New Research Projects Will Examine How Nurses' Contributions Affect Patient Care and Safety

Nine "INQRI" grants awarded to interdisciplinary research teams

    • September 27, 2006

The Robert Wood Johnson Foundation (RWJF) today announced the first round of grants awarded through its Interdisciplinary Nursing Quality Research Initiative (INQRI) program. Nine teams of nurse scholars and scholars from other disciplines will conduct two-year research projects to examine the link between nurses' contributions and the safety and quality of patient care. (See attached list.)

More than half (54 percent) of all health care providers in the United States are nurses, but little rigorous research exists that demonstrates the impact of nurses' care on patient outcomes. INQRI, a five-year program under the direction of Mary Naylor, Ph.D., R.N., F.A.A.N., Marian S. Ware professor in gerontology at the University of Pennsylvania School of Nursing and co-directed by Mark Pauly, Ph.D., the Bendheim Professor at the University of Pennsylvania's Wharton School, aims to identify causal linkages between nursing and health outcomes for patients.

"We know that nurses play a pivotal role in ensuring patient safety, preventing medication errors and influencing the overall quality of care that patients receive but we have limited evidence about the exact nature and impact of nursing's contribution," said Naylor. "The research that the INQRI teams generate will provide that evidence, identifying not only how nurses affect patient care, but also how clinical leaders and policy-makers can support changes that improve the quality of care that nurses are able to provide."

Teams of nurse scholars and scholars from other disciplines—such as informatics, health policy, economics and medicine—each received up to $300,000 for their projects, designed to generate, disseminate and translate research to improve the quality of care provided in hospitals. The first round of projects are focused in three areas: (1) producing and validating measures that capture nurses' contributions to high-quality care in inpatient settings; (2) investigating the link between the work of nurses and the quality of care provided in acute care settings; and (3) evaluating the impact of innovative nurse-led initiatives on patient outcomes.

"The INQRI program is designed to produce research that has impact," explained Lori Melichar, Ph.D., an economist who is spearheading RWJF's role in the INQRI program. "Our expectation is that by bringing interdisciplinary methods and perspectives to questions about nursing and soliciting early input from potential end users of the findings, we will help to ensure that the research questions and results will be meaningful and relevant to a broad range of decision-makers."

A call for proposals will be issued in October for the 2007 cohort of INQRI grants.

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About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) Program
Round 1

Linking Blood Stream Infection Rates to Intensive Care
Johns Hopkins University
Baltimore, MD
Dr. David Thompson
Dthomps1@jhmi.edu
The goal of this study is 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 plans to use 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
Atlanta, GA
Dr. Gerri Lamb
glamb@emory.edu
An interdisciplinary team of nurse scientists and system engineers will develop 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
Rochester, MN
Dr. Marcelline Harris
Harris.marcelline@mayo.edu
Led by scholars in nursing and health services research and informatics, the goal of this interdisciplinary team is 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 (P4P).

Quality Care on Acute Inpatient Units
The Regents of the University of California
San Francisco, CA
Dr. Mary Blegen
Mary.Blegen@nursing.ucsf.edu
The goal of this interdisciplinary project led by a nurse scholar is 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
New York, NY
Dr. Shoshanna Sofaer
Shoshanna_sofaer@baruch.cuny.edu
Led by scholars in health policy, public policy and nursing, the goal of this project is to develop nursing-sensitive quality measures that patients and other decision-makers will find important and useful. In addition to checking out, with recent patients, how they respond to existing nursing quality measures, the project will also work on new measures in an area that both patients and professionals often point to as critical: the coordination of their care. The team hopes these measures will both identify the contributions nurses make to the health of their patients and how they need to improve.

Measuring Nursing Care Quality Related to Pain Management
University of Utah
Salt Lake City, UT
Dr. Susan Beck
Susan.beck@nurs.utah.edu
The purpose of this study is 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
Philadelphia, PA
Dr. Sean Clarke
sclarke@nursing.upenn.edu
Led by a nurse scholar, the goal of this interdisciplinary team is to analyze and validate measures from the National Quality Forum nursing-sensitive measure set using data collected from approximately 600 acute care hospitals in three 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, patients' outcomes. The project will also provide the first predictive validation for the National Quality Forum nursing measures against an external data set.

Lessons Learned from State Roll-Out of the NQF Nursing Sensitive Measures
Massachusetts Hospital Research and Education Association, Inc.
Boston, MA
Dr. Joyce Clifford
jcliffor@caregroup.harvard.edu
Led by a team of health services researchers, the goal of this interdisciplinary team is to evaluate two statewide implementations of the NQF Nursing-Sensitive Measures created to provide hospitals and the public with comparative measures of nursing quality. The two statewide implementations are 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 other states that seek to implement the nurse-sensitive measures endorsed by the National Quality Forum.

The Nursing Ambulatory to Hospital Transitions (NAHT) Program
Massachusetts General Hospital
Boston, MA
Dr. Barbara Roberge
broberge@partners.org
The goal of this nurse-led interdisciplinary research team is 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.