# Communicating Narrative Concerns Entered by RNs (CONCERN)

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2024 · $794,802

## Abstract

PROJECT SUMMARY/ABSTRACT
The Communicating Narrative Concerns Entered by RNs (CONCERN) system is an expert-knowledge,
machine learning, predictive model (CONCERN-PM) that produces an early warning score (CONCERN-EWS)
and is implemented as clinical decision support (CONCERN-CDS) to alert nurses and physicians about
hospitalized patients who are at risk of decompensation. CONCERN-PM leverages nursing documentation
patterns as a proxy measure of nurses’ decisions to increase surveillance and related interventions which are
an indicator of nurse concern about hospitalized patients – a key early indicator of decompensation. This five-
site observational implementation study is a renewal to our successful National Institute for Nursing
Research (NINR) funded R01, in which we developed and evaluated the CONCERN (Communicating
Narrative Concerns Entered by RNs) predictive model and clinical decision support (CDS) for hospitalized
patients in a multi-site randomized controlled clinical trial, with interim results of a 27% reduced likelihood of
inpatient mortality for patients whose clinicians received the CONCERN CDS intervention versus those who
did not. CONCERN-CDS alerts clinicians that a patient is at risk 42 hours earlier than leading EWS1. In this
renewal R01, we will conduct a five-site observational implementation study to evaluate fairness and
population validity of the CONCERN-PM, ecological validity of the CONCERN-CDS, and explore the
contribution of caregiver generated data to the performance of the CONCERN-PM as the next phase in
our multi-site nursing data science and implementation science program. EWS are in broad use at health
systems nationally, however, we have identified a lack of research findings demonstrating external validity and
fairness in other leading EWS.2 We will leverage 5 diverse study sites to test fairness, population validity, and
ecological validity across rural, suburban, and urban settings. The evaluation will be informed by the RE-AIM
(Reach, Effectiveness, Adoption, Implementation and Maintenance) and CFIR (
Consolidated Framework for
Implementation Research)
implementation science frameworks. The specific aims of this R01 Renewal are to:
Aim 1. Translate the CONCERN-PM to 2 additional specialty patient populations (emergency department and
inpatient pediatrics) and with the addition of social determinants of health (SDOH) data to evaluate model
calibration and performance across different patient populations and health systems; Aim 2. Evaluate
CONCERN-CDS implementation across all adult inpatient units at 5 health systems, in inpatient pediatric units
at 3 health systems and in the emergency department at 2 health systems to understand health system and
patient population characteristics associated with a successful implementation using RE-AIM and CFIR
Frameworks, and Aim 3. Using a patient-centered design approach, explore the creation of a patient-facing
CONCERN-PM and CDS for caregivers of inpatient pediatric pa...

## Key facts

- **NIH application ID:** 10832692
- **Project number:** 5R01NR016941-08
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Kenrick Dwain Cato
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $794,802
- **Award type:** 5
- **Project period:** 2017-04-06 → 2027-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10832692

## Citation

> US National Institutes of Health, RePORTER application 10832692, Communicating Narrative Concerns Entered by RNs (CONCERN) (5R01NR016941-08). Retrieved via AI Analytics 2026-06-01 from https://api.ai-analytics.org/grant/nih/10832692. Licensed CC0.

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