Monday, March 25, 2013

INQRI: A Focus on Measurement

Ellen T. Kurtzman, MPH

Since its inception, INQRI has funded rigorous research to develop, test, and improve performance measures that capture nurses' contributions to high quality, cost-effective care.  From the beginning, program support emphasized projects that would contribute to the science of nursing and inform key priority areas for which no measures--or inadequate measures--existed.

For example, INQRI grantees Shoshanna Sofaer, DrPH and Jean Johnson, PhD, FAAN conducted focus groups with recently hospitalized patients to understand their perception of the NQF nursing sensitive measures.  Participants found several patient safety measures to be compelling and clearly believed that nurses had a significant role in hospital quality. However, they did not think nurses should be advising patients to quit smoking, arguing that nurses have better things to do with their time. In part because of this research, NQF dropped smoking-cessation counseling for myocardial infarction, heart failure and pneumonia from the nursing-sensitive measures.

Grantees Marcelline Harris, PhD, RN and Jack Needleman, PhD, FAAN focused their INQRI project on refining one of the most controversial measures of nursing-sensitive quality of care: failure to rescue. Their team developed three revised failure to rescue measures, one based on discharge data where the diagnosis was not coded as "present on admission" and two based on data where the diagnosis was coded as "present on admission."

Sean Clarke, PhD, CRNP, FAAN, Doug Sloane, PhD, and their INQRI team analyzed how a number of the NQF nursing sensitive measures track with each other. For example, the team wanted to uncover if staffing and practice environment measures could predict the quality of care received by patients.  Researchers merged survey data and patient outcomes data from about 600 hospitals in three states with new performance measures disseminated by the Centers for Medicare & Medicaid Services on the Hospital Compare website.

Of course, these are just three examples of the impact that INQRI programs have had in the field of measurement....there are many more that have made lasting contributions.  Certainly, as implementation of the Affordable Care Act proceeds and as health care continues to be more transparent and accountable, providers, payers, health care practitioners, and policymakers will need to draw from the rich work of these investigators and the INQRI legacy.

Ellen T. Kurtzman is assistant research professor in the School of Nursing at The George Washington University. For nearly a decade, she has been working in the field of patient safety and health care quality. Prior to her arrival at GW, she was the architect of National Quality Forum-endorsed™ (NQF) consensus standards for measuring nursing’s contribution to quality. While at NQF, Ms. Kurtzman also led national efforts to establish hospital and home health care quality and performance standards. In advancing these causes, she has published and presented on nursing performance measurement, public reporting, and quality issues. She is also a former member of INQRI’s National Advisory Committee.

This post is part of our week-long blog carnival focused on the Medical Care supplement.  Click here to access all posts in this carnival.

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