Using a standardized language to increase collaboration between research and practice

A standardized language: The Omaha System 

The Omaha System is a unique language or taxonomy in that it originated as a collaborative effort between research and practice. It has existed in the public domain since its origin. During 4 federally funded research projects conducted from 1975–1993, numerous clinicians and researchers served on joint project teams and advisory committees. Together, they developed a conceptual model that reflects the pivotal position of the individual, family, and community; the partnership with clinicians; and the value of the problem-solving process. They created, revised, and refined the structure and terms of the 3 components—the Problem Classification Scheme, the Intervention Scheme, and the Problem Rating Scale for Outcomes—and established reliability, validity, and usability. They designed the Omaha System to be computer-compatible with the goal of improving practice, documentation, and information management. Details about Omaha System research, history, automated users, and computer software vendors are described in numerous publications.2, 3

In 2005, Monsen and Bowles authored chapters and described examples of Omaha System practice and research in the United States and globally. In her chapter, Monsen summarized details about diverse practice sites that used the Omaha System, their programs, and their multidisciplinary clinicians.4 Graphs depicted the data-based information that practice sites generated to demonstrate the value and outcomes of their services. Bowles summarized the rich history of Omaha System research and 50 unique studies in her chapter.5 A table of evidence included authors, sample, setting, purpose, design, and findings. The research was organized into 8 categories with sample sizes ranging from 10 to over 1500 subjects. Studies from the Universities of Pennsylvania and Arizona were listed in the tables; these examples illustrate extensive collaboration between research and practice and the use of the Omaha System.

Transitional Care Model, University Of Pennsylvania 

The Transitional Care Model program of research at the University of Pennsylvania includes 8 studies and spans 2 decades. Frail, older adults, chronic illness, and the rising costs of healthcare were themes of these studies.6, 7, 8, 9 Two of the studies are underway in collaboration with a major insurance company and a major health plan located in the United States, and were designed to translate model healthcare protocols and Omaha System documentation to the care of 600 members.

During the early phases of the research, the University of Pennsylvania team learned that data extraction from narrative progress notes was very difficult. This prompted the team to use the standardized Omaha System for all of their clinical research documentation. Each participating nurse used the Omaha System to conduct assessments, create care plans, and document interventions. Data were entered into a clinical information system developed for the studies. The research team and the participating nurses used the data to identify best practices and improve outcomes of care.

When key stakeholders review the standardized data, they will clearly see the characteristics of their members, the challenges faced in meeting their complex, chronic care needs, and the specific interventions completed on behalf of each member as well as aggregate data across the membership. Efforts to expand the Transitional Care Model and Omaha System to more members are underway within each organization. This research is demonstrating that the standardized language and comprehensive structure of the Omaha System enhances collaboration among the nurses, researchers, and insurers.

Interdisciplinary case management model, University of Arizona 

Since 1996, faculty members from the Colleges of Nursing and Pharmacy at the University of Arizona conducted multiple studies on the border of Arizona and Sonora, Mexico using the Omaha System.10, 11 Their research and practice collaboration involved interdisciplinary case management with a delivery model designed to provide client-focused care. Subjects included young pregnant women, and adults with diabetes or who were at risk for developing diabetes. Subjects represented an under-served population, and were primarily persons of Mexican origin. Study sites included community health centers, an alternative high school, and homes.

The Arizona case management program of research used an interdisciplinary team approach. Nursing and pharmacy faculty served as team facilitators, with the participation of university colleagues and students from public health, social work, and medicine as well as community members. “Promotoras,” or community health workers, were also essential team members who made significant contributions to culturally tailoring community-based interventions. The interdisciplinary team members worked together to provide services, document those services, and analyze data. Study findings demonstrated a large number of problems per subject, the identification of the most appropriate interventions, and the positive impact of services.

The initial program of research was extended to include 2 community-based studies. The first study included promotoras and Mexican immigrant women with type II diabetes12; a similar population was included in the second study. Additional studies are planned for the Arizona-Mexico border region. Using the Omaha System facilitated the collaboration of research and practice, and communication among the subjects, researchers, and providers.

Implications 

In numerous studies, researchers at the Universities of Pennsylvania and Arizona have demonstrated the benefit of using the Omaha System for standardized data collection. Their experiences suggest that a standardized language is an important strategy to increase the benefits of collaboration between practice and research. Large Omaha System data sets emerging in practice settings have the potential to address collaborative research agendas to improve healthcare quality in the future.