Patient Outcomes Research-Nursing, Important Component
N
URSING CARE is a critical element in patient care and can substantially influence patient health outcomes. In the past 5 years, much attention in the health services research community has focused on medical treatment effectiveness or outcomes research. It is now timely to focus on the role of nursing in patient outcomes research and to discuss ways of increasing nursing involvement. The Omnibus Reconciliation Act of 1989 created a new agency in the Public Health Service with a mission to explore the appropriateness and effectiveness of the use of services and procedures in the prevention, diagnosis, treatment, and management of clinical conditions. In the JulyAugust 1992 Research column, Weis briefly discussed the history of the Agency for Health Care Policy and Research (AHCPR), Patient Outcomes Research Teams (PORTS), and data sources with potential for nursing research. In fiscal year (FY) 199 1, AHCPR supported 94 Medical Treatment Effectiveness Program (MEDTEP) research grants and contracts, ranging from complex PORTS through smaller scale studies involving the measurement of health status, meta-analytic techniques, and the analysis of small area practice variations. The investigators involved in these extramural research projects represent a wide variety of disciplines including health care providers, epidemiologists, biostatisticians, economists, and sociologists. The nursing profession has a significant role to play within the research team approach, which is fundamental to MEDTEP. It is important for nurse researchers to become key members of outcomes research teams. However, as of Ft’ 91 relatively few investigators with nursing degrees were associated with studies supported under AHCPR’s MEDTEP extramural activities. Approximately 422 investigators were involved in the conduct of grant and contract research supported by AHCPR MEDTEP funds in FY 9 1. Of these, 23 investigators were either listed with nursing degrees or were known by staff members ofAHCPR or the National Center for Nursing Research (NCNR) to have such a degree. This rough count of nurses listed as investigators
MARY A. CUMMINGS, DRPH, Health Sue&t
RN
Administrator
Center for Medical Effectiueness Research
Agencyfor Health Care Policy and Rexzrch 2101 E Jefferwz
St. Suite 605
RockvilLe, MD 20852
This article was produced in the federal domain under the auspices
of the Agency
Department
of Health
for Health and Human
Care Policy and Research, Services.
The views
expressed are the author’s, This is a US government work. There are no restrictions on its use. 8755-7223/92/0806-0002$00.00/0
318
Journal
of Profeshzal
Nursing,
an
represented less than 6 per cent of the total number of investigators in ali MEDTEP research projects in FY 91. The success of MEDTEP and its goals for a more costeffective and quality-conscious health care system rest on collaborative efforts with all health care providers. However, the number of nurses involved in extramural research on patient outcomes does not reflect their increasing involvement in the development of clinical practice guidelines under the auspices of AHCPR or their participation in other aspects of AHCPR’s broad mandate. Fourteen nurses are now on the professional staff of AHCPR, which develops and implements many of the new grant and contract programs in patient outcomes research. To increase the involvement of the nursing scientific community, these nurses have participated in a variety of conferences, workshops, and other activities in the effort to promote nurses’ understanding and participation in effectiveness and outcomes research. Research into the relationship between nursing care and patient outcomes is a critical missing component in current patient outcomes research. In order that it become an integral part, methodologies need to be developed to define and measure nursing outcomes as noted by Moritz at the 1991 International Nursing Research Conference. This may require integrating the methods and concepts of health services research into nursing research. It will be important for nurse researchers to become familiar with some of the methodological problems and issues the PORT projects face in carrying out patient outcomes research as described by Cummings, Scott, and Weis at the International Nursing Research Conference. Studies of the variations in nursing practice should be carried out in an effort to understand the influence of these variations on patient outcomes. Existing data bases can provide some of the needed information (as noted by Weis in the July-August Research column and by Weis, Scott, and Cummings, at the 1991 International Nursing Research Conference). New data bases will need to be developed. Nurse researchers should consider incorporating techniques such as meta-analysis and decision modeling into the methodologies that they currently use. Nurse researchers need to become more proactive and to create opportunities for involvement in ongoing outcomes research as well as to prepare new proposals for consideration by AHCPR and other public and private funding sources. PORT projects and other types of medical effectiveness research offer broad opportunities for nurses and other professionals to increase their role in health services research and to learn and/or apply various methods and tools of scientific and empirical inquiry. The development of a nursing effectiveness research PORT on a high priority topic, a smaller research project, or a project as an adjunct study to a PORT are possibilities to be considered.
VoI 8, No 6 (November-December),
1992:
p 3 18
N
URSING CARE is a critical element in patient care and can substantially influence patient health outcomes. In the past 5 years, much attention in the health services research community has focused on medical treatment effectiveness or outcomes research. It is now timely to focus on the role of nursing in patient outcomes research and to discuss ways of increasing nursing involvement. The Omnibus Reconciliation Act of 1989 created a new agency in the Public Health Service with a mission to explore the appropriateness and effectiveness of the use of services and procedures in the prevention, diagnosis, treatment, and management of clinical conditions. In the JulyAugust 1992 Research column, Weis briefly discussed the history of the Agency for Health Care Policy and Research (AHCPR), Patient Outcomes Research Teams (PORTS), and data sources with potential for nursing research. In fiscal year (FY) 199 1, AHCPR supported 94 Medical Treatment Effectiveness Program (MEDTEP) research grants and contracts, ranging from complex PORTS through smaller scale studies involving the measurement of health status, meta-analytic techniques, and the analysis of small area practice variations. The investigators involved in these extramural research projects represent a wide variety of disciplines including health care providers, epidemiologists, biostatisticians, economists, and sociologists. The nursing profession has a significant role to play within the research team approach, which is fundamental to MEDTEP. It is important for nurse researchers to become key members of outcomes research teams. However, as of Ft’ 91 relatively few investigators with nursing degrees were associated with studies supported under AHCPR’s MEDTEP extramural activities. Approximately 422 investigators were involved in the conduct of grant and contract research supported by AHCPR MEDTEP funds in FY 9 1. Of these, 23 investigators were either listed with nursing degrees or were known by staff members ofAHCPR or the National Center for Nursing Research (NCNR) to have such a degree. This rough count of nurses listed as investigators
MARY A. CUMMINGS, DRPH, Health Sue&t
RN
Administrator
Center for Medical Effectiueness Research
Agencyfor Health Care Policy and Rexzrch 2101 E Jefferwz
St. Suite 605
RockvilLe, MD 20852
This article was produced in the federal domain under the auspices
of the Agency
Department
of Health
for Health and Human
Care Policy and Research, Services.
The views
expressed are the author’s, This is a US government work. There are no restrictions on its use. 8755-7223/92/0806-0002$00.00/0
318
Journal
of Profeshzal
Nursing,
an
represented less than 6 per cent of the total number of investigators in ali MEDTEP research projects in FY 91. The success of MEDTEP and its goals for a more costeffective and quality-conscious health care system rest on collaborative efforts with all health care providers. However, the number of nurses involved in extramural research on patient outcomes does not reflect their increasing involvement in the development of clinical practice guidelines under the auspices of AHCPR or their participation in other aspects of AHCPR’s broad mandate. Fourteen nurses are now on the professional staff of AHCPR, which develops and implements many of the new grant and contract programs in patient outcomes research. To increase the involvement of the nursing scientific community, these nurses have participated in a variety of conferences, workshops, and other activities in the effort to promote nurses’ understanding and participation in effectiveness and outcomes research. Research into the relationship between nursing care and patient outcomes is a critical missing component in current patient outcomes research. In order that it become an integral part, methodologies need to be developed to define and measure nursing outcomes as noted by Moritz at the 1991 International Nursing Research Conference. This may require integrating the methods and concepts of health services research into nursing research. It will be important for nurse researchers to become familiar with some of the methodological problems and issues the PORT projects face in carrying out patient outcomes research as described by Cummings, Scott, and Weis at the International Nursing Research Conference. Studies of the variations in nursing practice should be carried out in an effort to understand the influence of these variations on patient outcomes. Existing data bases can provide some of the needed information (as noted by Weis in the July-August Research column and by Weis, Scott, and Cummings, at the 1991 International Nursing Research Conference). New data bases will need to be developed. Nurse researchers should consider incorporating techniques such as meta-analysis and decision modeling into the methodologies that they currently use. Nurse researchers need to become more proactive and to create opportunities for involvement in ongoing outcomes research as well as to prepare new proposals for consideration by AHCPR and other public and private funding sources. PORT projects and other types of medical effectiveness research offer broad opportunities for nurses and other professionals to increase their role in health services research and to learn and/or apply various methods and tools of scientific and empirical inquiry. The development of a nursing effectiveness research PORT on a high priority topic, a smaller research project, or a project as an adjunct study to a PORT are possibilities to be considered.
VoI 8, No 6 (November-December),
1992:
p 3 18
