Skip to main content
NCBI home page
Journal of the American Medical Informatics Association: JAMIA logoLink to Journal of the American Medical Informatics Association: JAMIA
. 1995 May-Jun;2(3):169–182. doi: 10.1136/jamia.1995.95338870

Informatics: essential infrastructure for quality assessment and improvement in nursing.

S B Henry 1
PMCID: PMC116251  PMID: 7614118

Abstract

In recent decades there have been major advances in the creation and implementation of information technologies and in the development of measures of health care quality. The premise of this article is that informatics provides essential infrastructure for quality assessment and improvement in nursing. In this context, the term quality assessment and improvement comprises both short-term processes such as continuous quality improvement (CQI) and long-term outcomes management. This premise is supported by 1) presentation of a historical perspective on quality assessment and improvement; 2) delineation of the types of data required for quality assessment and improvement; and 3) description of the current and potential uses of information technology in the acquisition, storage, transformation, and presentation of quality data, information, and knowledge.

Full Text

The Full Text of this article is available as a PDF (1.6 MB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson C. A., Cassidy B., Rivenburgh P. Implementing continuous quality improvement (CQI) in hospitals: lessons learned from the International Quality Study. Qual Assur Health Care. 1991;3(3):141–146. doi: 10.1093/intqhc/3.3.141. [DOI] [PubMed] [Google Scholar]
  2. Aucott J. N., Taylor A. L., Wright J. T., Jr, Ganz M. B., Landefeld C. S., Pelecanos E. I., Carrol A. M., Dombrowski R. C., van Why K. J., Lederman R. Developing guidelines for local use: algorithms for cost-efficient outpatient management of cardiovascular disorders in a VA Medical Center. Jt Comm J Qual Improv. 1994 Jan;20(1):17–32. doi: 10.1016/s1070-3241(16)30050-5. [DOI] [PubMed] [Google Scholar]
  3. Berwick D. M. Measuring health care quality. Pediatr Rev. 1988 Jul;10(1):11–16. doi: 10.1542/pir.10-1-11. [DOI] [PubMed] [Google Scholar]
  4. Blumberg M. S. Risk adjusting health care outcomes: a methodologic review. Med Care Rev. 1986 Fall;43(2):351–393. doi: 10.1177/107755878604300205. [DOI] [PubMed] [Google Scholar]
  5. Brook R. H., Ware J. E., Jr, Davies-Avery A., Stewart A. L., Donald C. A., Rogers W. H., Williams K. N., Johnston S. A. Overview of adult health measures fielded in Rand's health insurance study. Med Care. 1979 Jul;17(7 Suppl):iii-x, 1-131. [PubMed] [Google Scholar]
  6. Bulechek G. M., McCloskey J. C. Nursing interventions: what they are and how to choose them. Holist Nurs Pract. 1987 May;1(3):36–44. doi: 10.1097/00004650-198705000-00008. [DOI] [PubMed] [Google Scholar]
  7. Clark J., Lang N. Nursing's next advance: an internal classification for nursing practice. Int Nurs Rev. 1992 Jul-Aug;39(4):109-11, 128. [PubMed] [Google Scholar]
  8. Classen D. C., Pestotnik S. L., Evans R. S., Burke J. P. Computerized surveillance of adverse drug events in hospital patients. JAMA. 1991 Nov 27;266(20):2847–2851. [PubMed] [Google Scholar]
  9. Corrigan J. M., Nielsen D. M. Toward the development of uniform reporting standards for managed care organizations: the Health Plan Employer Data and Information Set (Version 2.0). Jt Comm J Qual Improv. 1993 Dec;19(12):566–575. doi: 10.1016/s1070-3241(16)30037-2. [DOI] [PubMed] [Google Scholar]
  10. De Groot H. A., Forsey L., Cleland V. S. The Nursing Practice Personnel Data Set. Implications for professional practice systems. J Nurs Adm. 1992 Mar;22(3):23–28. doi: 10.1097/00005110-199203000-00010. [DOI] [PubMed] [Google Scholar]
  11. Donabedian A. Institutional and professional responsibilities in quality assurance. Qual Assur Health Care. 1989;1(1):3–11. doi: 10.1093/intqhc/1.1.3. [DOI] [PubMed] [Google Scholar]
  12. East T. D., Young W. H., Gardner R. M. Digital electronic communication between ICU ventilators and computers and printers. Respir Care. 1992 Sep;37(9):1113–1123. [PubMed] [Google Scholar]
  13. Eddy D. M., Billings J. The quality of medical evidence: implications for quality of care. Health Aff (Millwood) 1988 Spring;7(1):19–32. doi: 10.1377/hlthaff.7.1.19. [DOI] [PubMed] [Google Scholar]
  14. Gillis P. A., Booth H., Graves J. R., Fehlauer C. S., Soller J. Translating traditional principles of system development into a process for designing clinical information systems. Int J Technol Assess Health Care. 1994 Spring;10(2):235–248. doi: 10.1017/s026646230000619x. [DOI] [PubMed] [Google Scholar]
  15. Goldstein M. K., Clarke A. E., Michelson D., Garber A. M., Bergen M. R., Lenert L. A. Developing and testing a multimedia presentation of a health-state description. Med Decis Making. 1994 Oct-Dec;14(4):336–344. doi: 10.1177/0272989X9401400404. [DOI] [PubMed] [Google Scholar]
  16. Greenfield S., Nelson E. C. Recent developments and future issues in the use of health status assessment measures in clinical settings. Med Care. 1992 May;30(5 Suppl):MS23–MS41. doi: 10.1097/00005650-199205001-00003. [DOI] [PubMed] [Google Scholar]
  17. Griffith H. M., Robinson K. R. Current Procedural Terminology (CPT) coded services provided by nurse specialists. Image J Nurs Sch. 1993 Fall;25(3):178–186. doi: 10.1111/j.1547-5069.1993.tb00778.x. [DOI] [PubMed] [Google Scholar]
  18. Griffith H. M., Robinson K. R. Survey of the degree to which critical care nurses are performing current procedural terminology-coded services. Am J Crit Care. 1992 Sep;1(2):91–98. [PubMed] [Google Scholar]
  19. Hegyvary S. T., Haussman R. K. Nursing professional review. J Nurs Adm. 1976 Nov;6(9):12–16. [PubMed] [Google Scholar]
  20. Hegyvary S. T., Haussman R. K. The relationship of nursing process and patient outcomes. J Nurs Adm. 1976 Nov;6(9):18–21. [PubMed] [Google Scholar]
  21. Henry S. B., Holzemer W. L., Reilly C. A., Campbell K. E. Terms used by nurses to describe patient problems: can SNOMED III represent nursing concepts in the patient record? J Am Med Inform Assoc. 1994 Jan-Feb;1(1):61–74. doi: 10.1136/jamia.1994.95236137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Holzemer W. L., Henry S. B. Computer-supported versus manually-generated nursing care plans: a comparison of patient problems, nursing interventions, and AIDS patient outcomes. Comput Nurs. 1992 Jan-Feb;10(1):19–24. [PubMed] [Google Scholar]
  23. Holzemer W. L., Henry S. B., Stewart A., Janson-Bjerklie S. The HIV quality audit marker (HIV-QAM): an outcome measure for hospitalized AIDS patients. Qual Life Res. 1993 Apr;2(2):99–107. doi: 10.1007/BF00435729. [DOI] [PubMed] [Google Scholar]
  24. Horn S. D., Sharkey P. D., Buckle J. M., Backofen J. E., Averill R. F., Horn R. A. The relationship between severity of illness and hospital length of stay and mortality. Med Care. 1991 Apr;29(4):305–317. doi: 10.1097/00005650-199104000-00001. [DOI] [PubMed] [Google Scholar]
  25. Huber D. G., Delaney C., Crossley J., Mehmert M., Ellerbe S. A nursing management minimum data set. Significance and development. J Nurs Adm. 1992 Jul-Aug;22(7-8):35–40. doi: 10.1097/00005110-199207000-00009. [DOI] [PubMed] [Google Scholar]
  26. Iezzoni L. I., Ash A. S., Cobb J. L., Moskowitz M. A. Admission MedisGroups score and the cost of hospitalizations. Med Care. 1988 Nov;26(11):1068–1080. doi: 10.1097/00005650-198811000-00005. [DOI] [PubMed] [Google Scholar]
  27. Iezzoni L. I., Ash A. S., Coffman G. A., Moskowitz M. A. Predicting in-hospital mortality. A comparison of severity measurement approaches. Med Care. 1992 Apr;30(4):347–359. doi: 10.1097/00005650-199204000-00005. [DOI] [PubMed] [Google Scholar]
  28. Iezzoni L. I., Moskowitz M. A. A clinical assessment of MedisGroups. JAMA. 1988 Dec 2;260(21):3159–3163. doi: 10.1001/jama.260.21.3159. [DOI] [PubMed] [Google Scholar]
  29. Kasper J. F., Mulley A. G., Jr, Wennberg J. E. Developing shared decision-making programs to improve the quality of health care. QRB Qual Rev Bull. 1992 Jun;18(6):183–190. doi: 10.1016/s0097-5990(16)30531-0. [DOI] [PubMed] [Google Scholar]
  30. Knaus W. A., Draper E. A., Wagner D. P., Zimmerman J. E. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818–829. [PubMed] [Google Scholar]
  31. Knaus W. A., Draper E. A., Wagner D. P., Zimmerman J. E. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med. 1986 Mar;104(3):410–418. doi: 10.7326/0003-4819-104-3-410. [DOI] [PubMed] [Google Scholar]
  32. Knaus W. A., Wagner D. P., Draper E. A., Zimmerman J. E., Bergner M., Bastos P. G., Sirio C. A., Murphy D. J., Lotring T., Damiano A. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991 Dec;100(6):1619–1636. doi: 10.1378/chest.100.6.1619. [DOI] [PubMed] [Google Scholar]
  33. Knaus W. A., Wagner D. P., Lynn J. Short-term mortality predictions for critically ill hospitalized adults: science and ethics. Science. 1991 Oct 18;254(5030):389–394. doi: 10.1126/science.1925596. [DOI] [PubMed] [Google Scholar]
  34. Knaus W. A., Wagner D. P., Zimmerman J. E., Draper E. A. Variations in mortality and length of stay in intensive care units. Ann Intern Med. 1993 May 15;118(10):753–761. doi: 10.7326/0003-4819-118-10-199305150-00001. [DOI] [PubMed] [Google Scholar]
  35. Kohane I. S. Getting the data in: three year experience with a pediatric electronic medical record system. Proc Annu Symp Comput Appl Med Care. 1994:457–461. [PMC free article] [PubMed] [Google Scholar]
  36. Lang N. M., Clinton J. F. Assessment of quality of nursing care. Annu Rev Nurs Res. 1984;2:135–163. [PubMed] [Google Scholar]
  37. Lang N. M., Marek K. D. The classification of patient outcomes. J Prof Nurs. 1990 May-Jun;6(3):158–163. doi: 10.1016/s8755-7223(05)80146-2. [DOI] [PubMed] [Google Scholar]
  38. Lang N. M., Marek K. D. The policy and politics of patient outcomes. J Nurs Qual Assur. 1991 Jan;5(2):7–12. [PubMed] [Google Scholar]
  39. Le Gall J. R., Lemeshow S., Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993 Dec 22;270(24):2957–2963. doi: 10.1001/jama.270.24.2957. [DOI] [PubMed] [Google Scholar]
  40. Leape L. L. Practice guidelines and standards: an overview. QRB Qual Rev Bull. 1990 Feb;16(2):42–49. doi: 10.1016/s0097-5990(16)30335-9. [DOI] [PubMed] [Google Scholar]
  41. Lindberg D. A., Humphreys B. L., McCray A. T. The Unified Medical Language System. Methods Inf Med. 1993 Aug;32(4):281–291. doi: 10.1055/s-0038-1634945. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Lohr K. N. Outcome measurement: concepts and questions. Inquiry. 1988 Spring;25(1):37–50. [PubMed] [Google Scholar]
  43. Marek K. D. Outcome measurement in nursing. J Nurs Qual Assur. 1989 Nov;4(1):1–9. [PubMed] [Google Scholar]
  44. Marker C. G. The Marker Umbrella model for quality assurance: monitoring and evaluating professional practice. J Nurs Qual Assur. 1987 May;1(3):52–63. doi: 10.1097/00001786-198705000-00010. [DOI] [PubMed] [Google Scholar]
  45. Marker C. G. The Marker model: a hierarchy for nursing standards. J Nurs Qual Assur. 1987 Feb;1(2):7–20. doi: 10.1097/00001786-198702000-00003. [DOI] [PubMed] [Google Scholar]
  46. Martin K. S., Scheet N. J., Stegman M. R. Home health clients: characteristics, outcomes of care, and nursing interventions. Am J Public Health. 1993 Dec;83(12):1730–1734. doi: 10.2105/ajph.83.12.1730. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Miller R. A., McNeil M. A., Challinor S. M., Masarie F. E., Jr, Myers J. D. The INTERNIST-1/QUICK MEDICAL REFERENCE project--status report. West J Med. 1986 Dec;145(6):816–822. [PMC free article] [PubMed] [Google Scholar]
  48. Moorhead S. A., McCloskey J. C., Bulechek G. M. Nursing interventions classification. A comparison with the Omaha System and the Home Healthcare Classification. J Nurs Adm. 1993 Oct;23(10):23–29. [PubMed] [Google Scholar]
  49. Olivas G. S., Del Togno Armanasco V., Erickson J. R., Harter S. Case management--a bottom-line care delivery model. Part II: Adaptation of the model. J Nurs Adm. 1989 Dec;19(12):12–17. [PubMed] [Google Scholar]
  50. Olivas G. S., Del Togno-Armanasco V., Erickson J. R., Harter S. Case management: a bottom-line care delivery model. Part 1: The concept. J Nurs Adm. 1989 Nov;19(11):16–20. [PubMed] [Google Scholar]
  51. Ozbolt J. G., Fruchtnicht J. N., Hayden J. R. Toward data standards for clinical nursing information. J Am Med Inform Assoc. 1994 Mar-Apr;1(2):175–185. doi: 10.1136/jamia.1994.95236147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Ozbolt J. G., Graves J. R. Clinical nursing informatics. Developing tools for knowledge workers. Nurs Clin North Am. 1993 Jun;28(2):407–425. [PubMed] [Google Scholar]
  53. Rettig R. History, development, and importance to nursing of outcomes research. J Nurs Qual Assur. 1991 Jan;5(2):13–17. [PubMed] [Google Scholar]
  54. Saba V. K. Home health care classification. Caring. 1992 May;11(5):58–60. [PubMed] [Google Scholar]
  55. Saba V. K. The classification of home health care nursing diagnoses and interventions. Caring. 1992 Mar;11(3):50–57. [PubMed] [Google Scholar]
  56. Shea S., Sideli R. V., DuMouchel W., Pulver G., Arons R. R., Clayton P. D. Computer-generated informational messages directed to physicians: effect on length of hospital stay. J Am Med Inform Assoc. 1995 Jan-Feb;2(1):58–64. doi: 10.1136/jamia.1995.95202549. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Stewart A. L., Hays R. D., Ware J. E., Jr The MOS short-form general health survey. Reliability and validity in a patient population. Med Care. 1988 Jul;26(7):724–735. doi: 10.1097/00005650-198807000-00007. [DOI] [PubMed] [Google Scholar]
  58. Turley J. P. A framework for the transition from nursing records to a nursing information system. Nurs Outlook. 1992 Jul-Aug;40(4):177–181. [PubMed] [Google Scholar]
  59. Ventura M. R. Correlation between the quality patient care scale and the Phaneuf audit. Int J Nurs Stud. 1980;17(3):155–162. doi: 10.1016/0020-7489(80)90040-1. [DOI] [PubMed] [Google Scholar]
  60. Warner H. R., Jr, Bouhaddou O. Innovation review: Iliad--a medical diagnostic support program. Top Health Inf Manage. 1994 May;14(4):51–58. [PubMed] [Google Scholar]
  61. Wolford G. R., Brown M., McCool B. P. Getting to go in managed care. Health Care Manage Rev. 1993 Winter;18(1):7–19. [PubMed] [Google Scholar]
  62. Zander K. Nursing case management: strategic management of cost and quality outcomes. J Nurs Adm. 1988 May;18(5):23–30. [PubMed] [Google Scholar]

Articles from Journal of the American Medical Informatics Association are provided here courtesy of Oxford University Press

RESOURCES