# Redesigning Systems to Improve Quality for Hospitalized Patients

> **NIH AHRQ R18** · NORTHWESTERN UNIVERSITY · 2021 · $339,593

## Abstract

PROJECT SUMMARY
Despite recent improvements, we are still a long way from consistently delivering high quality care to
hospitalized patients. Most adults requiring hospitalization are admitted for medical conditions, yet the optimal
model of care for these patients is yet to be established. Current care delivery models lack the ability to
optimally coordinate care on a daily basis and improve performance over time. A growing body of research has
tested interventions to redesign aspects of care delivery for hospitalized medical patients. These interventions
improve processes and culture, but the evidence that patient outcomes have improved is equivocal.
Importantly, most studies have examined the effect of single interventions in isolation, yet these interventions
are better conceptualized as complementary and mutually reinforcing components of a redesigned clinical
microsystem. Clinical microsystems are the front line care giving units where patients, families, and care teams
meet. We developed a set of complementary, mutually reinforcing interventions based on available evidence
and anchored in a clinical microsystem framework. The 5 interventions include: 1) Unit-based Physician
Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced Interdisciplinary Rounds, 4) Unit-level
Performance Reports, 5) Patient Engagement Activities. Our long term goal is to discover and disseminate the
optimal model of care to improve outcomes for hospitalized patients. Our specific objective for this proposal is
to implement a set of evidence-based complementary interventions across a range of clinical microsystems,
identify factors and strategies associated with successful implementation, and evaluate the impact on quality.
We will use mentored implementation, i.e., coaching by external professionals who are experts in the area of
focus, to help facilitate change. We will enroll 4 hospitals in this quality improvement mentored implementation
study. Our hypothesis is that uptake of the complementary components of the intervention set will result in
improvements in teamwork climate and patient outcomes. Specific Aims of the Redesigning Systems to
Improve Quality for Hospitalized Patients include 1) conduct a multi-site mentored implementation quality
improvement study in which each site adapts and implements complementary interventions to improve care for
medical patients, 2) evaluate the effect of the intervention set on teamwork climate and patient outcomes
related to safety, patient experience, and efficiency, and 3) assess how site-specific contextual factors interact
with the variation in the intensity and fidelity of implementation to effect teamwork and patient outcomes. The
findings generated from this study will be directly applicable to hospitals throughout the U.S. and our
partnership with the Society of Hospital Medicine, the American Nurses Association, and the Institute for
Patient- and Family-Centered Care will ensure effective dissemination and impa...

## Key facts

- **NIH application ID:** 10216337
- **Project number:** 5R18HS025649-05
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Kevin J O'Leary
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $339,593
- **Award type:** 5
- **Project period:** 2017-09-30 → 2023-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10216337

## Citation

> US National Institutes of Health, RePORTER application 10216337, Redesigning Systems to Improve Quality for Hospitalized Patients (5R18HS025649-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10216337. Licensed CC0.

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