. In the Journal, we have pulled together the work from several of the INQRI projects that address care of older adults. I am thrilled to share these with our readership, because I believe they provide some very useful information for those of us to use in the field. The work by Bobay and colleagues in this issue, for example, provides a critical foundation for intervention work to improve discharge success following acute care admissions for older adults. Clearly, there is a need to review how discharge education is being done, particularly among those aged 85 years and older. In addition to what we have published in the Journal, the following projects are potentially relevant to older adults, and I encourage you all to monitor for publications on these projects in the near future and to reflect on and apply findings to how we can specifically address and improve the care provided to older adults across the entire health care continuum.
Cohort 1
Linking Blood Stream Infection Rates to Intensive Care
Johns Hopkins University
David Thompson and Jill Marsteller
The goal of this study was to implement a comprehensive safety program including an evidence-based intervention to reduce centralline-associated bloodstream infections while examining the context of nursing care delivery on patient outcomes. This interdisciplinary research team used the expertise of nurses to develop and deliver a quality improvement initiative that reflects the positive clinical contributions of nurses in the critical care setting. This study is likely to inform other nurse-led medical error reduction interventions and contribute to the quality improvement literature and the science of rigorously evaluated evidence-based interdisciplinary nursing practice.
Nurse-Sensitive Measurement of Hospital Care Coordination
Emory University
Gerri Lamb and Francois Sainfort
An interdisciplinary team of nurse scientists and system engineers developed a new tool to capture what nurses do when they coordinate care for hospitalized patients. The tool, the first of its kind, will enable nurses and hospitals to document this important nursing work and will lead to a better understanding of how to improve care coordination and the quality of patient care in hospitals.
Improving the NQF Failure to Rescue Metric
Mayo Clinic
Marcelline Harris and Jack Needleman
Led by scholars in nursing and health services research and informatics, the goal of this interdisciplinary team was to refine one of the most controversial measures of nursing-sensitive quality of care: failure to rescue. Refinement of this measure is expected to result in a measure of the quality of nursing care that is more likely to be used for quality improvement, public accountability, and pay for performance.
Quality Care on Acute Inpatient Units
University of California
Mary Blegen and Tom Vaughn
The goal of this interdisciplinary project led by a nurse scholar was to test the power of the National Quality Forum–endorsed measures to advance quality nursing research and design, test other measures as potential indicators of nursing quality, and determine the impact of nurse staffing on these indicators in specific types of patient care units. Findings from this study are likely to inform the decisions of policy makers and others who are considering alternative proposals to ease the effects of current and future nursing shortages.
Developing and Testing Nursing Quality Measures with Consumers and Patients
Baruch College
Shoshanna Sofaer and Jean Johnson
Led by scholars in health policy and public policy and nursing, the goal of this project was to develop nursing-sensitive quality measures that patients and other decision makers will find important and
useful. In addition to existing nursing quality measures, the project also worked on new measures in an area that both patients and professionals often point to as critical: the coordination of their care.
Measuring Nursing Care Quality Related to Pain Management
University of Utah
Susan Beck and Patricia Berry
The purpose of this study was to develop and test a questionnaire that can be used to measure
opinions of patients about how their nurses manage their pain. Many patients in the hospital report significant pain, which can cause distress and limit their ability to carry out their usual activities. The information from this project will provide researchers with an understanding of how patients with pain understand and interpret questions related to the quality of their nursing care. This measure is likely to prove salient to consumers interested in selecting hospitals that can best address their care needs, as well as to hospital administrators and policy makers interested in improving the quality of nursing-related care.
Validating NQF Nursing-Sensitive Performance Measures
University of Pennsylvania
Sean Clarke and Doug Sloane
Led by a nurse scholar, the goal of this interdisciplinary team was to analyze and validate measures from the National Quality Forum nursing sensitive measure set using data collected from approximately 600 acute care hospitals in 3 states, as well as Medicare hospital performance measures, in 2005–2006. This validation study will be the foundation for blending new types of data on hospital quality in studies to help understand how staffing levels and the ways nursing services are organized influence the care patients receive and, ultimately, patient outcomes. The project also provided the first predictive validation for the National Quality Forum nursing measures against an external data set.
Lessons Learned from State Rollout of the National Quality Forum (NQF) Nursing Sensitive Measures
Massachusetts Hospital Research and Education
Association, Inc.
Pat Noga and Barry Kitch
Led by a teamof health services researchers, the goal of this interdisciplinary team was to evaluate
2 statewide implementations of the NQF Nursing-Sensitive Measures created to provide hospitals and the public with comparative measures of nursing quality. The 2 statewide implementations were a voluntary effort in Massachusetts hospitals and a government-mandated effort in Maine hospitals. This study has the potential to inform policy makers and advocates in oth
การแปล กรุณารอสักครู่..