Category Archives: Quality of care

Feb 3 2014
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Evidence to Improve the Quality of Care

Richard Kronick, PhD, was named director of the Agency for Healthcare Research and Quality (AHRQ) in August 2013. Kronick is a health policy researcher with a background in academia as well as in federal and state government. He received a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research in 1998.

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Human Capital Blog: Congratulations on your new position at AHRQ. This is an exciting time for health care. What do you see as AHRQ’s place in the U.S. health care universe?

Richard Kronick: Thank you! You’re right—this is an exciting time.

We have an almost $3 trillion health care system. We pour tremendous resources into the delivery of medical care—but comparatively little effort into trying to understand how health care can be delivered more safely, with higher quality, and be more accessible and affordable. AHRQ’s role is to produce evidence that can be used to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with the U.S. Department of Health and Human Services (HHS) and other partners to make sure that the evidence is understood and used.

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Jan 9 2014
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Guide to Nursing’s Role in Care Coordination

A new guide, Care Coordination: The Game Changer—How Nursing Is Revolutionizing Quality Care, explores how care coordination is positioned in the context of health reform. It was published by the American Nurses Association (ANA).

Care coordination has long been an integral part of nursing practice, the ANA said in a news release, with registered nurses leading the way in designing and delivering successful team-based care coordination programs that improve patient care and reduce costs. In the book, editor Gerri Lamb, PhD, RN, FAAN, and 23 leaders in care coordination explore topics including:

  • A historical perspective on nursing and quality care;
  • The role of care coordination in quality and safety;
  • Models and tools for improving quality and safety;
  • The role of nurse leaders in advancing care coordination;
  • The care coordinator’s role in reducing avoidable hospital stays;
  • Partnering with patients and families for better outcomes; and
  • Community-based care transitions.

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Dec 5 2013
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Human Capital News Roundup: Light-based defibrillators, the primary care workforce, how women change men, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

A strong primary care system is essential to improving health care in the United States, and front-line clinicians, staff, and leaders need to re-examine traditional roles and responsibilities, Maryjoan Ladden, PhD, RN, FAAN, told Medical Home News. Ladden is senior program officer for RWJF’s Human Capital portfolio. To investigate primary care workforce transformation, RWJF funded The Primary Care Team: Learning from Effective Ambulatory Practices (LEAP), Ladden said.  Her full interview is available at: http://medicalhomenews.com/ (subscription required.)

Women with post-traumatic stress disorder (PTSD) gain weight more rapidly and are more likely to be overweight or obese than other women, according to a study co-authored by RWJF Health & Society Scholars alumna Magdalena Cerda, DrPH. The study, featured in Health Canal, is the first to look at the relationship between PTSD and obesity over time.

New tools such as the Omnibus Risk Estimator, which the American Heart Association recommends doctors use instead of cholesterol tests to determine whether to prescribe statins, are developed with little regulatory authority over their design and use, Jason Karlawish, MD, writes in a New York Times op-ed. Karlawish, recipient of an RWJF Investigator Award in Health Policy Research, encourages better oversight and regulations to monitor such tools.

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Dec 4 2013
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The Importance of Nursing in Achieving the “Best Care at Lower Cost”

Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.

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The Institute of Medicine (IOM) released the findings of its Committee on the Learning Health Care System in America in a report entitled “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America[i] in September, 2012. The report recognized that the complexity of clinical decision-making is rapidly increasing and that clinicians need to continuously update their skills in order to keep up with (1) rapidly expanding diagnostic and treatment options and (2) the increasingly complex and chronic clinical condition of patients.  Given the growing external demands placed on nurses, the IOM reports that a critical determinant of the success of an organization in dealing with these demands is how “a learning health care organization harnesses its internal wisdom—staff expertise, patient feedback, financial data, and other knowledge—to improve its operations.”

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Nurses in particular are in an excellent position to play a central role in creating a virtuous feedback loop such that it is feasible to continuously adjust and incrementally improve systems in response to rapidly changing external demands.  The report, supported by the results of a growing and increasingly robust body of academic research, stresses the important role of leadership and management in fostering and maintaining an environment within which continuous learning could take hold.

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Nov 26 2013
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Empathy and Appreciation for the Impact of the Social Determinants of Health

Gretchen Hammer, MPH, is executive director of the Colorado Coalition for the Medically Underserved. She works with local and state health care leaders and policy-makers to improve Colorado’s health care system.

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Healing is both an art and a science. On one hand, clinicians are intensely driven by the quantifiable, the measurable, and the evidence-based algorithms that lead to accurate diagnosis and treatment as well as allow us to develop new innovations in medicine. However, healing is also an art. Patients are not just a collection of systems that can be separated out and managed in isolation of the whole patient. Each patient and their family has a unique set of values, life experiences, and resources that influence their health and ability to heal. Recognizing the wholeness and uniqueness of each patient is where the art of healing begins.

Empathy is defined as “the ability to understand and share the feelings of another.” It takes presence of mind and time to be empathetic. For clinicians, finding the balance between the necessary detachment to allow for good clinical decision making and empathy can challenging.  This balance can be particularly difficult for students and new clinicians.

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Oct 15 2013
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A Journey Well Worth Taking

Linda Burnes Bolton, DrPH, RN, FAAN, is vice president for nursing, chief nursing officer, and director of nursing research at Cedars-Sinai Medical Center in Los Angeles. She was vice chair of the Institute of Medicine Commission on the Future of Nursing, and is a trustee of the Robert Wood Johnson Foundation. It has been three years since the Institute of Medicine issued Future of Nursing: Leading Change, Advancing Health.

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Developing the Institute of Medicine report, Future of Nursing: Leading Change, Advancing Health and working to implement its recommendations has been a magnificent journey. It hasn’t been about nursing, but rather about health and health care. We focus on nursing, because it is one of the keys to improving health and health care. But our success, and the reason people are joining us on this journey, is because the report and its recommendations mean better health for the public and a stronger health care system for the country.

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What began as a report has become a groundswell.  It is doing exactly what we hoped it would do, bringing people together to strengthen our health care system. Today a large, multidisciplinary, national movement is engaging nurses, consumers, and other health professionals in local and regional efforts to bring this report to life. There are great examples, for instance, of people from diverse fields coming together to remove practice barriers, physicians saying they believe medicine must be a “team sport,” consumers working to improve care in their communities—and much more.

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May 15 2013
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Will Dr. Robot Open New Doors for Nurses?

Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.

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Technological innovation is rapidly transforming patient care. A new generation of innovations will potentially change the most fundamental aspect of the patient experience – patients’ interactions with physicians and nurses. The FDA recently approved the first autonomous telemedicine robot for use in acute care hospitals. Even more advanced technologies, some capable of processing up to tens of millions of pages of plain medical text per second, are being tested and may soon be used to diagnose conditions and recommend treatment, with limited input from clinicians.

"We suggest that nurses should embrace rather than fear these innovations."

This new technology has the potential to perform several tasks more efficiently than clinicians, albeit with some limitations. It can quickly and effectively sift through large amounts of information and, based on a complex set of guidelines, create a probability-weighted list of diagnoses and recommendations. The result will be purely evidence-based and free of human cognitive decision-making biases.  The technology can drastically speed diffusion of new research and guidelines through electronic dissemination, similar to automatic software updates, and make most novel treatment regimens instantly available to patients.

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May 11 2013
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Challenging Myths About Supplemental Nurses

Ying Xue, DNSc, RN, is an associate professor at the University of Rochester School of Nursing and an alumnus of the Robert Wood Johnson Foundation Nurse Faculty Scholars program. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

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For the past two decades, supplemental nurses have been about 4 percent of the nursing workforce. These are nurses hired from staffing agencies to temporarily fill vacant nursing positions. The business of supplemental nurse staffing began in the 1970s as a symptom and a response to the nursing shortage. A central concern over the decades has been whether quality of patient care provided by supplemental nurses is the same as that provided by permanent nurses.

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On the one hand, some argue that the temporary nature of the position (which varies from per-diem to a few months) might have an adverse effect on patient outcomes due to supplemental nurses’ lack of familiarity with unit policies and health care providers, and disruption in continuity of care. Others contend that supplemental nurses might have a positive effect on patient outcomes because they alleviate deficiencies in nurse staffing. 

What’s the answer to this decades’ old question?  Surprisingly, relatively little research has been conducted to provide a definitive answer, but several recent studies not only are shedding light on the issue, but helping to reframe the question by challenging some old myths.

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May 8 2013
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Do We Know What Kids in the Hospital Think of Their Care? Check.

Nancy Ryan-Wenger, PhD, RN, CPNP, FAAN, is the director of nursing research and an investigator at the Center for Innovation in Pediatric Practice at Nationwide Children’s Hospital in Columbus, Ohio. As a grantee of the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), she was a lead investigator of the first-ever study to systematically elicit the views of hospitalized children and adolescents on the quality of their nursing care, and also the first to evaluate children’s perceptions of nurses’ behavior for evidence of any disparities across demographic groups. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

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Have we asked the children?

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That became a pressing question for me when I retired from academia after 30 years and joined the staff of Nationwide Children’s Hospital. I became aware of things that are highly important to hospitals, such as opinions of the quality of care. Yet when I saw the patient surveys at Nationwide, they were almost always completed by parents, and 80 percent of the questions were geared toward parents: Were they kept informed of their child’s condition? Did they have a comfortable place to sleep? Was their child treated kindly by staff member?

Those are important questions, certainly, but if you’re doing a patient survey, don’t you want to know what the patient thinks?

Have we asked the children?

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May 8 2013
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Recent Research About Nursing: Lower Mortality Rates at Magnet Hospitals

This is part of the May 2013 issue of Sharing Nursing's Knowledge.

Hospitals that have achieved "Magnet" recognition have lower mortality rates, according to new research led by Matthew D. McHugh, PhD, JD, MPH, RN, of the University of Pennsylvania School of Nursing, with support from the Robert Wood Johnson Foundation (RWJF).

McHugh and colleagues examined patient, nurse, and hospital data for 56 hospitals designated as Magnets by the American Nurses Credentialing Center, along with comparable data from 508 non-Magnet hospitals. They found that "Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor’s degrees and specialty certification," and that "patients treated in Magnet hospitals had 14 percent lower odds of mortality and 12 percent lower odds of failure-to-rescue." They concluded that "lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes."

About 8 percent of hospitals in the United States have achieved Magnet designation. They are recognized for quality patient care, nursing excellence, and innovations in professional nursing practice.

The study was published in the May issue of Medical Care, a journal of the American Public Health Association. McHugh is an RWJF Nurse Faculty Scholar.

Learn more about the RWJF Nurse Faculty Scholars program.
Read the study.
Read a FierceHealthcare story about the study.