There are parallel situations with the National Century Financial Enterprises case in todays credit market turmoil. There is the criminal intent at the original source of the transaction, on the parts of NCFE and those who wrote the mortgages (Final chapters in NCFE saga? May 5, p. 31). Also, there was often naivete or criminal intent on the part of the other parties. In both scenarios, the transactions became securitized and were bought by secondary institutions unaware, often intentionally or incompetently, of their complexity and lack of value. Those at NCFE have been held accountable for their greed and actions.
You can quantify nurses' quality of care
Time will tell if those at the initial mortgage desk who acted with the knowledge they were transferring the risk of the improper loans will have similar appropriate consequences.
Donald MellmanNeurosurgeon, consultant Tampa, Fla.
While we agree with Melanie Evans that nurses contributions to better health have not been measured and that pinpointing what nurses do isnt easy, we do believe that it is possible not only to measure what nurses do, but also more importantly what effects on quality they achieve (Nursing great expectations, April 21, p. 28).
In fact, that is what the Robert Wood Johnson Foundations Interdisciplinary Nursing Quality Research Initiative, or INQRI, is attempting to do. Interdisciplinary teams of researchers from around the country (including Sean Clarke of the University of Pennsylvania, who was quoted in your article) have been trying to quantify how much nurses contribute to quality and capture the scientific evidence that hospitals and health leaders will need to understand why investing in a high-quality nurse workforce is essential to keeping patients safe and healthy.
This year, the first round of INQRI grantees will produce critical evidence to inform policymakers and healthcare leaders about the link between nursing and better quality, and most importantly, whether the quality measures we currently rely on are aligned to patient needs. These grantees have studied whether hospitalized patients find nurse quality measures useful and can understand them.
Using this information, they have developed new and improved ways to measure and communicate the role nurses play in outcomes that are important to patients, such as whether their pain was addressed, whether staffing levels were appropriate to prevent falls, pressure ulcers and other preventable errors, and how the organization of nursing services influences the care patients receive and the outcomes of that care. All 21 INQRI-funded projects are meant to have a relevant and timely impact on quality improvement.
As Evans indicates, nurses do account for a large sector of the healthcare workforce yet they have been largely overlooked by groups developing policies related to quality improvement because of a lack of evidence to support what they can contribute. It may be true that nurses will receive additional scrutiny or blame in the current push to improve quality, and they are more than ready to be held accountable as long as the measures hospitals and policymakers are using as benchmarks are relevant and scientifically based.
Evidence emerging from the INQRI program makes us optimistic that an increased recognition of what nursing contributes to quality will result in an increase in stature and resources allocated to the profession.
Mark PaulyBendheim professor of healthcare systems University of Pennsylvania Philadelphia
Mary NaylorMarian S. Ware professor of gerontology University of Pennsylvania
Regarding Laura Adams online Guest Commentary, Change to EMRs will alter the message (See the Community section of modernhealthcare.com under Previous Guest Commentaries): While there are clearly a wide range of advantages in electronic medical records as far as sickness care is concerned, the potential in managing health may be even greater. We can no longer afford to be as sick as we are as a population. Governments, employers, insurers and at least a minority of physicians, hospitals and patients have already moved in the proactive direction.
While reducing the incidence and prevalence of disease and injuryby a dramatic amountwould benefit almost everyone; providers that invest and engage in proactive health management would be cutting their own reimbursement. Rather than looking forward with glee to an ever-increasing demand for sickness carealready predicted as a result of the aging baby boomerssome providers are looking to stem the tide rather than being raised by it. Prepaid group practices such as Kaiser Permanente and Group Health Cooperative have long promoted member health and sought to reduce the need for sickness care. Integrated healthcare systems such as Duke University Health System, Henry Ford Health System, Mayo Clinic, Sutter Health and others either offer proactive health management programs to their own employees and dependents, or to local, sometimes national employers, with many doing both.
EMRs offer a foundation for sharing information and meeting the challenges of preventive care among providers who are sharing methods best-suited to the unique problems and potential of individual patients and families. No one provider is likely to have all the answers; collaboration among those who are best in their fields would be much more feasible and affordable if they are all reading from the same records. And since patients normally play the major role in health management, enabling them to access and control their own EMRs is essential.
While primary physicians may have resisted investing in EMRs, and payers in general have been less than generous in their support for this technology, the proactive side of health offers them all enough value to be worthy of their combined investments and collaboration.
Scott MacStravicFreelance writer Port Ludlow, Wash.
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