Apprehensions regarding costs, access, effectiveness, and appropriate use of health care in America have been the topic of concern for policy makers for many years. In 1998, the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry called for a national commitment to improve quality in both the public and private sectors. To track progress, the commission recommended that an annual quality report be developed. Subsequently, Congress enacted the Healthcare Research and Quality Act of 1999, which directs the Agency for Healthcare Research and Quality (AHRQ) to prepare an annual report on national trends in the quality of health care provided to the American people.1AHRQ leadership asked the Institute of Medicine (IOM) to provide a vision for this National Health Care Quality Report (NHCQR), which resulted in the 2001 publication Envisioning the National Health Care Quality Report.
The charge to the IOM committee can be summed up with the following 4 questions:
1.What are the most important questions in evaluating whether health care is improving?
2.What major aspects of quality should be included in the report?
3.What are the specific measures that could be used?
4.What should be the format of the report?
Perhaps the most important question for nursing is whether the profession will contribute to this report and to the opportunity to translate research into policy!
One only has to look at the 2-dimensional matrix developed to measure quality (in the NHCQR) to see the relevance to nursing and the nursing profession's historical interests. Safety, effectiveness, patient centeredness, and timeliness are critical components in the first dimension of the matrix. These are aspects for which individual measures may change over time as new health practices and improvements in quality measurement are developed. Consumer perspectives are the basis for the second dimension, with the challenge being to meet consumer needs throughout the life cycle: staying healthy, getting better, living with illness or disability, and coping with the end of life. In addition to the 2 dimensions, important crosscutting issues are equity and efficiency.
There are a number of questions that faculty, researchers, and practitioners in the nursing profession need to explore. For example, in basic education program courses, such as Fundamentals of Nursing 101, students are taught about prevention of falls, medical errors, and infection control. Are students informed that these issues are on the national “safety” research agenda and are the issues from Fundamentals of Nursing courses linked to the students' research courses? Do students know about AHRQ-funded research related to these basic care procedures? After graduation, do new nursing staff understand how these safety issues and the data available in hospitals and nursing homes are important to the national research agenda?
When teaching advanced practice nurses in master's programs, are faculty alerting students to research that relates to their issues and concerns, such as prescribing and caring for vulnerable populations? Are advanced practice issues being linked to research courses, and is the importance of practice-based research being reinforced, especially as it relates to impact on federal policy? Again, research such as the recent practice-based research network study funded by AHRQ should be highlighted. Finally, are promising, potential future researchers (at all levels) being introduced to the importance of conducting needed research linked to the measurement of quality of care and the NHCQR?
In practice settings, are tired, overworked staff nurses told that their concerns about staffing and safety are on the national research agenda? Are research articles and other publications related to their issues of burnout, fatigue, staffing, and the nursing shortage being circulated? Are they informed that nursing research colleagues are currently funded by AHRQ to identify the linkages between these issues and the national patient safety agenda? Do advanced practice nurses in ambulatory care know that research has been funded (again by AHRQ) that explored prescribing patterns and new roles, such as the nurse practitioner on the hospitalistteam?
Increasing numbers of nurse researchers are funded by AHRQ to conduct health services research that addresses many of these critical issues. Some of the titles of grants developed by nurse principal investigators and funded by AHRQ include the following: Unit Level Workload Impacts on Patient Safety, Nurse Staffing and Adverse Patient Outcomes, and Staff Nurse Fatigue and Patient Safety. Related to the equity issue, nurse researchers also have received funding for topics such as intervention of minority partners of persons with AIDS, life stress and pre-term birth among urban black women, and access to mammography for older women of color.
In this column we are not able to highlight all the research conducted by nurse researchers that is funded by AHRQ. However, it is important for all nurses, whether in education, practice, or research, to be informed about ongoing research related to the NHCQR and to make it visible in the classroom and the practice setting and to expand on current work through future research!
For additional information, please check AHRQ's Web site at: http://www.AHRQ.gov.■
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