Happy Memorial Day

From everyone at the INQRI program, we wish you a very Happy Memorial Day! We will be back with new blog posts tomorrow morning.

Reducing Readmissions

This week INQRI's director, Mary Naylor, joined more than 200 hospital administrators, doctors, nurses and national experts for a discussion centered around developing strategies to reduce hospital readmissions in the five-county Philadelphia area.

Naylor described her transitional care model (TCM) which uses advance practice nurses to target the chronically ill elderly. This population accounts for 75 percent of Medicare costs. Using their intervention, Naylor's team reduced rehospitalizations through three months with a savings of more than $2,000/month/participant.

Click here to learn more about the event in the Philadelphia Inquirer.

Click here to read about the findings of INQRI researchers at Marquette University. This team has been working to prevent unnecessary readmissions by studying what hospital-based nurses do to influence outcomes that occur after discharge from a hospital.

Health Wonk Review

Check out this week's edition of the Health Wonk Review hosted by David E. Williams of the Health Business Blog.  This week offers up a great selection of views with 23 blog represented... including ours.

About the Health Wonk Review:

Health Wonk Review is a biweekly compendium of the best of the health policy blogs. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant's blog. For participants, it's a way to network and share ideas, and for those readers who don't live in this space every day, it's a way to sample some of the latest thinking and the "best of the best."

About this week's host:

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultants in technology enabled health care services, pharma, biotech, and medical devices.

INQRI Grantees Receive New Grant to Extend Their Work

Congratulations to INQRI grantees Cindy Corbett and Stephen Setter, who were recently awarded funding from the Agency for Healthcare Research and Quality (AHRQ) for a grant titled: “Transitional Care Medication Safety and Medical Liability: Closing the Chasm.” This grant is a direct extension of the team's INQRI-funded project, "Empowering Home Care Nurses to Efficiently Resolve Medication Discrepancies" which is nearing completion.

In their INQRI work, the team conducted a clinical trial that investigated a new nurse-led, informatics-based intervention to contribute to a better understanding of the potential for home care nurses to lead in the identification and resolution of medication discrepancies during transitions between hospital and home care providers. They hypothesized that with this improvement in their environment, home care nurses already on staff could enhance patients' outcomes, reduce healthcare costs, and eliminate the need for duplicative services by external consultants or specialty providers. The team will present their findings at the INQRI Annual Meeting (September 15-16, 2010).

INQRI Grantee Examines the Effect of Nurse "Presenteeism" on Quality of Patient Care

The negative effects of "presenteeism"—lower productivity at work due to employee health problems—are widely known in business circles.

But what does presenteeism mean for the health care industry, and particularly for nurses—the largest group of health care professionals in the country—and their patients?

Susan Letvak, R.N., Ph.D., an Interdisciplinary Nursing Quality Research Initiative (INQRI) researcher and an associate professor of nursing at the University of North Carolina at Greensboro, has the answer: Keeping nurses healthy will help keep patients healthy, too.

Click here to read more.

INQRI Grantee Named Dean

Congratulations to INQRI Grantee John Welton, Ph.D., R.N. who was recently named the Dean of the School of Nursing and Health Sciences at Florida Southern College. Welton was previously an assistant professor in the College of Nursing at the Medical University of South Carolina. He received his bachelor of science in nursing degree from Skidmore College, his master of science degree in nursing administration from the University of North Carolina at Charlotte and his doctorate in nursing from University of North Carolina at Chapel Hill with a minor in medical informatics. Welton and his co-PI, Richard Lindrooth, Ph.D. completed their INQRI project, "Linking Processes of Nursing Care and Patient Safety Outcomes: An Analysis of the Cause and Effect of Safe Practice" last summer. He will assume the role of dean on June 1.

Nurses' Contributions to Prescribing and Reconciling Meds

Advanced practice nurses in Ohio are seeking more authority to prescribe drugs.  Given the higher demand for care forecast due to health reform and the fact that patients often have to wait for a doctor to be available to prescribe pain relievers, nurses are prepared to fill the gap.  It is expected that legislators in the Ohio House will vote this week on a bill that would allow advanced-practice nurses to write prescriptions for controlled substances, including fentanyl, oxycodone and Ritalin.  Click here to read more about this story in the Columbia Dispatch. 

INQRI understands the vital role that nurses play in the correct use of medication.  Grantees at Johns Hopkins Hospital have evaluated the effectiveness of a nurse-pharmacist clinical information coordination team in improving medication reconciliation management on admission and discharge, quantified potential harm due to reconciliation failures and determined the cost-benefit related to averted harm. Thus far, their work suggests how important medication reconciliation at the time of admission and at discharge is to avoiding adverse drug effects, improving patient safety and reducing healthcare costs.  Click here to watch the team present their findings.

44 Illinois Hospital ICUs Reported Zero CLABSIs Last Year

FierceHealthcare reported that 44 Illinois hospital ICUs reported zero central line-associated bloodstream infections (CLABSIs) last year, all of which used a checklist strategy created by Peter Pronovost and adopted by the Institute for Healthcare Improvement. The organizations are part of a 52-hospital collaborative that aims to eliminate CLABSIs in ICUs.  The collaborative, "On the CUSP: Stop BSI,"  features the work of INQRI grantees David Thompson and Jill Marsteller.

Click here to learn more about their INQRI project, "Linking Blood Stream Infection Rates to Intensive Care."

Click here to read more about the Illinois report at FierceHealthcare.

Click here to learn more about On the Cusp.

Early Bird Registration for the Quality Colloquium

Early bird registration is available until Friday for the Ninth National Quality Colloquium, which will be held August 16-19, 2010.

Event Features:

• A Hybrid Conference, Internet Event and Training Tool
• An Executive Education Course on Patient Safety, Healthcare Quality Enhancement and Medical Errors Reduction for Healthcare Executives, Clinicians and Patient Care Staff
• Onsite at Harvard University's Annenberg Hall and Faculty Club
• Online In Your Own Office or Home live via the Internet with 24/7 Access for Six Months

For more information, please visit the Colloquium's website.

Register by Friday, May 21, 2010 for Early/Early Bird discount and save $800.

Click here to register.

INQRI Grantee Speaking at a National Press Club Briefing

INQRI grantee Shoshanna Sofaer, Dr.P.H. (Chair of Health Care Policy, Baruch College – The City University of New York) will be part of an exciting briefing this week at the National Press Club.

The Center for Advancing Health will present an analysis of Americans’ engagement in our health care based on responses to questions from more than 20 surveys supported by the federal government and private foundations and organizations. This report outlines the size of the challenge ahead, describes emerging behavioral patterns and suggests some practical next steps.

National Press Club – The Holeman Lounge
529 14th Street, NW, 13th Floor
Washington, DC
Thursday, May 20, 2010
8:30 am – 9:00 am: registration and breakfast
9:00 am – 10:30 am: forum

To learn more about Dr. Sofaer's INQRI project, please click here.

More Nurses Means More Patients Live

In 2002, INQRI National Advisory Committee member Linda Aiken published a study in the Journal of the American Medical Association, which revealed that as hospital nurses are assigned more and more patients to care for, the number of patients who die increases. Dr. Aiken just released new data which shows that adding a patient to nurses' workloads increased patient mortality by 6 percent in Pennsylvania, 10 percent in New Jersey and 13 percent in California.

Click here to read an article about Dr. Aiken's findings by Theresa Brown, RN, with CNN News.

Click here to read a Q&A with Dr. Aiken on INQRI's website, focused on health reform and nursing.

Empowering Nurses Positively Affects Patient Care

"Empowering nurses to become leaders in patient safety can have positive effects not only on the patient population's quality of care, but on staff satisfaction levels."

-- Heather Comak, for HealthLeaders Media, May 13, 2010

Hear, hear!!!

Click here to read Comak's article, "Quality Safety Investigator Program Encourages Bedside Nurses to be Patient Safety Champions."

Improving Care During Off-Peak Hours

INQRI's team at Midwestern University has been highlighted recently in two online publications. The team released an article, "Expanding What We Know About Off-peak Mortality in Hospitals" in the March 2010 issue of the Journal of Nursing Administration and news of the study has been picked up by the media:

Study shows how nurses can improve ‘off-peak’ care
By Marion Davis, Contributing Writer, Providence Business News
Click here to read the story.

Nurses Week: How to improve patient care during off-peak hours
By Jeff Weber, Heartbeats blog for MyCentralJersey.com
Click here to read the story.

Nurse Assessments Key to Understanding Discharge Readiness

Although the prevention of hospital readmission and use of emergency departments is a vital strategy in reducing health care costs, there has been little research on nurse assessment and patient perceptions of discharge readiness in relation to postdischarge outcomes.  However, a new study published in Medical Care can shed some light on this issue.  INQRI's team at Marquette University conducted a study with 162 adult medical-surgical patients and their discharging nurses from 13 units in four hospitals.  They found low correlations between nurse assessment and patient perceptions of discharge readiness.  In fact, nurses rated patient readiness higher than did the patients.  The team concluded that since nurses' assessment was more strongly associated with postdischarge utilization, formalizing nurse assessment could help identify patients at risk for readmission.

Click here to access the article on the journal website.

"A Time for Change: Restructuring America's Health Care Delivery System"

INQRI's Senior Program Officer, Lori Melichar, is in New York City today, attending the International Health Care Conference, "A Time for Change: Restructuring America's Health Care Delivery System." The event is being held at Cornell University's ILR School.

Follow Lori's comments throughout the event by visiting her Twitter page.

Click here to learn about the event.

The Role Of Nurse Practitioners In Reinventing Primary Care

INQRI director Mary Naylor and Ellen Kurtzman have a new piece in the May 2010 edition of Health Affairs, "The Role of Nurse Practioners in Reinventing Primary Care."

"Nurse practitioners are the principal group of advanced-practice nurses delivering primary care in the United States. We reviewed the current and projected nurse practitioner workforce, and we summarize the available evidence of their contributions to improving primary care and reducing more costly health resource use. We recommend that nurse practice acts—the state laws governing how nurses may practice—be standardized, that equivalent reimbursement be paid for comparable services regardless of practitioner, and that performance results be publicly reported to maximize the high-quality care that nurse practitioners provide."

Click here to read the article.

RWJF's Voices of Quality

Each month, the Robert Wood Johnson Foundation releases "The Quality Report," an e-newsletter which provides a monthly report from their Quality/Equality program area. One of the highlights each month is the "Voices of Quality" segment - an opportunity to hear from a health care provider about what works.

This month, Shelley Hirshberg, the executive director of the P2 Collaborative of Western New York, the lead organization for Western New York's Aligning Forces for Quality, discusses her personal experience becoming an engaged health care consumer.

Click here to listen.

Today's Webinar

Special thanks to Mary Blegen for today's presentation "Impact of Teamwork and Communication Interventions of Patient Safety," focused on the Triad for Optimal Patient Safety.

If you missed the session, please visit our website to either download the slides or view the presentation on your desktop.

Stay tuned for more information about our final session in the series. We will welcome a speaker from the Sebastian Ferraro Foundation on June 16th. Details to come.

The Medication Management Webinar Series is a year-long initiative, co-sponsored by the Interdisciplinary Nursing Quality Research Initiative (INQRI) program and the Gordon and Betty Moore Foundation.

Please Join Us This Afternoon...

This week, INQRI and the Gordon and Betty Moore Foundation are pleased to welcome Mary Blegen to our webinar series on medication management.

Triad for Optimal Patient Safety
Speaker: Mary Blegen, University of California - San Francisco
Date: May 6, 2010: 2:00 p.m. - 3:00 p.m. ET
Click here to register.

Please contact Heather Kelley with any questions.
Please visit the INQRI website to view previous presentations.

The Medication Management Webinar Series is a year-long initiative, co-sponsored by the Interdisciplinary Nursing Quality Research Initiative (INQRI) program and the Gordon and Betty Moore Foundation.

INQRI Team Hosting Two Meetings for Release of Findings

An INQRI team at Midwestern State University is hosting two meetings this summer to present the findings from their study, "The Effect of Off-peak Hospital Environments on Nurses' Work: an Institutional Ethnography." One meeting will be held July 13, 2010 in Dallas and the other will be held July 30, 2010 in Houston.

Click here to download the invitation.

Click here to learn more about the team's recently published article in the Journal of Nursing Administration.

INQRI Research Team the First Commissioned by ANCC

An INQRI team from University of Maryland School of Nursing and Johns Hopkins University is the first to lead a study commissioned by the American Nurses Credentialing Center (ANCC). The team includes Robin Newhouse, PhD, RN, Laura Morlock, PhD, Cheryl Dennison, PhD, RN, Peter Pronovost, MD, PhD, Kevin Frick, PhD, Yulan Liang, PhD, Meg Johantgen, PhD, RN and Sue Thomas, PhD, RN.

In their INQRI study, this interdisciplinary research team evaluated the effects of a rural hospital collaborative established to facilitate translation of evidence on heart failure (HF) patient care. Specifically, the team examined nursing characteristics that are associated with improvements in HF patient care.  The ANCC study will extend research conducted through their INQRI study in a sample of 46 Magnet® recognized healthcare organizations.

The two-year grant will enable Newhouse to test nursing interventions with a direct effect on improved heart failure patient outcomes. The team will evaluate the effect of standardized education on heart failure patient care (knowledge, self care and readmissions), identify hospital and nursing characteristics that are associated with improvements in HF patient care and evaluate the cost effectiveness of nursing interventions to improve HF patient care.

Quality Of Care, Patient Safety See Gains

American Medical News, Kevin B. O'Reilly, 04/27/2010

The U.S. health system continues to slowly improve its performance on many measures of quality and patient safety while struggling to cut racial and ethnic disparities.

The Agency for Healthcare Research and Quality published the findings in April in companion reports on health care quality and health care disparities. The reports are based on data from 2000 to 2007 on hundreds of measures tracked by the federal government.

American health care bettered its performance on 59% of 169 quality measures, with a 2.3% annual median rate of improvement. Meanwhile, hospitals improved their performance on 52% of 33 patient safety measures.

Please click here to read the rest of the article at the American Medical News.