Round 1 Grants
The Robert Wood Johnson Foundation (RWJF) awarded the first round of grants through its Interdisciplinary Nursing Quality Research Initiative (INQRI) program on August 15, 2006. Nine teams of nurse scholars and scholars from other disciplines were selected to conduct two-year research projects to examine the link between nurses' contributions and the safety and quality of patient care.
Round 1 Grants
Linking Blood Stream Infection Rates to Intensive Care
Johns Hopkins University
Dr. David Thompson
Dr. Jill Marsteller
The goal of this study was to implement a comprehensive safety program including an evidence based intervention to reduce central line-associated blood stream 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, contribute to the quality improvement literature and to the science of rigorously evaluated evidence based interdisciplinary nursing practice.
Nurse-Sensitive Measurement of Hospital Care Coordination
Emory University
Dr. Gerri Lamb
Dr. 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
Dr. Marcelline Harris
Dr. 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
Dr. Mary Blegen
Dr. Tom Vaughn
Does the composition of hospital nurse staffing levels matter when it comes to preventing costly complications and death following those complications? A team at the University of California, led by Mary Blegen, Tom Vaughn (from the University of Iowa) and Colleen Goode (from the University of Colorado), examined the extent to which nurse staffing levels affected the incidence of complications and the failure to rescue from those complications, (i.e. death following complications). Their examination showed that nursing hours per patient day were strongly associated with lower rates of pressure ulcers and hospital acquired infections, and fewer deaths from complications. Further, more RN hours in the mix had additional benefit with still lower rates of failure to rescue and hospital acquired infections. Their work shows that higher levels of nursing hours per patient day and RN skill mix in intensive care units and in general units will lead to better patient outcomes, information that can guide states considering regulation of nurse-patient staffing ratios to address patient safety gaps.
Developing and Testing Nursing Quality Measures with Consumers and Patients
Baruch College
Dr. Shoshanna Sofaer
Dr. Jean Johnson
The INQRI-supported work of Shoshanna Sofaer, Jean Johnson and colleagues at Baruch College and The George Washington University has helped shed light on whether some of the National Quality Forum's (NQF) nursing sensitive measures are perceived as meaningful by consumers. The team designed and conducted focus groups with recently hospitalized patients to understand their perception of the nursing sensitive measures. Consumers found several patient safety measures to be very compelling, and clearly believed that nurses had a significant role in hospital quality. On the other hand, consumers didn't think nurses should be advising patients to quit smoking, arguing that nurses have better things to do with their time. They also found measures of nurse skill mix and turnover rates confusing. The team learned that overall, the public, while valuing nurses highly, has an incomplete understanding of what they do, including what they do based on their own assessments, and to whom they are accountable. Researchers performed a thorough literature review regarding the actions of nurses in care coordination and conducted interviews with nurses in four hospitals and held nine focus groups with recent patients. They found that while consumers clearly recognize the importance of care coordination, their perceptions of the nurses' role differed from the perspective of the nurses. The team found that there are limits to the patients' ability to truly observe many aspects of care coordination, which may explain why nurses see their role as broader and more central than do the patients. This research provides great weight to the importance of seeking public views when creating measures of nurse quality and showed that the public has much to contribute to the process. Findings could influence the process by which NQF endorses measures. In part because of this research, NQF recently dropped smoking cessation counseling for myocardial infarction, heart failure and pneumonia from the nursing sensitive measures.
Measuring Nursing Care Quality Related to Pain Management
University of Utah
Dr. Susan Beck
Dr. 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 your 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
Dr. Sean Clarke
Dr. Doug Sloane
Led by Sean Clarke, an INQRI team at the University of Pennsylvania conducted a study to understand how a number of the National Quality Forum's nursing sensitive measures track with each other. Do nurse staffing and practice environment measures for hospitals predict the quality of care patients receive? And do quality of care measures link with endpoints like inpatient mortality? This project merges unique survey data and patient outcomes data from approximately 600 hospitals in three states with new performance measures disseminated by the Centers for Medicare and Medicaid Services on the HospitalCompare web site.
Lessons Learned from State Roll-Out of the NQF Nursing Sensitive Measures
Massachusetts Hospital Research and Education Association, Inc.
Dr. Pat Noga
Dr. Barry Kitch
In 2004, the National Quality Forum (NQF) endorsed a set of nursing sensitive measures, with the goal to provide hospitals, the public and purchasers with comparative measures that accurately reflect nursing performance. Massachusetts and Maine were among the first states to adopt statewide initiatives for the public reporting of nursing performance through the use of nurse sensitive measures. An INQRI team, led by Pat Noga and Barry Kitch, conducted a hospital leadership survey, including interviews with key stakeholders and hospital case studies to analyze these states' experiences implementing the initiatives. The team found that reaching agreement on the measures was a substantial and lengthy undertaking, and that while hospital leaders believed that public reporting of nurse sensitive measures was likely to have a positive impact both on the quality of nursing care and patient outcomes, they also found the initiatives to be burdensome. However, in both states, most believed that a public mandatory program would work best to improve quality of nursing care. Respondents were concerned about the accuracy and consistency of data collection and reporting across hospitals and wondered if the reports would be useful to the general public. Based on the experiences in Maine and Massachusetts, the researchers believe that it is possible to publicly report measures of nursing quality and that doing so can have a positive impact on the quality of care. The team theorizes that these initiatives are likely generalizable to other quality measurement initiatives not focused on nurse sensitive measures. The work of Noga and Kitch suggests that despite the perceived burden of implementing hospital reporting programs, public mandatory reporting may be viewed as a substantial impetus for improving the quality of nursing care.
The Nursing Ambulatory to Hospital Transitions (NAHT) Program
Massachusetts General Hospital
Dr. Barbara Roberge
Dr. Kenneth Minaker
The goal of this nurse-led interdisciplinary research team was to validate and test the impact of identifying and communicating a pre-hospital preventive patient risk profile on nurse-sensitive outcomes for hospitalized older adults. Study findings have the potential to influence not only the quality of the transition from community to hospital, but also nursing care delivered in the hospital, which will positively impact the patient experience.