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The Impact of Changes in Nursing Systems and Models of Care on Patient Outcomes: A Panel Study

Award Number: R01NR014855
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/15/2014
PERIOD OF PERFORMANCE END DATE: 06/30/2031

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The Impact of Changes in Nursing Systems and Models of Care on Patient Outcomes: A Panel Study - Project Summary / Abstract Health systems continue to struggle to deliver reliable, high-quality care despite abundant evidence supporting effective clinical and organizational interventions. Translation often fails because the optimal systems and models of care are not sufficiently understood and aligned to facilitate effective care consistently. An underappreciated source of potential solutions is through nursing. Our project addresses this gap by identifying how modifiable nursing system features, such as adequate staffing, education, teamwork, work environment quality, and leadership, shape the real-world effectiveness of proven clinical and organizational interventions, and how external forces, such as policy reforms and corporatization, alter these relationships over time. Building on a 2+ decade, multistate longitudinal panel that links nurse, patient, and organizational data, this project uses causal designs to move beyond static “does it work?” questions toward mechanism-rich answers about how, for whom, and under what conditions nursing systems and models of care produce better outcomes. Our first aim is to identify modifiable nurse work environment features that amplify the effectiveness of each other and of evidence-based clinical interventions in practice. The second aim determines whether outcome improvements associated with staffing policies and Magnet/Pathway organizational reforms are mediated by changes in nursing resources and moderated by other work environment features. The final aim examines how corporatization in healthcare (i.e., consolidation and private equity ownership) affects nurse and patient outcomes, and whether effective leadership, clinician engagement, and policy safeguards moderate any adverse effects. By triangulating findings across emergent organizational change, intentional reforms, and external shocks, we can produce robust, complementary evidence on the causal mechanisms through which nursing systems enable reliable, high-quality care. Results can inform practice and policy strategies to optimize systems of care delivery, strengthen the nursing workforce, and protect population health across care settings.


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 = $812,445 )
2026	2026	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	003	10	9/17/2026	COMPETING CONTINUATION	$812,445
2026	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	002	9	9/14/2026	NON-COMPETING CONTINUATION	$0
2026	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	9	11/3/2025	NON-COMPETING CONTINUATION	$0
2026	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	001	9	8/4/2026	NON-COMPETING CONTINUATION	$0
														Subtotal = $812,445

Issue Date FY: 2025 ( Subtotal = $729,853 )
2025	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	001	9	6/17/2025	NON-COMPETING CONTINUATION	$729,853
2025	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	8	4/23/2025	TERMINATION	$0
														Subtotal = $729,853

Issue Date FY: 2024 ( Subtotal = $867,792 )
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	004	8	4/30/2024	SUPPLEMENT FOR EXPANSION	$84,959
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	002	8	2/1/2024	NON-COMPETING CONTINUATION	$704,550
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	005	8	5/2/2024	NON-COMPETING CONTINUATION	$78,283
2024	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	003	7	2/1/2024	SUPPLEMENT FOR EXPANSION	$0
2024	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	001	7	2/1/2024	NON-COMPETING CONTINUATION	$0
2024	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	7	1/23/2024	SUPPLEMENT FOR EXPANSION	$0
														Subtotal = $867,792

Issue Date FY: 2023 ( Subtotal = $1,020,853 )
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	7	1/11/2023	NON-COMPETING CONTINUATION	$793,353
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	002	7	9/14/2023	NON-COMPETING CONTINUATION	$0
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	001	7	6/20/2023	NON-COMPETING CONTINUATION	$0
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	003	7	9/14/2023	SUPPLEMENT FOR EXPANSION	$227,500
														Subtotal = $1,020,853

Issue Date FY: 2022 ( Subtotal = $815,404 )
2022	2022	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	6	3/31/2022	COMPETING CONTINUATION	$815,404
														Subtotal = $815,404

Issue Date FY: 2021 ( Subtotal = $0 )
2021	2018	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	5	2/1/2021	SUPPLEMENT FOR EXPANSION	$0
														Subtotal = $0

Issue Date FY: 2020 ( Subtotal = $0 )
2020	2018	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	5	6/25/2020	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2019 ( Subtotal = $0 )
2019	2018	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	5	1/8/2019	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2018 ( Subtotal = $895,696 )
2018	2018	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	001	5	9/14/2018	SUPPLEMENT FOR EXPANSION	$406,403
2018	2018	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	5	6/4/2018	NON-COMPETING CONTINUATION	$489,293
														Subtotal = $895,696

Issue Date FY: 2017 ( Subtotal = $489,293 )
2017	2017	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	4	6/29/2017	NON-COMPETING CONTINUATION	$489,293
														Subtotal = $489,293

Issue Date FY: 2016 ( Subtotal = $577,827 )
2016	2016	UNIVERSITY OF PENNSYLVANIA	3451 WALNUT STREET	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	3	6/15/2016	NON-COMPETING CONTINUATION	$577,827
														Subtotal = $577,827

Issue Date FY: 2015 ( Subtotal = $654,229 )
2015	2015	UNIVERSITY OF PENNSYLVANIA	3451 WALNUT STREET	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	2	6/24/2015	NON-COMPETING CONTINUATION	$654,229
														Subtotal = $654,229

Issue Date FY: 2014 ( Subtotal = $679,904 )
2014	2014	UNIVERSITY OF PENNSYLVANIA	3451 WALNUT STREET	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Nursing Research	000	1	9/12/2014	NEW	$679,904
														Subtotal = $679,904

Grand Total All Awards = $7,543,296

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The Impact of Changes in Nursing Systems and Models of Care on Patient Outcomes: A Panel Study

Award Number: R01NR014855

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

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

PERIOD OF PERFORMANCE START DATE: 09/15/2014

PERIOD OF PERFORMANCE END DATE: 06/30/2031

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