Wednesday, April 2, 2025
4/2/2025
A Social-Ecological Approach to Identify Nursing Models of Care to Reduce Emergency Department Disparities - Project Summary Candidate: To achieve her career goal of becoming an independent investigator, K. Jane Muir, PhD, APRN, FNP-BC seeks mentored research training in health equity research, machine learning techniques, and causal inference approaches. This career development award identifies modifiable nursing features to improve emergency department (ED) patient outcomes with a focus on reducing patient outcome disparities. Research Context: Hospital EDs have the potential to save lives, but pervasive delays and chaotic aspects of emergency care place patient’s health outcomes at risk while widening disparities in care for racial and ethnic minorities. Registered nurses direct all processes of care in hospital EDs including triage, throughput, and patient disposition, yet few studies have determined whether they are adequately resourced to do so. Grounded in the Social Ecological Model, this study aims to determine the extent to which hospital nursing models of care are associated with patient outcomes and disparities to improve ED care outcomes. Specific Aims. 1) To determine which nursing models of care (defined by different combinations of ED and inpatient nursing resources) are associated with ED patient outcomes; 2) To determine the association of nursing models of care on ED patient outcome disparities. Research Plan: Datasets include, 1) Penn’s Nurses4All multi-state nurse survey, 2) the American Hospital Association Annual Hospital Survey, 3) AHRQ Healthcare Cost Utilization Project patient database. In Aim 1, machine learning will be used to identify nursing models of care characterized by ED and inpatient nursing resources (nurse staffing levels, nurse work environments, skill mix, nurse practitioners) associated with ED patient outcomes (ED length of stay, ED revisits, disposition against medical advice, 30-day hospital readmissions, in-hospital mortality) in hospitals overall with separate comparisons among minority share and non-minority share hospitals. In Aim 2, disparities in ED patient outcomes associated with nursing models of care will be examined among racial/ethnic minority patients compared to Whites. Career Development Plan: With an interdisciplinary and experienced team of mentors, Dr. Muir will pursue didactics, seminars and conferences to complete the training goals, which are to 1) cultivate and apply expertise in the theory, design, and evaluation of research advancing health equity; 2) apply advanced machine learning techniques to develop hospital nursing models of care defined by combinations of ED and inpatient nursing resources; 3) expand and apply skills in causal inference approaches with observational data. Environment: The University of Pennsylvania School of Nursing offers an ideal environment to pursue the proposed training and research. Dr. Muir is well-positioned to successfully complete the proposed aims and training because of her experienced mentorship team and extensive resources for career development.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).