Research Brief

Primary Care Shortages: Its More than Just a Head Count

A new research brief by INQRI co-directors Mary Naylor, PhD, RN, FAAN, and Mark Pauly, PhD, and Janet Weiner, MPH, associate director for Health Policy at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, examines how the Affordable Care Act, an aging population, and fewer primary care physicians will affect the need for primary care providers and what must be done to meet that increased need and stem a potential primary care shortage. View it here.

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INQRI grantee Patti Dykes, Blackford Middleton, and their team are committed to making consumers more aware of the problem of falls in hospitals.  To educate patients and families about how they can work with nurses and other providers to prevent falls, the team developed a consumer website entitled, “Falls TIPS” (Falls: Tailoring Interventions for Patient Safety). The site is available through the Partners Health System webpage.

INQRI grantees Pat Noga and Barry Kitch led a project which evaluated the experiences of hospitals in two states that had mandated the implementation of the National Quality Forum's Nursing-Sensitive Measures. The team found that reaching agreement on the measures was a substantial and lengthy undertaking, and that while hospital leaders believed that public reporting of nurse sensitive measures was likely to have a positive impact both on the quality of nursing care and patient outcomes, they also found the initiatives to be burdensome.

Based on their research in Maine and Massachusetts (two states among the first to adopt statewide initiatives for the public reporting of nursing performance through the use of nurse sensitive measures), INQRI researchers Pat Noga and Barry Kitch believe it is possible to publicly report measures of nursing quality and that doing so can have a positive impact on the quality of care.

Barbara Resnick was awarded two Helen and Leonard Stulman Foundation grants to expand her INQRI work on disseminating function focused care to additional assisted living facilities. With part of this funding, Dr. Resnick has established a website which provides information and tips for caregivers to encourage residents to participate in routine daily functional tasks and engage in other types of physical activity.

This article explicates the intragroup social dynamics and work of a nursing and education research team as a community of research practice interested in organizational cultures and occupational subcultures. Dynamics were characterized by processes of socialization through reeducation and group social identity formation that enabled members to cross discipline-bordered traditions and produce interdisciplinary mixed methods combinations. Combinations were achieved at the paradigm level through the generation of a shared viewing position and theoretical model. At methods and technique levels, such achievements were accomplished through methodological capitalization and prioritization and the development of a quantitative culture assessment tool that can be used in combination with complementary qualitative observation and interview protocols. Recommendations for other teams are provided.

During times of transition, the pharmaceutical care patients receive is often suboptimal and wrought with danger. Home healthcare nurses play a pivotal and important role in providing transitional care to patients by identifying and resolving medication discrepancies. Nurses must partner with pharmacists, physicians, and others involved with care transitions to decrease the likelihood of patients experiencing untoward health consequences associated with medications.

To measure the quality of oncology nursing care, a high priority for members of the Oncology Nursing Society, researchers rely on patient-satisfaction measures that tend to be framed in terms of overall satisfaction during an entire hospital stay. The Pain and Nursing Care Quality (PaNCQ) Survey, however, seeks to develop a simple measure of the quality of nursing care related to pain management at the end of a nursing care shift in the acute care setting.

The Agency for Healthcare Research and Quality (AHRQ) patient safety indicator "death among surgical inpatients with serious treatable complications" (or failure-to-rescue) uses rules to exclude complications thought to be present-on-admission (POA). However, exclusion rules were developed with limited information on whether complications were POA. This study examines whether the accuracy of failure-to-rescue exclusion rules can be improved with data with good POA indicators.

There are substantial shortfalls in nurse staffing in U.S. neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights. This study examines the adequacy of NICU nurse staffing in the U.S. using national guidelines and analyze its association with infant outcomes.

This presentation is the sixth in a series providing the study findings from INQRI's final cohort of grantees. Their work focused on translating research into practice. This session features Drs. Nancy Hanrahan and Phyllis Solomon presenting study findings from the translation of the Transitional Care Model for Persons with Serious Mental Illness (TCM-SMI) intervention to meet the complex needs of SMI clients in public managed care.