Supplement papers draw attention to INQRI's role in building evidence base for nurses' contributions to quality of care

Nurses are the largest group of health care professionals and have the most interaction with patients. Yet previously, there has been limited research regarding nursing's contributions to improving the quality of care. A special April supplement to Medical Care provides an update from the Interdisciplinary Nursing Quality Research Initiative (INQRI) — an ongoing program, sponsored by the Robert Wood Johnson Foundation (RWJF), to "generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality." Medical Care is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The INQRI program was launched in 2005 to help address the lack of evidence linking nursing to the quality of patient care. The INQRI program is led by Mary D. Naylor, PhD, of the University of Pennsylvania School of Nursing and Mark Pauly, PhD, of the University of Pennsylvania Wharton School, in collaboration with RWJF senior program officer Lori Melichar, PhD.

How Do Nurses Contribute to Health Care Quality Improvement?
"Over two and a half million registered nurses provide care in a diverse range of settings across the United States," according to an introductory article by Drs Naylor, Pauly, Melichar and coauthors. "Yet there is limited understanding about nurses' specific and distinct contribution to the quality of care provided to patients, families, and communities."

The special issue assembles invited contributions from experts working on various INQRI-funded initiatives, providing an update on the accomplishments of the INQRI program. The supplement papers discuss timely issues in research design and implementation, placing INQRI research in the context of advances in quality improvement, health policy and health services research. Naylor and colleagues write, "This edition of Medical Care provides an overview of some of the key discoveries made by INQRI grantees, examines cross-cutting issues experienced by research teams, and describes recommended approaches to advance this line of inquiry and its impact."

Dr Naylor is also lead author of a comprehensive review of research through the first five years of INQRI. The review shows significant advances in research supporting nursing's impact on the quality of care, "reflected in higher rates and quality of publications, enhanced methodologic rigor, and evidence of stronger interdisciplinary collaboration." While this progress can't be wholly ascribed to the INQRI project, "[T]he evidence supports the increased importance of changes consistent with INQRI's goal of measuring and enhancing nursing's contributions to the quality of patient care."

The supplement also presents reviews and updates from INQRI experts in five key areas:
•New tools for quality measurement—A report on four INQRI projects designed to develop "simple, feasible, affordable" tools for measuring health care quality. INQRI teams are focusing on measures that can be integrated into the health care delivery system and the growing use of electronic health records.
•Challenges to conducting interdisciplinary research—Collaborative efforts across nursing, medicine, economics, engineering, statistics, and other disciplines are viewed as essential, using "the entire continuum of care to provide value-added and cost effective care."
•Challenges in implementation science—New research methods from the emerging field of implementation science can provide the critical link between effective interventions, clinical practice, and patient outcomes.
•Dissemination and implementation—The experience of INQRI-funded projects to implement new quality improvement initiatives is presented, illustrating the key issues in achieving widespread adoption of effective innovations in care delivery.
•Building the "business case" for nursing.—Experience from INQRI studies highlights the challenges of demonstrating the value of investing in nursing, with the ultimate goal of achieving better patient outcomes in a financially sustainable manner.

"To achieve better care and outcomes while ensuring the efficient use of finite resources, it is essential to advance our understanding of the causal linkages between nurses and the care they deliver," Dr Naylor and coauthors conclude. Together with the editors of Medical Care, they hope the special issue will draw attention to INQRI's role in building the evidence base for nurses' contributions to "the quality of health delivery and the improvement of that care."

Source: University of Pennsylvania School of Nursing