title: Quality of evidence: usefulness in measuring the quality of health care.
abstract: BACKGROUND
  In 1998, the Committee on Health Care Quality in America was created and given the charge of devising a strategy to achieve substantial improvement in the quality of health care for all Americans. One strategy to move the quality agenda forward is the use of evidence by both providers of health care and consumers of health care. One feature of this agenda, evidence-based practice, refers to a hierarchy of evidence ranging from individual randomized, controlled trials to expert opinion.
  
  
  OBJECTIVE
  The purposes of this article are to describe the evidence base in nursing, discuss the quality and strength of nursing's evidence, illustrate the application of the Quality Health Outcomes Model, and present recommendations for practice, research, and policy to increase nursing's contribution to quality health care.
  
  
  CONCLUSIONS
  Nurses everywhere must use innovative solutions to operationalize the "evidence" in evidence-based nursing. The Quality Health Outcomes Model (QHOM) provides a useful way of advancing research and evidence about the quality of health care in America. In concert with the conceptual framework for the National Health Care Quality Report, the QHOM provides a map for identifying evidence gaps and research questions arising from the model and conceptual framework, as well as evidence synthesis (integrating methodologic quality) driven by theoretical understanding.
authors.affiliation: Office of International Programs & PAHO/WHO Collaborating Center for Nursing and Midwifery Leadership, and the Family and Community Health Division, University of Pennsylvania School of Nursing, Philadelphia, USA. baswan@nursing.upenn.edu
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Swan
authors.forename: Robert F
authors.initials: RF
authors.lastname: Boruch
mesh_terms: D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D016294:Models, Nursing; D017146:Models, Organizational; D024802:Nurse's Role; D009731:Nursing Audit; D009732:Nursing Care / Q000592:standards*; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care; D014481:United States; D016270:United States Agency for Healthcare Research and Quality