# An Alternative Approach to Understanding the Drivers of High-Performance End-of-life Care Delivery in the Intensive Care Unit

> **NIH AHRQ F32** · NORTHWESTERN UNIVERSITY · 2021 · $74,958

## Abstract

PROJECT SUMMARY/ABSTRACT
 The overall goal of this research proposal is to facilitate the candidate's development as an
independently-funded surgeon scientist with a focus on bioethics-oriented health services, outcomes, and
quality improvement research. The candidate and her mentors have also designed a robust training plan
consisting of regular mentorship and formal didactic coursework in research methodologies and bioethics. With
this proposed NRSA individual fellowship application, the candidate will focus on career development while
also building skills in both quantitative and qualitative research methods by studying the delivery of end-of-life
(EOL) care in intensive care units (ICU) at Northwestern Memorial Hospital (NMH).
 A large number of adults in the United States are admitted to ICUs near their end of life. About 20 to 30
percent of them die using ICU services and many more receive care that is discordant to their wishes. Wide
discrepancies exist in how EOL care is delivered. The range in practice patterns cannot be explained by
patient and unit-level characteristics. EOL care is not standardized and quality measures require validation.
Furthermore, identifying latent, unit-level structures, processes, and culture that impact patients' EOL
experiences are unrealized opportunities for improvement. NMH has five different ICUs that operate
independently of each other. We hypothesize that amongst these ICUs there is variability in the process and
outcomes of EOL care delivery. We will use a mixed-methods approach to identify latent unit level differences
that can be attributed to the structure, process, and culture of a given ICU. From the electronic health record
(EHR), we will find measurable and recordable data on EOL quality metrics. Then through a positive-deviant
framework, involving an ethnographic case study and semi-structured interviews of the ICU clinicians, our goal
is to uncover practice patterns associated with high-performance on specific EOL care domains. The proposed
project is innovative because it is the first time measuring domains of EOL care while also studying the
environments from which these patients receive care. The systematic analysis of the complex influences on
EOL care delivery will lead us towards unit level interventions to improve ICU patient care in the future.

## Key facts

- **NIH application ID:** 10200682
- **Project number:** 5F32HS027724-02
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Bona Ko
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $74,958
- **Award type:** 5
- **Project period:** 2020-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10200682

## Citation

> US National Institutes of Health, RePORTER application 10200682, An Alternative Approach to Understanding the Drivers of High-Performance End-of-life Care Delivery in the Intensive Care Unit (5F32HS027724-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10200682. Licensed CC0.

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