A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine. However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine. They usually include summarized consensus statements on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of his or her profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment.
The Agency for Healthcare Research and Quality is one of twelve agencies within the United States Department of Health and Human Services (HHS). The agency is headquartered in North Bethesda, Maryland, a suburb of Washington, D.C.. It was established as the Agency for Health Care Policy and Research (AHCPR) in 1989 as a constituent unit of the Public Health Service (PHS) to enhance the quality, appropriateness, and effectiveness of health care services and access to care by conducting and supporting research, demonstration projects, and evaluations; developing guidelines; and disseminating information on health care services and delivery systems.
Nursing research is research that provides evidence used to support nursing practices. Nursing, as an evidence-based area of practice, has been developing since the time of Florence Nightingale to the present day, where many nurses now work as researchers based in universities as well as in the health care setting.
A practice-based research network (PBRN) is a group of practices devoted principally to the care of patients and affiliated for the purpose of examining the health care processes that occur in practices. PBRNs are characterized by an organizational framework that transcends a single practice or study. They provide a "laboratory" for studying broad populations of patients and care providers in community-based settings.
A clinical nurse specialist (CNS) is an advanced practice nurse who can provide advice related to specific conditions or treatment pathways. According to the International Council of Nurses (ICN), an Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. Clinical Nurse Specialists are registered nurses, who have graduate level nursing preparation at the master's or doctoral level as a CNS. They are clinical experts in evidence-based nursing practice within a specialty area, treating and managing the health concerns of patients and populations. The CNS specialty may be focused on individuals, populations, settings, type of care, type of problem, or diagnostic systems subspecialty. CNSs practice autonomously and integrate knowledge of disease and medical treatments into the assessment, diagnosis, and treatment of patients' illnesses. These nurses design, implement, and evaluate both patient–specific and population-based programs of care. CNSs provide leadership in the advanced practice of nursing to achieve quality and cost-effective patient outcomes as well as provide leadership of multidisciplinary groups in designing and implementing innovative alternative solutions that address system problems and/or patient care issues. In many jurisdictions, CNSs, as direct care providers, perform comprehensive health assessments, develop differential diagnoses, and may have prescriptive authority. Prescriptive authority allows them to provide pharmacologic and nonpharmacologic treatments and order diagnostic and laboratory tests in addressing and managing specialty health problems of patients and populations. CNSs serve as patient advocates, consultants, and researchers in various settings [American Nurses Association (ANA) Scope and Standards of Practice (2004), p. 15].
Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the 1990s, when multiple countries reported significant numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization (WHO) calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety.
Alison Kitson FRCN is inaugural Vice President and Executive Dean of the College of Nursing and Health Sciences at Flinders University South Australia. She is also an Associate Fellow of Green Templeton College, Oxford, United Kingdom.
A patient safety organization (PSO) is a group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection and analysis, reporting, education, funding, and advocacy.
Health services research (HSR) became a burgeoning field in North America in the 1960s, when scientific information and policy deliberation began to coalesce. Also known as health systems research or health policy and systems research (HPSR), is a multidisciplinary scientific field that examines how people get access to health care practitioners and health care services, how much care costs, and what happens to patients as a result of this care. Health Services Research utilizes all qualitative and quantitative methods across the board to ask questions of the healthcare system. It focuses on performance, quality, effectiveness and efficiency of health care services as they relate to health problems of individuals and populations, as well as health care systems. Health Services Research addresses wide-ranging topics of structure, processes, and organization of health care services; their use and people's access to services; efficiency and effectiveness of health care services; the quality of healthcare services and its relationship to health status, and; the uses of medical knowledge.
Evidence-based nursing (EBN) is an approach to making quality decisions and providing nursing care based upon personal clinical expertise in combination with the most current, relevant research available on the topic. This approach is using evidence-based practice (EBP) as a foundation. EBN implements the most up to date methods of providing care, which have been proven through appraisal of high quality studies and statistically significant research findings. The goal of EBN is to improve the health and safety of patients while also providing care in a cost-effective manner to improve the outcomes for both the patient and the healthcare system. EBN is a process founded on the collection, interpretation, appraisal, and integration of valid, clinically significant, and applicable research. The evidence used to change practice or make a clinical decision can be separated into seven levels of evidence that differ in type of study and level of quality. To properly implement EBN, the knowledge of the nurse, the patient's preferences, and multiple studies of evidence must all be collaborated and utilized in order to produce an appropriate solution to the task at hand. These skills are taught in modern nursing education and also as a part of professional training.
E. Andrew Balas M.D., Ph.D. is a fellow of the American College of Medical Informatics and elected member of the European Academy of Sciences and Arts. He serves as Professor at Augusta University. Balas is Vice President of the Friends of the National Library of Medicine.
Translational research is research aimed at translating (converting) results in basic research into results that directly benefit humans. The term is used in science and technology, especially in biology and medical science. As such, translational research forms a subset of applied research.
ECRI is an independent nonprofit organization improving the safety, quality, and cost-effectiveness of care across all healthcare settings worldwide.
Informatics for Consumer Health (ICH) is a government initiative coordinated by the National Cancer Institute (NCI) within the National Institutes of Health (NIH). ICH focuses on a coordination of health information, technology, and health care delivery that empowers providers to manage care and increases the ability of consumers to gain mastery over their own health. The ICH online initiative involved stakeholders from various sectors—commercial IT, government, health care, education, research, and advocacy—exchanging ideas and resources to bridge information technology and health care with the goal of improving behavioral support for all consumers. The Informatics for Consumer Health field is related to health informatics, medical informatics, consumer health informatics, eHealth, and health information technology.
Knowledge translation (KT) is the activities involved in moving research from the laboratory, the research journal, and the academic conference into the hands of people and organizations who can put it to practical use. Knowledge translation is most often used in the health professions, including medicine, nursing, pharmaceuticals, rehabilitation, physical therapy, and public health.
Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.
The Comparative Effectiveness Research Translation Network (CERTAIN) is a learning healthcare system in Washington State focused on patient-centered outcomes research (PCOR) and comparative effectiveness research (CER), leveraging existing healthcare data for research and healthcare improvement, incorporating patient and other healthcare stakeholder voices into research, and facilitating dissemination and implementation of research evidence into clinical practice.
Sanjeev Arora, MD, MACP, FACG, an Indian-American physician, is the Founder and Director of Project ECHO, a telementoring model for quickly scaling up health expertise in local communities.
Learning health systems (LHS) are healthcare systems in which knowledge generation processes are embedded in daily practice to produce continual improvement in care.
