Measuring Nurses’ Impact on Health Care Quality: Progress, Challenges, and Future Directions

Background: Quality measurement is central in efforts to improve health care delivery and financing. The Interdisciplinary Nursing Quality Research Initiative supported interdisciplinary research teams to address gaps in measuring the contributions of nursing to quality care. Objective: To summarize the research of 4 interdisciplinary teams funded by The Interdisciplinary Nursing Quality Research Initiative and reflect on challenges and future directions to improving quality measurement. Methods: Each team summarized their work including the targeted gap in measurement, the methods used, key results, and next steps. The authors discussed key challenges and recommended future directions. Results: These exemplar projects addressed cross-cutting issues related to quality; developed measures of patient experience; tested new ways to model the important relationships between structure, process, and outcome; measured care across the continuum; focused on positive aspects of care; examined the relationship of nursing care with outcomes; and measured both nursing and interdisciplinary care. Discussion: Challenges include: measuring care delivery from multiple perspectives; determining the dose of care delivered; and measuring the entire care process. Meaningful measures that are simple, feasible, affordable, and integrated into the care delivery system and electronic health record are needed. Advances in health information systems create opportunities to advance quality measurement in innovative ways. Conclusions: These findings and products add to the robust set of measures needed to measure nurses’ contributions to the care of hospitalized patients. The implementation of these projects has been rich with lessons about the ongoing challenges related to quality measurement

Regulatory and valuation challenges of immune checkpoint inhibitors in lung cancer

Advances in innovative drug development translated into tangible improvements in clinical outcomes for patients with non-small cell lung cancer (NSCLC). Immunotherapy, specifically immune checkpoint inhibitors (ICIs), has transformed the standard of care for NSCLC patients. Although ICIs have brought meaningful opportunities in NSCLC care and transformed the treatment landscape, their regulatory decisions and economic value assessments pose important challenges. In this research, regulatory and valuation challenges of ICIs in NSCLC were explored to help support the future use of ICIs in health systems

Health Systems and Population Ageing in the Asia-Pacific Region: Challenges and Policy Options for the Future

Health care for the ageing population has surfaced as a critical issue in many countries that have undergone rapid demographic and epidemiological transition. As chronic and degenerative health conditions are expected to intensify the demand and expenditure for health care, it becomes necessary to plan for appropriate and cost-effective services for the increasing number and proportion of elderly persons. Hence the urgency to apply bold and innovative approaches to the organization and financing of health care against the pressures of increasing costs for rapidly ageing societies. What are the regional lessons and what would be the long term impact on health and health systems? It is timely to take stock and monitor the trends and issues in healthcare systems around the region and to identify from a comparative perspective, the challenges that have arisen with changing social, economic and political conditions, and the ways in which governments are responding to these challenges. In this regard, it would be important to examine the changing roles concerning the interface between the public, private and voluntary sectors; the extent of public-private participation and integration in health and social care; and the policy implications in terms of future developments for health governance, education and research throughout the region

Through the lens: empowering women in vulnerable communities to voice their concerns

Participatory Action Research (PAR) methodologies can help empower marginalised groups to capture and articulate their experiences and concerns to decision-makers. Future Health Systems (FHS) has worked with women in the Sundarbans of West Bengal to use Photovoice – a PAR method using photographs and narrative – to raise awareness of the challenges the women face to access health care. The initiative has led local policymakers and health workers to prioritise, and take steps to address, the issues

Clinician Evaluators: Take Your Mark!

Discuss two implementation outcomes (adoption and reach) and explain why they are important for clinicians to measure and report, with application to own work. Name sources of data that are accessible to clinicians in health care settings, with consideration of own setting. Describe a range of dissemination strategies used to create impact, including new ideas for dissemination of own work. References Proctor, E. K., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G. A., Bunger, A., . . . Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. doi:10.1007/s10488-010-0319-7. Polaha, J., & Sunderji, N. (2018). A vision for the future of Families, Systems, & Health: Focusing on science at the point of care delivery. Families, Systems, & Health, 36(4), 423-426. Polaha, J., Schetzina, K., Baker, M., & Morelen, D., (2018). Adoption and reach of parent management interventions in pediatric primary care. Families, Systems, & Health, 36(4), 507-512. Funderburk, J. & Polaha, J. (2017). To clinician innovators: A special invitation. Families, Systems, and Health, 35(2), 105-109 Polaha, J. & Nolan (2014). Dissemination and implementation science: research for the real world medical family therapist. In J. Hodgson, T. Mendenhall, & A. Lamson (Eds). Medical Family Therapy. Switzerland: Springer International

[Editorial] Marketing as an integrator in integrated care

Purpose: Integrated care requires solutions that cannot be delivered without addressing the underlying multidisciplinary problems. Yet with a few notable exceptions, there is a lack of coordination between disciplines, to effectively integrate knowledge. The main aim of this special section is to provide a platform that explicitly coordinates and curates multidisciplinary research aimed at providing a shared understanding and knowledge base that directly addresses the fragmentation in this field, with an explicit focus on the role of Marketing as a key but often neglected partner. We identify four big challenges (Self, Society, Micro Systems and Macro Systems) to which Marketing can contribute, illustrating these potential contributions through the articles and accompanying practitioner commentaries of this special section. Methodology: Ferguson demonstrates how reflexive introspection can be used, beyond its therapeutic benefits, to bring a deeper understanding of the meaning of illness and treatments from a patient’s perspective. Orazi and Newton establish experimentally the positive impact of collaborative sources on health messaging receptivity. Taiminen, Saramieni and Parkinson survey physicians to evaluate acceptance of/barriers to incorporating digital self-services into overall care delivery. Cruz, Snuggs and Tsarenko utilise interviews to understand the patient’s negotiation of the service labyrinth and fragmentation. Findings: We demonstrate the scope and flexibility of marketing theories and methods and how these can be applied to the four main challenges of integrated care: Self; Society; Micro Systems; Macro Systems. Research Implications: We identify directions for future research as a means of stimulating fruitful multidisciplinary partnerships in the four key challenge areas. It is only by collaborating across disciplines that we can really develop and provide insights that inform policy, practitioners, society and consumers on how to future-proof our care services. Originality/Value: In addition to publishing new research, this special section directly encourages multidisciplinary collaboration between marketing, as a neglected partner, and health/social care disciplines by showcasing the theories and methods that can be used to address our identified four key challenges to integrated care. In a novel approach, practitioner commentaries evaluate the value of each study, placing them in the wider integrated care context and hence pointing out further directions for development

Mitigating The Burden Of Diabetes In Sub-Saharan Africa Through An Integrated Diagonal Health Systems Approach

Diabetes is a chronic non-communicable disease (NCD) presenting growing health and economic burdens in sub-Saharan Africa (SSA). Diabetes is unique due to its cross-cutting nature, impacting multiple organ systems and increasing the risk for other communicable and non-communicable diseases. Unfortunately, the quality of care for diabetes in SSA is poor, largely due to a weak disease management framework and fragmented health systems in most sub-Saharan African countries. We argue that by synergizing disease-specific vertical programs with system-specific horizontal programs through an integrated disease-system diagonal approach, we can improve access, quality, and safety of diabetes care programs while also supporting other chronic diseases. We recommend utilizing the six World Health Organization (WHO) health system building blocks – 1) leadership and governance, 2) financing, 3) health workforce, 4) health information systems, 5) supply chains, and 6) service delivery – as a framework to design a diagonal approach with a focus on health system strengthening and integration to implement and scale quality diabetes care. We discuss the successes and challenges of this approach, outline opportunities for future care programming and research, and highlight how this approach can lead to the improvement in the quality of care for diabetes and other chronic diseases across SSA

Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

In response to widespread concerns regarding Veterans\u27 access to VA care, Congress enacted the Veterans Access, Choice and Accountability Act of 2014, which required VA to establish the Veterans Choice Program (VCP). Since the inception of VCP, more than two million Veterans have received care from community providers, representing approximately 25% of Veterans enrolled in VA care. However, expanded access to non-VA care has created challenges in care coordination between VA and community health systems. In March 2018, the VA Health Services Research and Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination