Table 5: National improvement research agenda.

CategoryPriority topicsExamples of
strategies and research issues

(A) Coordination and transitions of care
This category emphasizes strategies for care improvement to care processes in specific clinical conditions. At this time, care coordination and transitions of care are the key clinical focus
(i) Evaluate strategies and methods to assure coordination and continuity of care across transitions in given clinical populations
(ii) Test and refine methods of handoffs and other strategies to assure safe, effective, and efficient transitions in given clinical populations
Interprofessional team performance, medication reconciliation, discharge for prevention of early readmission, patient-centered care, and measurement of targeted outcomes

(B) High-performing clinical systems and microsystems approaches to improvement
This category emphasizes structure and process in clinical care and healthcare as complex adaptive systems
(i) Determine effectiveness and efficiency of various methods and models for integrating and sustaining best practices in improving care processes and patient outcomes
(ii) Investigate strategies to engage frontline providers in improving quality and patient safety
(iii) Evaluate strategies for preventing targeted patient safety incidents
(iv) Establish reliable quality indicators to measure impact of improvement and isolate nursing care impact on outcomes
Frontline provider engagement, unit-based quality teams, factors related to uptake, adoption, and implementation, sustaining improvements and improvement processes, academic-practice partnership, and informatics solutions

(C) 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
(i) Evaluate strategies and impact of employing evidence-based practice in clinical care for process and outcomes improvement
(ii) Determine gaps and bridge gaps between knowledge and practice
(iii) Transform evidence for practice through conducting systematic reviews, developing practice guidelines, and integrating practice into clinical decision making
(iv) Develop new research methods in evidence-based quality improvement, including comparative effectiveness research and practice-based evidence
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 evidence-based practice, and technology-based integration

(D) 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
(i) Investigate strategies for creating organizational environments, processes that support cultures fully linked to maintaining quality, and patient safety in order to maximize patient outcomes
(ii) Determine effective approaches to developing organizational climates for change, innovation, and organizational learning
Professional practice environments, protecting strategy from culture, shared decision making and governance, patient-centered models, leadership to instill values and beliefs for culture of patient safety, and organizational design (e.g., omit first-order failures)