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The impact of specialty nursing certification on patient outcomes and costs in acute care: An individual value-added performance analysis

Award Number: R01HS028806
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: 08/01/2023
PERIOD OF PERFORMANCE END DATE: 05/31/2028

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The impact of specialty nursing certification on patient outcomes and costs in acute care: An individual value-added performance analysis - Contact PD/PI: Yakusheva, Olga PROJECT SUMMARY Specialty registered nurse (RN) certifications can be a popular choice for practicing RNs to to advance their knowledge and expertise and are one way hospitals invest in their nursing workforce. An estimated 40% of acute care RNs hold specialty certification and as many as 55% of hospitals offer tuition reimbursement and paid time off for completion potentially costing organizations several mission dollars annually. While RN specialty certification is a multi-million dollar industry, surprisingly little evidence exists about the value added by RN specialty certifications in terms of improved nurse performance and patient and organizational outcomes. Evidence that does exist is inconclusive and judged as low quality due to cross-sectional study designs, aggregation of data at the hospital- or unit-level, and poor quality of certifications data in most hospital human resource databases. Lack of robust evidence may lead to broad-scale under- (or over-) investment in specialty RN certification in the healthcare industry, potentially contributing to excessive costs and suboptimal patient outcomes. In collaboration with the 4th largest healthcare system in the United States (CommonSpirit Health, over 140 hospitals across 21 states), we will conduct nurse-patient linked analyses of the impact of RN specialty certification on nurse performance, patient outcomes, and costs. Our proposal draws on our team’s prior and current expertise in nurse-patient linked analyses of electronic health record data, individual nurse value-added performance measurement, and quasi-experimental regression methods for causal inference (i.e. difference-in-difference with time-varying treatment effects). In Aim 1, we will determine whether RN specialty certifications improve nurse performance using a one-nurse-to-many-patients linking approach we developed, allowing us to test the causal effect of obtaining a specialty certification on nurse performance and whether the effect of specialty certification on nurse performance depends on the type of certification (e.g. critical care, medical-surgical, wound/ostomy) and on nurse characteristics (education, experience). In Aim 2, using a one- patient-to-many-nurses linking approach we have developed, we will determine if patient outcomes and organizational financial outcome improve with a higher proportion of specialty-certified nurses; this Aim allow us to examine whether patients who receive a greater proportion of care from specialty certified nurses have improved outcomes and lower costs, and the financial impact (cost-benefit) of increasing the proportion of specialty certified nurses in different types of organizations (e.g. Magnet/non-Magnet, teaching/non-teaching). In Aim 3, we will explore the contexts and mechanisms that support or hinder the impact of specialty nurse certification on patients, costs, and organizational outcomes, through focus groups and interviews with nurses and nurse leaders. Taken together the aims of this mixed methods study will provide the most robust, causal, and generalizable evidence to inform investments in nurse human capital to optimize nurse performance, achieve targeted patient outcomes, and reduce costs of care. Project Summary/Abstract Page 7


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: 2026 ( Subtotal = $0 )
2026	2025	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	12/18/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2025 ( Subtotal = -$12 )
2025	2024	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE STE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	002	2	2/25/2025	NON-COMPETING CONTINUATION	$0
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	2/10/2025	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	004	3	2/27/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$73,183
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	1	2/25/2025	NEW	-$73,195
														Subtotal = -$12

Issue Date FY: 2024 ( Subtotal = $397,014 )
2024	2024	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	003	3	9/19/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$397,014
2024	2024	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	002	2	9/19/2024	NON-COMPETING CONTINUATION	-$397,310
2024	2024	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	5/16/2024	NON-COMPETING CONTINUATION	$397,310
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	1	2/28/2024	NEW	$0
														Subtotal = $397,014

Issue Date FY: 2023 ( Subtotal = $391,859 )
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	000	1	7/26/2023	NEW	$391,859
														Subtotal = $391,859

Grand Total All Awards = $788,861

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The impact of specialty nursing certification on patient outcomes and costs in acute care: An individual value-added performance analysis

Award Number: R01HS028806

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: 08/01/2023

PERIOD OF PERFORMANCE END DATE: 05/31/2028

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