Interdisciplinary Nursing Quality Research Initiative (INQRI): Developing And Testing Nursing Quality Measures with Consumers And Patients Christine Pintz PhD RNC FNP Academy Health Research Meeting June 9, 2008

Interdisciplinary Research Team Baruch College, School of Public Affairs Shoshanna Sofaer DrPH – Principal Investigator Kirsten Firminger PhD candidate George Washington University, School of Medicine and Health Sciences Jean Johnson PhD, RN, FAAN – Co-Principal Investigator Ellen Dawson PhD, RN, ANP – Co-Investigator Christine Pintz PhD, FNP Andrea Brassard DNSc, MPH, ANP

Developing And Testing Nursing Quality Measures with Consumers And Patients Project aims: 1.Aim One: To learn how recently hospitalized members of the public respond to the nursing sensitive quality measures endorsed by the National Quality Forum (the NQF-15); 2.Aim Two: To identify observable actions and processes through which nursing services influence the quality of coordination of patient care, that have the potential to be translated into nursing sensitive quality measures; and 3.To learn how recently hospitalized members of the public view the role of nursing services in care coordination and respond to the emergent nursing sensitive quality indicators developed by the project under Aim Two.

Background How do nurses’ contribute to patient safety and health care quality? How do consumers perceive nursing quality?

Aim One – Research Questions Research Questions 1.Which of the NQF measures do members of the public believe reflect important aspects of hospital quality that are sensitive to nursing services? 2.About which of these measures do they believe (or find it plausible) that there is likely to be variation in the performance of nursing professionals? 3.Which of these measures can members of the public understand when they have been translated into “plain English”?

Mixed Methods Qualitative Methods Focus groups Quantitative Methods Surveys

Methods Focus Group Structure/Sample Nine focus groups ( n =81) with recently hospitalized patients were conducted in three locations, Washington, DC, Chicago and Phoenix. Participants were heterogeneous in age, gender, race/ethnicity and education level and were grouped by reason for hospitalization – either obstetric, medical illness or surgical.

Methods Focus Groups discussed Perceptions of Nursing Quality NQF-15 –Understandable? –Important? –Variation in nursing quality? –Influence on hospital choice?

Methods Pre Group Surveys Demographics Hospitalizations Opinions about –Extent of variation of hospital quality –Extent of variation of nursing quality –Degree that nurses influence quality

Methods Quantitative ratings collected during focus groups about each one of the NQF-15 measures –How important? –How likely to vary across hospitals? –How likely that a very high or low score would lead individual to reconsider their hospital choice? Discussions held after silent ratings by individuals

Methods Why did we use quantitative ratings? –Reduce bias –Ascertain level of support for measure –Prompt discussion –Provide time to reflect –Equalize participation –Different source of data - triangulation

Methods Interdisciplinary research team: Strong team collaboration Focus group facilitators were from different disciplines (nursing, health services research) Disclosure of discipline? Data Analysis

Some Limitations: Number of ratings Time Constraints Accessing the target population

Advantages Explore topic from the consumers perspectives Hear narratives of their hospital experiences Prompt discussion and provide some support of findings Which may lead to unexpected insights