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Organizing nursing to improve care quality and safety: a hybrid implementation-effectiveness study

Award Number: R01HS027181
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/30/2020
PERIOD OF PERFORMANCE END DATE: 09/29/2024

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Organizing nursing to improve care quality and safety: a hybrid implementation-effectiveness study - Project Summary A significant number of patients are harmed or die every year because of unsafe, inappropriate or inadequate healthcare delivery. The Agency for HealthCare Research and Quality has identified Registered Nurses (RNs) as a patient safety strategy for reducing patient mortality and morbidity. However, variability in research findings indicate the relationship is not as simple as `more nurses = better outcomes'. Despite the fact that RNs are the largest health workforce component, with identified potential to improve patient safety, currently no evidence-based frontline RN care model exists. The long-term goal of this research is to generate critical knowledge that enables wide-spread implementation and sustained utilization of evidence-based frontline RN care models that maximize the quality and safety of care received. One emerging model highlighted by policy makers and increasingly taken up by health systems across the nation is the Clinical Nurse Leader (CNL) care model. The purpose of this study is to estimate the CNL care model's effectiveness in impacting better care and better health. It leverages a natural experiment in 66 clinical care units in 9 hospitals across 5 states (GA, TX, MI, NC, IL) that are integrating CNLs into their frontline nursing care delivery model. A hybrid type II implementation-effectiveness study will be used to accomplish the following aims. Aim 1. Evaluate the effect of CNL-integrated care delivery on changes in nationally endorsed and standardized quality and safety outcomes including patient satisfaction, infection rates, falls, LOS, and readmissions. Quasi-experimental interrupted time series (ITS) design using regression methods to evaluate outcome change for individual units. A meta-analysis implementing multilevel random effects models will provide combined unit-specific and overall estimates of effect size for each outcome. All analysis will control for pre-intervention trends, seasonality, temporal dependence, and unit-level demographics. Aim 2. Identify characteristics of CNL implementation that are sufficient and necessary to achieve outcomes. Already collected data (surveys, interviews) will be used to identify, characterize, and measure CNL implementation in each clinical unit. Qualitative Comparative Analysis will be used to identify CNL implementation and practice characteristics that are consistently present in units with improved outcomes (sufficient conditions) and thresholds that must be in place for outcomes to occur (necessary conditions). By leveraging sophisticated analytic methods that capture the dynamic interdependency of contextual factors in nursing practice, this study will be the first to examine nursing as an organizational strategy to increase care quality and safety, to measure its effectiveness, and provide specific `recipes' of successful CNL care model configurations that health systems can match to their needs to achieve intended quality and safety outcomes.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$3 )
2025	2022	UNIVERSITY OF CALIFORNIA IRVINE	160 ALDRICH HALL	IRVINE	CA	92697	ORANGE	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	1/7/2025	NON-COMPETING CONTINUATION	-$3
														Subtotal = -$3

Issue Date FY: 2022 ( Subtotal = $399,999 )
2022	2022	UNIVERSITY OF CALIFORNIA, IRVINE	141 INNOVATION DR STE 250	IRVINE	CA	92617	ORANGE	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	9/20/2022	NON-COMPETING CONTINUATION	$399,999
														Subtotal = $399,999

Issue Date FY: 2021 ( Subtotal = $400,000 )
2021	2021	UNIVERSITY OF CALIFORNIA, IRVINE	141 INNOVATION DR STE 250	IRVINE	CA	92617	ORANGE	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	9/16/2021	NON-COMPETING CONTINUATION	$400,000
														Subtotal = $400,000

Issue Date FY: 2020 ( Subtotal = $374,292 )
2020	2020	UNIVERSITY OF CALIFORNIA, IRVINE	141 INNOVATION DR STE 250	IRVINE	CA	92617	ORANGE	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	9/24/2020	NEW	$374,292
														Subtotal = $374,292

Grand Total All Awards = $1,174,288

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Organizing nursing to improve care quality and safety: a hybrid implementation-effectiveness study

Award Number: R01HS027181

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/30/2020

PERIOD OF PERFORMANCE END DATE: 09/29/2024

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