News from AHRQ..................................................................................................................................

NURSING AND THE AGENCY FOR HEALTHCARE RESEARCH AND

QUALITY (AHRQ): AN AGENDA

Patricia Hinton Walker, PhD, RN, FAANHeddy Hubbard, MPH, RN

Apprehensions regarding costs, access, effectiveness, andappropriate use of health care in America have been the

topic of concern for policy makers for many years. In 1998, thePresident’s Advisory Commission on Consumer Protectionand Quality in the Health Care Industry called for a nationalcommitment to improve quality in both the public and privatesectors. To track progress, the commission recommended thatan annual quality report be developed. Subsequently, Congressenacted the Healthcare Research and Quality Act of 1999,which directs the Agency for Healthcare Research and Quality(AHRQ) to prepare an annual report on national trends in thequality of health care provided to the American people.1

AHRQ leadership asked the Institute of Medicine (IOM) toprovide a vision for this National Health Care Quality Report(NHCQR), which resulted in the 2001 publication Envisioningthe National Health Care Quality Report.

The charge to the IOM committee can be summed up withthe following 4 questions:

1. What are the most important questions in evaluatingwhether health care is improving?

2. What major aspects of quality should be included in thereport?

3. What are the specific measures that could be used?

4. What should be the format of the report?

Perhaps the most important question for nursing is whetherthe profession will contribute to this report and to the oppor-tunity to translate research into policy!

One only has to look at the 2-dimensional matrix developedto measure quality (in the NHCQR) to see the relevance tonursing and the nursing profession’s historical interests. Safety,effectiveness, patient centeredness, and timeliness are criticalcomponents in the first dimension of the matrix. These areaspects for which individual measures may change over time as

new health practices and improvements in quality measure-ment are developed. Consumer perspectives are the basis for thesecond dimension, with the challenge being to meet consumerneeds throughout the life cycle: staying healthy, getting better,living with illness or disability, and coping with the end of life.In addition to the 2 dimensions, important crosscutting issuesare equity and efficiency.

There are a number of questions that faculty, researchers,and practitioners in the nursing profession need to explore. Forexample, in basic education program courses, such as Funda-mentals of Nursing 101, students are taught about preventionof falls, medical errors, and infection control. Are studentsinformed that these issues are on the national “safety” researchagenda and are the issues from Fundamentals of Nursingcourses linked to the students’ research courses? Do studentsknow about AHRQ-funded research related to these basic careprocedures? After graduation, do new nursing staff understandhow these safety issues and the data available in hospitals andnursing homes are important to the national research agenda?

When teaching advanced practice nurses in master’s pro-grams, are faculty alerting students to research that relates totheir issues and concerns, such as prescribing and caring forvulnerable populations? Are advanced practice issues beinglinked to research courses, and is the importance of practice-based research being reinforced, especially as it relates to impacton federal policy? Again, research such as the recent practice-based research network study funded by AHRQ should behighlighted. Finally, are promising, potential future researchers(at all levels) being introduced to the importance of conductingneeded research linked to the measurement of quality of careand the NHCQR?

In practice settings, are tired, overworked staff nurses toldthat their concerns about staffing and safety are on the nationalresearch agenda? Are research articles and other publicationsrelated to their issues of burnout, fatigue, staffing, and thenursing shortage being circulated? Are they informed that nurs-ing research colleagues are currently funded by AHRQ toidentify the linkages between these issues and the nationalpatient safety agenda? Do advanced practice nurses in ambula-tory care know that research has been funded (again by AHRQ)that explored prescribing patterns and new roles, such as thenurse practitioner on the hospitalist team?

Increasing numbers of nurse researchers are funded by

Patricia Hinton Walker is a dean and professor at Uniformed ServicesUniversity of the Health Sciences at the Graduate School of Nursing.Heddy Hubbard is the acting director of the Center for Outcomes andEffectiveness Research at the Agency for Healthcare Research and Quality.

Nurs Outlook 2003;51:3-4.© 2003 Mosby, Inc. All rights reserved.0029-6554/2003/$30.00 � 0doi:10.1067/mno.2003.28

NURSING OUTLOOK JANUARY/FEBRUARY 2003 Walker and Hubbard 3

AHRQ to conduct health services research that addressesmany of these critical issues. Some of the titles of grantsdeveloped by nurse principal investigators and funded byAHRQ include the following: Unit Level Workload Impactson Patient Safety, Nurse Staffing and Adverse Patient Out-comes, and Staff Nurse Fatigue and Patient Safety. Relatedto the equity issue, nurse researchers also have receivedfunding for topics such as intervention of minority partnersof persons with AIDS, life stress and pre-term birth amongurban black women, and access to mammography for olderwomen of color.

In this column we are not able to highlight all the researchconducted by nurse researchers that is funded by AHRQ.

However, it is important for all nurses, whether in education,practice, or research, to be informed about ongoing researchrelated to the NHCQR and to make it visible in the classroomand the practice setting and to expand on current work throughfuture research!

For additional information, please check AHRQ’s Web siteat: www.AHRQ.gov. �

............................................................REFERENCE

1. Institute of Medicine. “Envisioning the National Health Care QualityReport.” National Academies Press, 2001.

Nursing and the Agency for Healthcare Research and Quality (AHRQ): An Agenda Walker and Hubbard...................................................................................................................................

4 VOLUME 51 • NUMBER 1 NURSING OUTLOOK