Projects
Team contributions to patient care in the intensive care unit (ICU)
In our first published paper examining team contributions, we used Yakusheva’s value-added modeling approach to study ICU nursing teams and their impact on patient outcomes. This paper was published in the American Journal of Respiratory and Critical Care Medicine.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7049918/ OR https://pmc.ncbi.nlm.nih.gov/articles/PMC7049918/pdf/rccm.201903-0543LE.pdf
pre-OPTIC: Examining optimal ICU team composition in adult critical care units
American Thoracic Society Nursing Research Grant
MPIs: Deena Costa PhD, RN (contact) & Olga Yakusheva PhD
Co-investigators: Deanna Marriott, PhD
Team: Marlene Otto, Nathan Wright, Lara Khadr, Kathryn Lee, PhD
With American Thoracic Society grant funding, our team developed, implemented and validated a method to identify nurses, physicians and respiratory therapists caring for mechanically ventilated adults in 5 ICUs in a single academic medical center using electronic health record data. In a paper in JAMIA, we describe our approach, its validation and share information so that other researchers can apply our methods. [Link to Yakusheva Journal of American Medical Informatics Association, 2025 paper].
We then applied this method for the first time, to capture interprofessional familiarity – how often clinicians shared patients in each ICU – and its association with individual patient care. Prior work demonstrated that nurse familiarity at the unit-level was an important indicator of improved ICU patient outcomes however, it had not yet been established whether familiarity among the nurses, physicians and respiratory therapists caring for mechanically ventilated adults was associated with improved patient care and outcomes. Using data from over 10,038 patient encounters over 2 years, we found that greater familiarity among the ICU interprofessional team each shift over the course of each patient’s ICU stay, was significantly associated with shorter duration of mechanical ventilation, greater likelihood of spontaneous breathing trials (an evidence-based care practice shown to improve patient outcomes) and lower likelihood of death. These findings were robust to different measurement of familiarity as we described in our paper published in American Journal of Respiratory and Critical Care Medicine [link to Costa et al., AJRCCM 2024].
ICONIC: A quality and cost analysis of interprofessional continuity among teams in the ICU
Agency for Healthcare Research and Quality, R01HS028438
PI: Olga Yakusheva PhD
Co-investigators: Deena Kelly Costa PhD, RN, Marianne Weiss PhD, RN, Deanna Marriott
Team: Marlene Otto, Kathryn Lee, Nathan Wright, Hyunji Kim
Our ATS grant funded work was a precursor methodologically to our ongoing AHRQ R01 known as the ICONIC project. ICONIC expands our ATS findings to examine continuity – a related but distinct measure of ICU teams.
One feature of the healthcare workforce that has received much attention in the past is continuity of care – whereby a patient is cared for by a small team of identified professionals over time. Continuity of care has long been recognized as an essential attribute of high- quality, patient-centered care with data supporting greater continuity is associated with fewer emergency department visits and hospitalizations, lower healthcare costs, and higher patient satisfaction in primary care. But few if any studies conceptualize, examine or measure continuity of care in the ICU – where care is delivered by interprofessional teams of physicians, nurses, and respiratory therapists. In our ICONIC project, we are examining the effect of continuity of ICU interprofessional teams on patient outcomes and organizational economic outcomes in two healthcare systems to guide future interventions in 13 ICUs across two different healthcare systems using data from 2018 – 2023. Using our pioneering quantitative methods and qualitative approaches, we assess intra-professional and interprofessional continuity over a patient’s ICU stay and each shift, determine how continuity is associated with outcomes and costs and explore how to implement a continuity-based staffing approach in intensive care units. We hypothesize that care delivered by shift-level ICU teams with higher intra- and inter-professional continuity will result in improved patient outcomes and reduced costs. Completion of the study will generate the most robust evidence, to date, to inform organizational priorities about continuity-based interprofessional staffing in ICUs, and to improve care for critically ill ICU patients.
CORE-ICU: Organizational resilience: A novel strategy for improving ICU outcomes
MPIs: Deena Costa PhD, RN (contact) and Mara Buchbinder PhD
Co-investigators: Olga Yakusheva, Lesly Kelly, Marianne Weiss, Theodore J. Iwashyna
ICU nurses, physicians and respiratory therapists are experiencing record high rates of burnout. Burnout is an occupational phenomenon resulting from chronic workplace stress and is characterized by exhaustion, depersonalization, and reduced professional efficacy. Burnout has been associated with poorer safety ratings, quality of care, and patient outcomes. Interventions to reduce burnout have focused on individual clinicians, but this approach neglects the organizational factors contributing to burnout, and consequently, has been only marginally effective. Organizational resilience is a promising approach for addressing burnout in ICU teams and improving outcomes in patients with acute respiratory failure. Organizational resilience is the capacity of a complex adaptive system to anticipate stressors, perform under stressful conditions, and adapt moving forward. While the relationships among organizational resilience and employee health and performance outcomes have been described in other settings, organizational resilience has not been measured in healthcare settings. Capitalizing on our team’s expertise in ICU organization and survey research, our partnership with the 4th largest U.S. healthcare system with hospitals in 21 states, we are conducting a novel mixed-methods sequential explanatory design study that examines resilience as an organizational phenomenon. By collecting survey data from ICU nurses, physicians, advance practice providers and respiratory therapists working in over 70 ICUs across the US, we are examining the dynamics of individual and organizational resilience, and how they contribute to patient outcomes (mortality and ventilator-free days) and clinician outcomes (burnout and wellbeing). We are also conducting qualitative work to describe the relationships between work environment, ICU organizational resilience, and interprofessional care. This project addresses a major gap in understanding how to best support a valuable healthcare resource: the clinicians that care for mechanically ventilated adults.
Individual nurse contributions to patient care
pre-ADVANCE: The impact of specialty nursing certification on patient outcomes and costs in acute care: An individual value-added performance analysis
American Nurses Foundation (ANF)
MPIs: Olga Yakusheva PhD (contact PI) and Deena Kelly Costa PhD, RN
Co-investigators: Marianne Weiss
Team: David Rymakuru, Kathryn Lee, Marlene Otto
Leveraging Dr. Yakusheva’s pioneering methods to examine the contribution of each individual nurse to patient care, we have ongoing thread of research that examines specialty nurse certification. While prior work has documented the benefits of specialty nurse certification for nurses, as well as how hospitals that have a greater proportion of specialty nurses is associated with improved outcomes for all patients, our work extends this first to explore how to enhance accuracy and completion of nurse specialty certification data at the hospital level and then to examine the individual contribution of a specialty certified nurse to each patient’s care. With funding from the American Nurses’ Foundation, we evaluate the direct contribution of specialty RN certification to patient outcomes and the organizational business case for specialy nurse certification in acute care settings. This is a 3-year linked nurse-patient level database study and the study sites are two large South Carolina healthcare systems (9 hospitals) and their patients (18 years or older) who were hospitalized for 24 hours or more and the RN certification data files of the nurses caring for these patients from January 1, 2020 through December 31, 2021.
ADVANCE: The impact of specialty nursing certification on patient outcomes and costs in acute care: An individual value-added performance analysis
Agency for Healthcare Research & Quality R01HS028806
MPIs: Olga Yakusheva PhD (contact) and Deena Kelly Costa PhD, RN
Co-investigators: Marianne Weiss, Lesly Kelly
Team: Nathan Wright, Kathryn Lee, Marlene Otto
Expanding upon our pre-ADVANCE research findings, we are examining the impact of RN specialty nurse certification on nurse performance, patient outcomes and costs in over 140 hospitals in 21 states. Our proposal draws on our team’s prior and current expertise in nurse-patient linked analyses of electronic health record data, individual nurse value-added performance measurement, and quasi-experimental regression methods for causal inference (i.e. difference-in-difference with time-varying treatment effects). We will determine whether RN specialty certifications improve nurse performance and we will determine if patient outcomes and organizational financial outcomes improve with a higher proportion of specialty-certified nurses. We will also explore the contexts and mechanisms that support or hinder the impact of specialty nurse certification on patients, costs, and organizational outcomes. Taken together, the aims of this mixed methods study will provide the most robust, causal, and generalizable evidence to inform investments in nurse human capital to optimize nurse performance, achieve targeted patient outcomes, and reduce costs of care.