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A quality and cost analysis of interprofessional team continuity in ICUs

Award Number: R01HS028438
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: 09/01/2022
PERIOD OF PERFORMANCE END DATE: 06/30/2027

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A quality and cost analysis of interprofessional team continuity in ICUs - PROJECT ABSTRACT Critical care is the most complex, resource-intensive and costly care setting contributing over $130 billion to national health expenditures annually. Approximately 4 million patients are admitted to intensive care units (ICUs) each year with average mortality rate ranging from 8-19. Recently COVID-19 has highlighted that staffing interprofessional teams in ICUs is quite challenging. One feature of healthcare staffing that has received much attention in settings outside of the ICU is continuity of care – whereby a patient is cared for by a small team of identified professionals over time – has been long recognized as an essential attribute of high- quality, patient-centered care. In primary care, greater continuity of patient care is associated with fewer emergency department visits and hospitalizations, lower healthcare costs, and higher patient satisfaction. Continuity-based acute care staffing models also exist, but are rarely adopted and sustained in practice, particularly in ICUs where continuity-based assignments can be challenging to operationalize. Importantly, although critical care is delivered by interprofessional teams of physicians, nurses, and respiratory therapists, continuity of interprofessional ICU teams has never been conceptualized or measured before. Without this knowledge, it is difficult to know whether hospitals and administrators should prioritize continuity of ICU care, which could be a missed opportunity to improve quality of patient care and outcomes in this critically ill, costly patient population. The overall goal of our study is to examine the effect of continuity of ICU interprofessional teams on patient outcomes and organizational economic outcomes, in order to develop an interprofessional assignment decision-support tool that optimizes the continuity of interprofessional ICU team care. We propose to examine the quality and costs of an interprofessional team continuity staffing approach in ICUs to guide future interventions in 13 ICUs across two different healthcare systems using data from over 2 years. We will examine interprofessional team continuity of shift-level ICU clinician teams (a nurse, a physician, and a respiratory therapist) assigned to each patient during the ICU stay. We define two dimensions of team continuity: intra-professional continuity, measuring each of the clinician’s experience caring for the patient previously during the patient’s stay, and inter-professional continuity, measuring the clinicians’ joint experience working together as a team. We hypothesize that care delivered by shift-level ICU teams with higher intra- and inter-professional continuity will result in improved patient outcomes and reduced costs. Our research team has a strong record of joint publications on attributes of patient care teams including continuity of care with expertise in health economics, critical care nursing and medicine and engineering. Completion of the study will generate the most robust evidence, to date, to inform organizational priorities about continuity-based interprofessional staffing in ICUs, to improve care for critically ill ICU patients.


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 = $398,354 )
2025	2025	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	003	4	6/19/2025	NON-COMPETING CONTINUATION	$398,606
2025	2024	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	2/13/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$0
2025	2024	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	002	3	2/25/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$106,738
2025	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE STE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	2/25/2025	NON-COMPETING CONTINUATION	-$106,990
														Subtotal = $398,354

Issue Date FY: 2024 ( Subtotal = $399,953 )
2024	2024	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	001	3	8/22/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$399,953
2024	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	8/22/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $399,953

Issue Date FY: 2023 ( Subtotal = $398,628 )
2023	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	6/20/2023	NON-COMPETING CONTINUATION	$398,628
2023	2022	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON STREET	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	3/3/2023	NEW	$0
														Subtotal = $398,628

Issue Date FY: 2022 ( Subtotal = $386,395 )
2022	2022	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON ST	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	5/18/2022	NEW	$386,395
														Subtotal = $386,395

Grand Total All Awards = $1,583,330

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A quality and cost analysis of interprofessional team continuity in ICUs

Award Number: R01HS028438

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: 09/01/2022

PERIOD OF PERFORMANCE END DATE: 06/30/2027

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