# Economic modeling to understand the relationship between clinicians and outcomes of mechanically ventilated patients

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2022 · $366,731

## Abstract

PROJECT SUMMARY
Up to one million Americans undergo mechanical ventilation (MV) each year and are subject to high rates of
morbidity and mortality. Despite the availability of high-quality evidence for therapies that improve outcomes,
adherence to best practices and patient outcomes remain variable. MV patients are nearly universally cared for
in intensive care units (ICUs), where interprofessional team-based care – involving physicians, respiratory
therapists, and nurses, among others – is the norm. Evidence for the benefits of team-based care has driven
recommendations from international societies to support this model; however, best practices for team
collaboration remain unknown. We have shown that physicians contribute to variability in outcomes of MV
patients, and other studies have demonstrated that specific nursing factors are associated with patient
outcomes. However, previous studies have not accounted for the entire team in assessment of individual
members. An improved understanding of the roles and contributions of different members of an ICU team
would inform practices and interventions that could improve patient outcomes in this high risk population. The
primary objective of this proposal, therefore, is to better understand the relative contributions of physicians,
nurses, and respiratory therapists individually and as teams to outcomes of patients who undergo MV. We will
use “value-added modeling” (VAM), an economic approach developed for empirical individual performance
measurement when multiple individuals work in a single process. VAM has been validated for measuring
performance of acute care nurses and is uniquely suited to this question, in that it accounts for the multiple
clinicians that influence outcomes of individual patients. We will achieve our objective through four aims. First,
we will apply VAM to model the relationship between clinicians and patient acuity in a broad population of MV
patients, in order to estimate relative clinician performance within each professional group. Second, we will
compare the contributions of physician, nurse, and respiratory therapist performance based on VAM across a
broad range of patient and economic outcomes. We will quantify the contributions of clinician performance
relative to patient factors using the omega statistic, a method for estimating the relative variance explained by
different variable groups in a multivariable model. Third, we will evaluate the performance of VAM in a second
patient population of MV patients admitted to a national sample of Veterans Administration acute care
hospitals, and in patients who do not undergo MV, to evaluate the generalizability of VAM methods to estimate
clinician performance. Fourth, we will identify clinician and team factors associated with higher performance
using a mixed-methods approach. This study will further our understanding of the relative clinician
contributions to patient outcomes using innovative modeling techniques, will contr...

## Key facts

- **NIH application ID:** 10413996
- **Project number:** 5R01HL146386-03
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Meeta Prasad Kerlin
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $366,731
- **Award type:** 5
- **Project period:** 2020-06-01 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10413996

## Citation

> US National Institutes of Health, RePORTER application 10413996, Economic modeling to understand the relationship between clinicians and outcomes of mechanically ventilated patients (5R01HL146386-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10413996. Licensed CC0.

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