Improvement Science Research Network

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The Improvement Science Research Network (ISRN) (Principal Investigator: Kathleen R. Stevens, EdD, MS, RN, ANEF, FAAN) is a large-scale practice based research network and coordinating center that was created to accelerate inter-professional improvement science in a systems context across multiple hospital sites. The ISRN, which is supported by the National Institutes of Health (NIH), was made possible through funds from the American Recovery and Reinvestment Act’s “Grand Opportunities” Program. The ISRN, which began in October 2009, aims to fill a national gap in improvement science by establishing a sustainable infrastructure for testing improvement strategies in health care settings. This infrastructure provides a link between the support center, network study sites and frontline research staff and facilitates the sharing of data between ISRN members. Built upon lessons learned from other practice-based research networks (PBRNs), the Improvement Science Research Network is housed in the University of Texas Health Science Centerat San Antonio's Clinical and Translational Science Award in the Institute for Integration of Medicine and Science.

The ISRN is one of several major projects overseen by the Academic Center for Evidence-Based Practice (ACE), located at UTHSCSA, under the direction of Kathleen R. Stevens, EdD, MS, RN, ANEF, FAAN. The ACE Center was also involved in the development of the AHRQ Health Care Innovations Exchange, which was designed to support and accelerate the adoption of innovations in health care delivery and patient safety.

What is Improvement Science?[edit]

While Improvement Science is an emerging field and has yet to establish a common vocabulary, it shares common aspects with other areas of research such as implementation science, translational science, and knowledge translation. All of these fields are similar in their focus on translating what is learned from research into actual practice to improve care and outcomes. However, "Improvement Science" is proposed as the broadest, most encompassing term.

Need for Improvement Science Taxonomy[edit]

The influence of Improvement Science will be driven by the ability to measure outcomes, and measurement of outcomes is not possible without a specific taxonomy reflective of the science itself. Improvement Science taxonomy will provide a way for subject matter experts to develop, reflect upon and characterize Improvement Science as a whole, rather than individual parts. Using a Taxonomy Management System, subject matter experts can develop content categories within a shared repository. A Taxonomy Management System that can readily import existing lists of terms into a repository can affect the outcome of a systematically developed, reliable, and valid taxonomy for Improvement Science that allows measurement of discrete Improvement Science variables over time. This will allow health care provider's and facilities the ability to demonstrate improvement, even when that improvement is discretely modest. The Improvement Science Taxonomy will be semantically meaningful across a multitude of other health care delivery taxonomies.

Development of the Improvement Science taxonomy is in the foundational stages of development. The goal is for end user's to have the ability to access Improvement Science technology resources and use a consistent set of terms for organizing, retrieving, and delivering information for their own improvement purposes.

Research Priorities[edit]

The Improvement Science Research Network established research priorities that distinguish it from other practice-based research networks. These priorities highlight the most important and urgent gaps in improvement knowledge as identified by clinical and academic scholars, leaders, and change agents in acute healthcare settings. The research priorities also inform decisions about the scope of future work and the dissemination of ISRN-sponsored knowledge in each of the following domains of improvement science:

1. Coordination and Transitions of Care – this category emphasizes strategies for improvement to care processes in specific clinical conditions. At this time, care coordination and transitions of care are the key clinical focus. Examples of Research Issues: Team performance, medication reconciliation, discharge for prevention of early readmission, patient centered care, measurement of targeted outcomes.
2. High Performing Clinical Systems and Microsystems Approaches to Improvement – this category emphasizes structure and process in clinical care and healthcare as complex adaptive systems. Examples of Research Issues: Frontline provider engagement, factors related to uptake, adoption and implementation, sustaining improvements and improvement processes.
3. Evidence-Based Quality Improvement and Best Practice – this category emphasizes closing the gap between knowledge and practice through transforming knowledge and designating and implementing best practices. Examples of Research Issues: Develop and critically appraise clinical practice guidelines, adoption and spread of best practices, customization of best practices, institutional elements in adoption, defining best practice in absence of evidence, consumers in EBP, technology-based integration.
4. Learning Organizations and Culture of Quality and Safety – this category emphasizes human factors and other aspects of a system related to organizational culture and commitment to quality and safety. Examples of Research Issues: Unit based nursing quality teams, protecting strategy from culture, engendering values and beliefs for culture of patient safety.

Governance[edit]

The ISRN is a membership organization guided by two groups: the Coordinating Center and the ISRN Steering Council.

The Coordinating Center is housed within the Academic Center for Evidence-Based Practice in the School of Nursing at the University of Texas Health Science Center, San Antonio. Founded upon a longstanding commitment to clinical and translational research, the ISRN Coordinating Center partners with the Institute for Integration of Medicine and Science (IIMS) to further reduce barriers to research and strengthen the science of quality improvement.

The Steering Council is composed of sixteen healthcare experts from both private and public organizations across the nation. Steering Council members come from a variety of backgrounds and contribute knowledge in areas such as healthcare informatics, healthcare information technology, quality measures, teamwork/TeamSTEPPS, patient safety, and implementation practice. The aggregate expertise of this multidisciplinary group reflects advanced knowledge of healthcare improvement and guides the ISRN’s research priorities and activities.

Events[edit]

Web Events

The Improvement Science Research Network Web Event series explores issues in the field of improvement science, provides updates regarding the ISRN activities, introduces new tools and research paradigms, and solicits input regarding new directions for research. The first session of the web event series, The Way Forward: An Introduction to Improvement Science, was held in June 2010. Presented by Jack Needleman, PhD, FAAN, and Kathleen Stevens, EdD, MS, RN, ANEF, FAAN, this introductory session showcased the activities of the ISRN as a catalyst for change. It defined Improvement Science, explored the overlapping paradigms of Improvement Science, translational science, and implementation science and explained the need and context for improvement science research. Furthermore, it enumerated the many challenges facing Improvement Science and health care improvement in general, including a lack of evidence-based research methodologies; limited institutional access to national Improvement Science experts; a need for on-site training in research methodologies; and the absence of a collegial and technological infrastructure to support a national agenda for Improvement Science research priorities. Finally, the event showcased the solutions available to meet these challenges, including the ISRN.

Conferences

ISRN offers a variety of opportunities for health professionals to learn and network with the best in the industry. From the annual Improvement Science Summit to the Summer Institute on Evidence Based Practice, ISRN aims at supporting an academic-practice partnership while improving quality in patient care.

The inaugural Improvement Science Summit: The Way Forward was held on July 8, 2010 in San Antonio, Texas. At this research methods conference, participants gathered for a full day of sessions covering key areas of Improvement Science, including the organization and mission of the ISRN, information about methodology and measurement, research design and statistics, and quality indicators in Improvement Science.

Summit participants also had the opportunity to join a team that will plan and conduct multisite improvement research on one of three topics: frontline engagement in quality improvement, team performance for patient safety, and preventing medication errors.

The Summit is held alongside the annual Summer Institute on Evidence-Based Practice. The Summer Institute is a two and a half day conference that is a direct response to the national call for healthcare providers to bridge research and quality care by preparing the workforce to redesign health systems that are safe and effective. Noted EBP leaders and experts present a coordinated, interactive curriculum. Major topics include the urgency of using evidence to improve clinical care, research evidence available for priority clinical conditions, innovation for quality and safety, infrastructure enhancement, and impact of EBP on selected roles within the health professions (clinician, manager, educator, and researcher).

ISRN Membership[edit]

The ISRN is a member driven network. Membership in the ISRN is open to individuals who are healthcare researchers, academicians, clinicians or administrators with a specific interest in patient safety and improvement research in the acute care setting. Membership in the ISRN includes multiple benefits such as:

  • Opportunities to participate in multi-site collaborations on patient safety and quality improvement research initiatives
  • Access to members-only ISRN online resources
  • Leverage of a national test bed for evaluating improvement strategies
  • Training resources such as IRB training
  • Expert guidance in conducting research
  • Technology infrastructure for participating in multi-site studies
  • Access to the ISRN web portal providing secure communication, storage and sharing of documents and data
  • A technical support system providing access to expert guidance in conducting research and using statistics

References[edit]

Agency for Healthcare Research and Quality. Fact Sheet: AHRQ support for primary care practice-based research networks (PBRNs), 2006.

American Nurses Association (ANA). The National Database of Nursing Quality Indicators. Washington, DC: ANA, 2007

Berwick DM. (2008). The science of improvement. JAMA. 2008;299(10):1182-4.

Davidoff F, Batalden P, Stevens D, Ogrinc G, & Mooney S. Publication guidelines for improvement studies in health care: evolution of the SQUIRE project. Ann Int Med. 2008;149(9):670-7.

Dolor RJ, Smith PC, Neale AV. Agency for Health Care Research and Quality Practice-Based Research Network. Institutional review board training for community practices: advice from the Agency for Health Care Research and Quality Practice-Based Research Network listserv. J Am Board Fam Med. 2008;21(4):345-52.

Graham DG, Spano MS, Stewart TV, Staton EW, Meers A, Pace WD. (2007). Strategies for planning and launching PBRN research studies: a project of the Academy of Family Physicians National Research Network (AAFP NRN). J Am Board Fam Med. 2007 Mar-Apr;20(2):220-8.

Newhouse RP, Petit JC, Poe S, Rocco L. (2006). The slippery slope: differentiating between quality improvement and research. J Nur Adm. 2006 Apr;36(4):211-9

Sorra JS, Nieva VF. Hospital survey on patient safety culture. Rockville, MD: Agency for Healthcare Research and Quality, 2004.

Tierney, WM, Oppenheimer, CC, et al. (2007). A national survey of primary care practice-based research networks. Ann Fam Med. 2007 May-Jun;5(3):242-50.

Westfall JM, Mold J, Fagnan L. Practice-based research -"Blue Highways" on the NIH Roadmap. JAMA 2007 Jan;24;297(4):403-6.

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