Creating and analyzing a statewide nursing quality measurement database.

Area of Science:

• Nursing Science
• Health Services Research
• Quality Improvement

Background:

• Establishing reliable and valid quality databases is crucial for examining the relationship between nurse staffing and patient care outcomes.
• The California Nursing Outcomes Coalition (CalNOC) project represents a significant statewide effort to collect comprehensive nursing quality data.

Purpose of the Study:

• To explicate a replicable methodology for designing and analyzing a large, ongoing, reliable, and valid quality database.
• To examine nurse staffing and patient care outcomes in acute care hospitals.

Main Methods:

• Prospective collection of nurse staffing, process of care, and patient outcomes data using the American Nurses Association's (ANA) nursing quality indicators.
• Data collected from a voluntary convenience sample at acute care hospitals in California via rolling-site accrual.
• Development and maintenance of the CalNOC database, the largest statewide repository of its kind in the US.

Main Results:

• As of May 2003, the CalNOC database included staffing data from 842 units in 134 hospitals over 20 quarters (April 1998-March 2003).
• The repository contained clinical outcome data on 34,262 patient falls, 41,982 patient observations for pressure ulcer prevalence, and 26,461 patient satisfaction surveys.
• Participating hospitals receive quarterly benchmarking reports; CalNOC methods have been adapted by other national databases and endorsed by the National Quality Forum.

Conclusions:

• A working model for collecting reliable and valid data was established from multiple California hospitals.
• The CalNOC data serve as a basis for studies contributing to evidence-based public policy.
• Ongoing study of the effects of nurse staffing on clinical and service outcomes is facilitated by this database.