Page 400 - Encyclopedia of Nursing Research

OUTCOMe MeASUReS n 367

Outcome measures as end points in clinical measures. The use of outcome measures in
research typically refer to a narrowly defined national health care policy requires a high
patient condition specific to a particular dis- degree of data standardization across sites, O
ease. In contrast, outcomes in health services which has been guided by federal agencies
research are used to characterize a range of like the Agency for Healthcare Research
constructs that are important for patients, and Quality (AHRQ) and nonprofit orga-
provider organizations, or health policy mak- nizations like the National Quality Forum
ers and reflect the quality of care provided in (NQF). AHRQ as part of the Department of
a specific setting. Not only are the outcomes Health and Human Services aims at improv-
more broadly defined in health services ing quality and safety in health care and
research but also the interventions that target therefore funds a range of research projects
these outcomes. Although clinical research and outcome focused initiatives. AHRQ’s
traditionally focuses on drugs or surgical quality indicators initiative provides four
procedures, health services research includes standardized sets (prevention, inpatient,
also interventions that reorganize patient patient safety, and pediatric) of indicators
care (Kane, 2006). The appropriate Medical that can be derived from administrative hos-
Subject Heading “Outcome Assessment” pital inpatient data (http://www.quality-
of the National Library of Medicine (1992) indicators.ahrq.gov/). Furthermore, AHRQ
stresses the importance of attaining a spec- maintains the National Quality Measures
ified outcome, which implies an increase, a Clearinghouse (http://qualitymeasures.ahrq.
decrease, or generally an improvement in gov/), which provides information on spe-
the outcome measure. Therefore outcome cific evidence-based health care quality mea-
measures in health services research can be sures. NQF aims for the standardization and
considered as indicators of a desired change endorsement of quality indicators, including
of an important measure and are frequently outcome measures. In 2004, NQF endorsed
used in research investigating health care a nursing-sensitive care measure set, which
quality. has become the landmark of outcome mea-
The first efforts in standardized out- surement of nursing quality (NQF, 2004).
come measurement in health care began This measure set consisted of 15 process,
with Florence Nightingale (1863). Her work structure, and outcome measures deemed
on hospital mortality and her proposal for to be nurse-sensitive performance measures.
a regular hospital statistic are the founda- Nurse sensitivity refers to measures “that
tions of this type of inquiry (Nightingale, are affected, provided, and/or influenced by
1863). In the last two decades, research on nursing personnel” (NQF, 2004, p. 2). The lat-
outcome measures has gained momentum est endorsement consists of 12 nurse-sensitive
as part of the growing awareness of health measures of which three can be considered
care quality issues. Starting with increas- as outcomes: pressure ulcer prevalence, falls
ing interest in provider profiling and highly prevalence, and falls with injury. Increasing
acclaimed national reports about patient interest in nursing outcomes has supported
safety and health care quality (Institute of the development and widespread use of
Medicine, Committee on Quality of Health nursing quality data including outcome mea-
Care in America, 2001), outcome measures sures. The largest program to collect nursing
have become a vital part of quality research. outcome data has been the National Database
In recent years, major federal health policy of Nursing Quality Indicators (n.d.), which
initiatives, such as those used by the Centers collects quarterly data for more than 16,000
for Medicare and Medicaid Services to pay units in more than 1,600 hospitals across the
for performance and public reporting ini- United States and internationally (http://
tiatives, have been incorporated outcome www.nursingquality.org).