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Effectiveness of Concurrent Care to Improve Pediatric and Family Outcomes at End of Life

Award Number: R01NR017848
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 07/29/2024
PERIOD OF PERFORMANCE END DATE: 05/31/2028

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Effectiveness of Concurrent Care to Improve Pediatric and Family Outcomes at End of Life - Enter the text here that is the new abstract information for your application. This section must be no longer than 30 lines of text. This grant proposal represents a first competitive renewal (Cycle 2) of a highly productive, NINR-funded research program investigating a health policy intervention for children and adolescents with serious illness. The Cycle 1 research question was whether pediatric concurrent care (simultaneous hospice and medical care) affected pediatric and family outcomes. A significant increase in fragmented care transitions and a high risk of adverse outcomes was identified, along with a cohort of rural children and adolescents significantly affected by this care environment. In response, Medicaid programs in several states ushered in transitional care regulations (TCR) for pediatric concurrent care that mandated collaborative team efforts from nurses, physicians, pharmacists, child life specialists, and other health care professionals to support and coordinate pediatric end-of-life care across settings during concurrent care. In Cycle 2, the proposed policy effectiveness project focuses on advancing pediatric health policy by examining this policy modification within a rural cohort. The project’s specific aims are to: (1) estimate the effect of the TCR intervention on rural children’s end-of-life health (i.e., functioning) and health care (i.e., resource use, spending); (2) identify a subgroup of at-risk rural children using innovative machine learning methods; (3) examine potential mechanisms and pathways that may inform further policy improvement strategies important to rural children and families generally and the at-risk subgroup in particular. These aims will be achieved by conducting a multi-level natural experiment with a difference-in-difference analysis, supervised and unsupervised machine learning, and mediation and moderation analysis. The project team has the expertise in pediatric concurrent care (Lindley), data science (Keim-Malpass, Cao) and statistical analysis (Cozad, Svynarenko). Practice partner includes the National Network of Pediatric Palliative Care Coalitions. The project is innovative because it advances the understudied area of policy-focused effectiveness science. The project is significant and will have an impact because it focuses on a major policy modification and because it will generate knowledge to inform rural health care for children.


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 = $405,372 )
2025	2025	UNIVERSITY OF TENNESSEE	201 ANDY HOLT TOWER	KNOXVILLE	TN	37996	KNOX	USA	Nursing Research	000	6	6/26/2025	NON-COMPETING CONTINUATION	$405,372
														Subtotal = $405,372

Issue Date FY: 2024 ( Subtotal = $472,703 )
2024	2024	UNIVERSITY OF TENNESSEE	201 ANDY HOLT TOWER	KNOXVILLE	TN	37996	KNOX	USA	Nursing Research	001	5	8/1/2024	COMPETING CONTINUATION	$54,081
2024	2024	UNIVERSITY OF TENNESSEE	201 ANDY HOLT TOWER	KNOXVILLE	TN	37996	KNOX	USA	Nursing Research	000	5	7/29/2024	COMPETING CONTINUATION	$418,622
														Subtotal = $472,703

Issue Date FY: 2023 ( Subtotal = -$54,081 )
2023	2021	UNIVERSITY OF TENNESSEE	201 ANDY HOLT TOWER	KNOXVILLE	TN	37996	KNOX	USA	Nursing Research	000	4	1/3/2023	NON-COMPETING CONTINUATION	-$54,081
														Subtotal = -$54,081

Issue Date FY: 2021 ( Subtotal = $481,128 )
2021	2021	UNIVERSITY OF TENNESSEE	1331 CIR PARK DR	KNOXVILLE	TN	37916	KNOX	USA	Nursing Research	000	4	5/19/2021	NON-COMPETING CONTINUATION	$481,128
														Subtotal = $481,128

Issue Date FY: 2020 ( Subtotal = $555,682 )
2020	2020	UNIVERSITY OF TENNESSEE	1331 CIR PARK DR	KNOXVILLE	TN	37916	KNOX	USA	Nursing Research	001	3	8/11/2020	SUPPLEMENT FOR EXPANSION	$99,228
2020	2020	UNIVERSITY OF TENNESSEE	1331 CIR PARK DR	KNOXVILLE	TN	37916	KNOX	USA	Nursing Research	002	3	8/13/2020	SUPPLEMENT FOR EXPANSION	$108,222
2020	2020	UNIVERSITY OF TENNESSEE	1331 CIR PARK DR	KNOXVILLE	TN	37916	KNOX	USA	Nursing Research	000	3	5/18/2020	NON-COMPETING CONTINUATION	$348,232
														Subtotal = $555,682

Issue Date FY: 2019 ( Subtotal = $372,311 )
2019	2019	UNIVERSITY OF TENNESSEE	1331 CIR PARK DR	KNOXVILLE	TN	37916	KNOX	USA	Nursing Research	000	2	5/3/2019	NON-COMPETING CONTINUATION	$372,311
														Subtotal = $372,311

Issue Date FY: 2018 ( Subtotal = $418,129 )
2018	2018	UNIVERSITY OF TENNESSEE	1331 CIR PARK DR	KNOXVILLE	TN	37916	KNOX	USA	Nursing Research	000	1	7/31/2018	NEW	$418,129
														Subtotal = $418,129

Grand Total All Awards = $2,651,244

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Effectiveness of Concurrent Care to Improve Pediatric and Family Outcomes at End of Life

Award Number: R01NR017848

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

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

PERIOD OF PERFORMANCE START DATE: 07/29/2024

PERIOD OF PERFORMANCE END DATE: 05/31/2028

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