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Welcome to the Center for Health Outcomes and Policy Research

Center Director, ​Dr. Linda H. Aiken, receives $2.9m from NINR to conduct large four-state panel study on nursing and patient outcomes
logo.9.17.jpgSeptember 15, 2014 - Center faculty, fellows and staff are gearing up to repeat the multi-state surveys of U.S. registered nurses conducted in 1999 and in 2006. Researchers were authorized by NINR to start immediately on the study entitled Panel Study of Effects of Changes in Nursing on Patient Outcomes. The newest influx of grant monies will help CHOPR investigators design and implement an efficient, innovative extension of the earlier survey, thus creating a larger study of the impact of change in nursing factors on outcomes. Slated to go live in January of 2015, approximately 300,000 registered nurses residing in Pennsylvania, New Jersey, Florida and California will receive the survey via US mail and will record their responses on the paper form or opt to complete it electronically. Researchers plan to analyze data from RNs working in over 600 hospitals and hundreds of nursing homes and home care agencies. The project has already been endorsed by many nursing organizations including the PA Action Coalition, NJ Board of Nursing, Florida State Board of Nursing, Natl. Council on State Boards of Nursing, and the CA Institute for Nursing and Health Care. Principal Investigator, Dr. Linda H. Aiken, leads the project with co-investigators: Center Associate Director, Dr. Matthew McHugh; Adjunct Professors, Drs. Douglas Sloane and Jeannie Cimiotti; Assistant Professor, Dr. Ann Kutney-Lee; Postdoctoral Fellows, Drs. Olga Jarrin and Hilary Barnes; and, Professor of Sociology, Dr. Herbert Smith. "Our study will examine organizational-level changes over time in nurse inputs in education, staffing, skill mix, and work environment between 1999, 2006, and 2015," said Dr. Linda Aiken, "the great strength of this project is that in creating a panel of organizational observations, we can see where change has occurred and why." The Center has also secured additional funding for the panel study from the Robert Wood Johnson Foundation, the National Council of State Boards of Nursing, the Hillman Foundation, and the Boettner Center.
Dr. Martin McKee, Professor of European Public Health at the London School of Hygiene and Tropical Medicine, is slated to meet with CHOPR faculty and fellows in September

mcKee.pngAugust 12, 2014 - Dr. McKee is founding director of the WHO European Centre on Health of Societies in Transition which comprises the largest team of researchers working on health and health policy in central and eastern Europe and the former Soviet Union. He is also the research director of the European Observatory on Health Systems and Policies, which is a unique partnership of universities, national and regional governments, and international agencies. McKee extends his reach even further as the President-elect of the European Public Health Association, an umbrella organization for public health associations and institutes in Europe. He is also a prolific writer and has published over 760 scientific papers and 42 books. You can find Dr. McKee every fall semester at the London school teaching the course he established on the issues of public health. "This course seeks to show that public health can actually be exciting and stimulating," says McKee. "It is intended for people who want to make the world a better, and fairer place to live in." He is a long time CHOPR research collaborator and serves with Dr. Aiken on the current Lancet Commission on Nursing in England. Dr. McKee will speak at noontime to Center faculty and fellows on Monday, September 22 about the "Quality Storm and Public Perceptions of Nurses in the UK." Follow the below links to learn more about the work of the Lancet Commission. Readers can also scroll down this page to read the initial story of the Lancet Commission's formation and appointment of Dr. Aiken.

​​CHOPR Study reveals how close Pennsylvania hospitals are to meeting IOM goals for an 80% BSN-prepared workforce
July 7, 2014 - Nearly four years after the release of the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, many states are continuing their work to increase the proportion of baccalaureate-prepared nurses (BSNs) to the recommended 80% level. This work is being accomplished primarily through the work of state-based action coalitions that are working locally to enact the recommendations. However, data to inform the decisions and recommendations of these working groups are difficult to find and is rarely carried out. Utilizing CHOPR's unique nurse survey from 2006, Assistant Professor of Nursing, Dr. Ann Kutney Lee, predoctoral fellow, Shweta Singh and Center Director, Dr. Linda H. Aiken, recently crafted a white paper that provides baseline data to the Pennsylvania Action Coalition on the number of BSNs working in hospitals in each of the nine regional action areas in the state. The research brief allows local agencies to benchmark themselves with respect to other hospitals in their region, and also outlines a set of recommendations for agencies and targets for policy intervention.
Links for Additional Information
•Representation of Baccalaureate-Prepared Nurse in PA Hospitals:ResearchBrief.pdf
•Follow the link & scroll down for more info about the CHOPR study
​Center Director, Dr. Linda H. Aiken, delivers keynote to the Association of Health Professionals of Sweden
withSineva.jpgMay 30, 2014 ​​- The CHOPR Center Director visited Stockholm, Sweden in early May to help examine the results of the RN4Cast EU-funded study of the hospital nurse workforce. The survey findings in Sweden were reviewed on May 5th at the Nobel Forum, and again on May 6th to the Association of Health Professonals of Sweden, sponsored by the Karolinska Institutet. The day long conference "Producing High Quality Health Care: Research on the Impact of Nursing" brought together key RN4Cast research partners including professors Peter Griffiths from the University of Southampton, Carol Tishelman from the Karolinska Institutet, and Jane Ball from Kings College in London. The symposium was hosted and moderated by Vårdförbundet president, Sineva Ribiero (pictured above with Linda H. Aiken); Kerstin Tham, vice-president of Karolinska Institutet; and, professor of nursing, Dr. Carol Tishelman. Dr. Aiken's keynote address entitled, "Impact on Nursing on Patient Outcomes" revealed some of the most pertinent issues surrounding the large study in Sweden. Dr. Griffiths helped bring clarity to organizing the nursing workforce for the best outcomes with his view from England. The afternoon panel discussion on the "Implications for Swedish Health Care" was populated by experts and officials in health care and government including the Stockholm County Council, the Karolinska Hospital, the Division for Public Health and Health Care, and the Health and Social Care Inspectorate.
Pennsylvania Hospital Senior Leadership listen to Brief on the Economic Value of Improving Nurse Staffing

PAhosp.jpgMarch 17, 2014 - Dr. Linda H. Aiken and a team of nurse scientists collaborated with Pennsylvania Hospital Research Scholars in order to present a brief on the business case for improving nurse staffing. The nurse scholars reported their findings   to the senior management team of Pennsylvania Hospital (PAH) as a part of the hospital's budget preparation process. Preparing a hospital budget is always a complex procedure and requires the participation and input from a broad cross section of hospital officials and departments. Clinical Nurses, Lindsay Verica and Lauren Ellis presented the literature and their professional insights on behalf of patients and in support of the profession of nursing. In addition, PAH Nursing Quality Coordinator for Quality and Safety, Katie Farrell, offered her observations in a speech entitled "Quality Nursing Outcomes, The Value Equation," which focused on the business case for nurse staffing. CHOPR nursing scientists, Dr. Sunny G. Hallowell and Dr. Ann Kutney-Lee helped lead the briefing. "We will most certainly utilize the evidence provided today and the work of the Exemplary Practice Budget Team to inform our investment decisions," said PAH Chief Nurse Executive, Mary Del Guidice, following the presentation. "It is vitally important every dollar be spent wisely and this work affords us the ability to do so."

Photo: PAH scholars and nurse colleagues are pictured above following a briefing with the hospital's senior leadership team, including CEO Dr. Michael Buckley (far right).

​CHOPR International Study Confirms Strong Link Between Nursing Education and Patient Outcomes

Europe-020v3.jpgFebruary 26, 2014 - New research published in The Lancet, shows that patients experiencing complications after surgery are more likely to survive if treated in hospitals with adequate nurse staffing levels and higher numbers of nurses prepared at the baccalaureate degree level. To determine whether differences in patient-to-nurse workloads and nurses’ educational qualifications affect patients’ survival after surgery, Professor of Nursing and Center Director, Linda H. Aiken along with the RN4Cast Consortium, analyzed responses from more than 26,000 nurses. The team led by Aiken reviewed the medical records of almost 500,000 patients (aged 50 years or older) who were discharged following a general surgical procedure in hospitals across nine European countries. The patient outcomes signal that in Europe, as in the U.S., failing to invest in bachelor’s nurse education and cutting costs by reducing nurse staffing may put hospitalized patients at greater risk of dying. The striking results show that every extra patient added to a nurse’s average workload increases the chance of surgical patients dying within 30 days of admission by 7%. Interestingly, a 10% increase in the proportion of nurses holding a bachelor degree is associated with a 7% decrease in the risk of death. “Our findings emphasize the risk to patients that could emerge in response to nurse staffing cuts under recent austerity measures, and suggest that an increased emphasis on bachelor’s education for nurses could reduce hospital deaths”, says Professor Linda H. Aiken speaking from the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, “A safe level of hospital nursing staff might help to reduce surgical mortality, and challenge the widely held view that nurses' experience is more important than their education.”

Photo (shown above): Co-directors of RN4Cast, Professors Linda H. Aiken and Walter Sermeus with resesarchers from Switzerland.

LINKS TO RESEARCH PAPER AND MORE ON THE GROUNDBREAKING RESEARCH

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Center Director, Dr. Linda H. Aiken, appointed to a special two-year Lancet Commission
January 22, 2014 - Dr. Linda H. Aiken, along with other international nurse leaders and executives have been authorized by the world's leading medical journal, The Lancet, to tackle the poor perception of nursing in the United Kingdom. Dr. Roger Watson, professor of nursing at the University of Hull will lead the commissioners and charge them with examining nursing education, practice, image, and workforce. The assignment was born out of the need to understand why the public carries a lower than average view of the nursing profession in the United Kingdom, especially when compared to other countries. For example, nursing in the United States comes out at the top of a Gallop poll for most trustworthy professions, and has been consistently graded so for the past twelve years. The fourteen high-profile nurse commissioners will study how to improve the poor public image of nursing in the UK. The Lancet publishes a weekly journal and six monthly specialty journals in the fields of global health, diabetes and endocrinology, oncology, neurology, respiratory medicine, and infectious diseases, and frequently holds Commissions on health issues.

Center Fellows discuss CHOPR'S diverse research projects with National Institute of Nursing Research Director, Dr. Patricia Grady

Pat Brady 003a.jpgNovember 6, 2013 - Internationally recognized nurse researcher and Director of the National Institute of Nursing Research (NINR), Dr. Patricia Grady, joined faculty and fellows of the Center for Health Outcomes and Policy Research for a roundtable discussion before facilitating the highly anticipated School of Nursing colloquium on “Nursing Science: Looking Ahead”. CHOPR fellows shared updates on their NINR-supported research and the potential these studies have to impact both clinical practice and healthcare policy. As discussed at the roundtable, CHOPR researchers are continuing to search for opportunities to use the Center’s innovative four-state nurse survey and existing clinical data resources in order to further inform patient care. Highlights of the discussion included Dr. Hallowell's collaboration with the Vermont Oxford Network to study the impact of nurse work environment on human breast milk support in the NICU for the most vulnerable of infants, Dr. Rochman’ s work with the American Heart Association’s "Get With The Guidelines" to examine nursing factors associated with in-hospital cardiac arrest survival, and the ways in which the Center is exploring ways to use the four-state survey in combination with patient level data to study a variety of clinical outcomes. The mission of the NINR is to promote and improve the health of individuals, families, and communities.

Above photo from left: Dr. Sunny G. Hallowell, Postdoctoral Fellow; Danielle Altares Sarik, Predoctoral Fellow; Jill Vanak, Predoctoral Fellow; Dr. Linda H. Aiken, Center Director, CHOPR; Dr. Patricia Grady, Director, NINR; Dr. Matthew D. McHugh, Associate Director, CHOPR; Dr. Olg Jarrín, Postdoctoral Fellow; Dr. Monica Rochman, Predoctoral Fellow.

​CHOPR Announces New Study to Focus on Nursing and Quality of Hospital Care in Israel
Group2_Web.jpgOctober 5, 2013 - A collaboration between nurse leaders from Jerusalem and CHOPR fac​ulty led by Center Director, Dr. Linda H. Aiken, was recently established and aims to replicate the work of the RN4Cast Consortium in the European Union. The new partnership promises to produce compelling recommendations on how to improve nursing care and patient outcomes in hospital settings in the country of Israel. The study findings will help the principal parties influence national policy changes to improve care.​ Dr. Hanna Admi, an expert in nursing management and clinical pediatric nursing traveled to the Center with her team in early October to help design and implement the study, "We are very excited to take this project to the next level," she said. Admi has been actively involved in the Association of Hospital Nursing Directors and is devoted to improving the quality of nursing care in Israel through nursing education, administration and research. The team also met with nursing school dean, Dr. Afaf Meleis, who was instrumental in securing a portion of the funding from the University of Pennsylvania. Photo shown above from left: Dr. Matthew D. McHugh, Associate Director of CHOPR; Dr. Hanna Admi, Director of Nursing, Rambam Health Care Campus, Haifa Israel; Dr. Linda H. Aiken, Director, Center for Health Outcomes and Policy Research; Dr. Orly Toren, Assistant Director of Nursing, Hadassah Medical Organization; and, Dr. Anat Peles Bortz, Nurse Researcher at Nurse Research at Clalit Health Services.
Center Assistant Professor of Nursing. J. Margo Brooks Carthon, Ph.D., A.P.R.N. selected as a 2013 Robert Wood Johnson Foundation Nurse Faculty Scholar
September 11, 2013 - Center Assistant Professor of Nursing, Dr. Margo Brooks Carthon, is one of just 12 nursing educators from across the United States to win a highly competitive grant from the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program this year. “This award from Robert Wood Johnson Foundation provides a wonderful opportunity to examine a serious public health problem that affects thousands of older minorities—avoidable re-hospitalizations. Results from the study will identify the post-discharge health needs of older minorities and elicit how nurse resources are best employed to reduce readmission disparities,” Brooks Carthon added. The RWJF Nurse Faculty Scholars program strives to strengthen the academic productivity and overall excellence of nursing schools by developing the next generation of leaders in academic nursing. Brooks Carthon is part of the program’s sixth cohort. Center faculty, Dr. Nancy Hanrahan, The Kurlowicz Term Associate Professor of Nursing; and, Dr. Matthew McHugh, The Rosemarie Greco Associate Professor in Advocacy, both held the position of RWJF Nurse Faculty Scholar in the past. According to RWJF, the support of junior nurse faculty will help curb a shortage of nurse educators, the lack of which could undermine the health and health care of all Americans. It is a well known fact that the Affordable Care Act is vastly increasing the number of people who can access health care in the United States. As the number of patients increases, there will be greater demand for skilled nurses as well as faculty to educate them. Folow this link to read more about Dr. Brooks Carthon's three-year funded study.
​Center Associate Director, Dr. Matthew McHugh, PhD, JD, RN, MPH, CRNP, FAAN, named The Rosemarie Greco Term Endowed Associate Professorship in Advocacy
September 3, 2013 - Dr. Matthew McHugh’s research focuses on the effects of policy and organizational factors on nursing practice and health outcomes. In a letter to the entire nursing school community announcing the prestigious appointment of Dr. McHugh, Dean Afaf Meleis writes, "[Dr. McHugh's] expertise in nursing, law, and public health brings an interdisciplinary eye to measuring the success of organizational structures and governmental actions in improving health outcomes and decreasing health disparities." Dr. McHugh is also a Senior Fellow of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, a Senior Fellow at Penn's Center for Public Health Initiatives, a Fellow at the University of Pennsylvania Institute on Aging, and an RWJF Nurse Faculty Scholar. The purpose of the term endowed Fund is to provide financial support to a faculty member at the Nursing School with an interest in policy and advocacy. Rosemarie Greco, for whom the chair is named, is immediate past chair of Penn Nursing’s Board of Overseers. Most recently she served as the Senior Advisor to the Governor on Pennsylvania's Health Care Reform Policy and has a very strong interest in working with Dr. McHugh on advocacy and policy changes. The endowment is sponsored by Excelon in honor of Greco's service to its Board of Directors for over 14 years.
CHOPR Director, ​Dr. Linda H. Aiken, oversaw the Project Workshop on Community Health Nursing in Chengdu, Sichuan China
China2013v3.jpgMay 10, 2013 - Members of the CMB (China Medical Board) Nursing Network from eight provinces in China assembled recently with Dr. Linda H. Aiken, Senior Advisor on Nursing for the CMB; and, Dr. Thomas Mackey, Associate Dean for Practice, and Director of the University of Texas Health Service. The purpose of the meeting was to design a multi-site model for expanded roles for nurses in community care. The CMB China Nursing Network is a collaboration between eight university nursing schools and their faculty. The CMB created the China Nursing Network (CNNN) in order to revise and update current nursing curricula, strengthen faculty, promote research, and experiment with new models of service delivery. The above photo taken with Drs. Aiken and Mackey include nurses and other officials from the West China Nursing School of Sichuan University in Chengdu; the Xi’an Jiaotong University School of Nursing; the Central South University School of Nursing; and, the China Medical University School of Nursing. Follow this link to learn more about CHOPR's research and work in China.
​The Center for Health Outcomes and Policy Research and the Pennsylvania Hospital Department of Nursing kickoff new collaborative research initiative
PAKickoff.jpgApril 22, 2013 - The Pennsylvania Hospital Nursing Research Scholarship Program was developed to provide clinical nurses the opportunity to learn and participate in scholarly research projects. Under the guidance of Dr. Linda H. Aiken and her team, nurses will receive education, mentoring and support. The Program, utilizing the tenants of the Magnet® Framework for Nursing Excellence, seeks to develop participants as research mentors for the staff at Pennsylvania Hospital, foster professional growth, develop a culture of research appreciation and utilization in clinical practice, and increase the amount of research conducted by direct care nurses at Pennsylvania Hospital. Photo from Left: Dr. Ann Kutney Lee, Assistant Professor of Nursing, CHOPR; Dr. Linda Hatfield, Director of Research and Evidence-Based Practice, Pennsylvania Hospital; Dr. Linda H. Aiken, Director, Center for Health Outcomes and Policy Research; Dr. Michael Buckley, Executive Director, Pennsylvania Hospital; and, Mary Del Guidice, Chief Nursing Officer, Pennsylvania Hospital.
Center Director, Dr. Linda H. Aiken, is the recipient of the inaugural 2013 Velji Global Health Project of the Year Award
LindaAward-003v1.jpgApril 15, 2013 - The CUGH Awards Committee has selected Dr. Linda H. Aiken, as the recipient of the Velji Project of the Year Award for 2013. The Consortium of Universities for Global Health (CUGH) honors individuals who have made exceptional contributions to the field of global health. The Award was presented to Dr. Aiken - a leader who exemplifies CUGH’s mission of building collaborations and exchange of knowledge across disciplines - at the Fourth Annual CUGH Conference in Washington, DC, entitled Global Health: Innovation, Implementation, Impact.

Follow this link to find out more about CUGH

​Standing Faculty from the School of Nursing with Leonard Davis Institute of Health Economics Executive Director, Dr. Daniel Polsky
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​January 10, 2013 - Photo shown above from left: Dr. Eileen Lake, Associate Director, CHOPR; Daniel Polsky, Executive Director, LDI; Dr. Linda H. Aiken, Director, CHOPR; and Dr. Yvonne Patterson, PhD, Associate Dean for Research, UPENN School of Nursing.
A Keynote Address Deliverd by Center Director, Dr. Linda H. Aiken, Garnered Media Attention Overseas
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Dr. Aiken delivered the keynote address at the Norwegian Nurses Organization's Centenary Jubillee in Oslo, Norway in celebration of the organization's 100th Anniversary.

Graduate Nurse Education Network of Greater Philadelphia to Produce More Advanced Practice Nurses
August 6, 2012 - The Hospital of the University of Pennsylvania has been funded by the federal government to facilitate an increase in the numbers of nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists educated in the Greater Philadelphia Region. The following nine nursing schools are participating. Interested applicants are referred to their websites for more information about applying.
HUP awarded funding to carry out Graduate Nurse Education Demonstration

HUP with CHOPR OfficialsAugust 3, 2012 - HUP officials gathered with CHOPR principals for the first time after learning that Penn is one of five hospitals selected to carry out the Graduate Nurse Education Demonstration. The primary goal of the demonstration is to increase the provision of qualified training to APRN students. The clinical training included in this demonstration will provide APRNs with the clinical skills necessary to provide primary care, preventive care, transitional care, chronic care management, and other services appropriate for Medicare beneficiaries.

Photo shown from left: Amy Miller, Research Center Administrator; Garry Scheib, Executive Director, HUP; Victoria Rich, Chief Nursing Officer, HUP; Dr. Linda H. Aiken, Center Director; Dr. Matthew McHugh, Assistant Professor of Nursing.

 
 

What is the RN4Cast-United States?
 

The RN4Cast-US is another name for one of the largest nursing care and patient outcomes study of its kind. This NINR, NIH-funded panel study on health care outcomes and health workforce policy is currently being carried out by the Center for Health Outcomes and Policy Research (CHOPR). Today, CHOPR investigators are taking steps to reach almost 300,000 RNs living and working in Philadelphia, California, Florida and New Jersey, to glean fresh responses to questions regarding nursing care in their practice setting and linking their answers to patient care outcomes. It’s a great opportunity for nurses in the field to make a difference by helping investigators record the impact of nursing care on patient safety, policy and practice.

The Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing is a research and research training enterprise focusing on the outcomes of health care and health workforce policy. Established in 1989, the Center is a unique community within the School of Nursing drawing together faculty, students, and pre- and post-doctoral fellows from nursing, sociology, demography, medicine, management, economics, and other related disciplines. With collaborators from around the world, Center researchers study health system reorganization and policy changes and aim to produce research evidence to improve the quality of health care.

Our Program of Research

Nursing workforce issues - the supply of nurses, nurse education, and scope of practice

The impact of legislation and policy, hospital organization and staffing, and hospital economic, geographic and social context on patient outcomes like mortality, adverse events, and hospital readmissions and nurse outcomes like job satisfaction and burnout.

The impact of policy, hospital organizational traits and context on racial, ethnic and socioeconomic disparities in health care outcomes

The impact of changing hospital populations -namely patients with increasingly complex and chronic conditions-on the organization of nursing care and patient and nurse outcomes.

Our studies have always involved adult medical/surgical patients and over the years we have expanded our focus to include pediatric, neonatal, psychiatric, oncology, ICU, the elderly, the chronically ill and other specialty populations.