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Established at the University of Pennsylvania in 1989, the Center for Health Outcomes and Policy Research, also known as CHOPR, operates as a unique community within the School of Nursing focusing on the outcomes of health care, health disparities, and health workforce policy.

Research, writing, thinking, and conversation at the Center for Health Outcomes and Policy Research has had a remarkable impact on health care, economics, social science and society.

Featured Research Projects

Panel Study of Effects of Changes in Nursing on Patient Outcomes

Funded by the National Institute of Nursing Research
Study Principal Investigator:  Linda H. Aiken, PhD, RN, FAAN
Supplemental Study: Alzheimer’s Disease and its related Dementias (AD/ADRD)
Supplemental Study Principal Investigator: Olga Jarrín, PhD, RN

CHOPR Replicated measurements made in 1999 and 2006 across approximately 665 hospitals and hundreds of nursing homes and home care agencies in the states of California, Florida, New Jersey and Pennsylvania, to examine organizational-level changes over time in nurse inputs in education, staffing, skill mix, and work environment. The supplemental study will determine the impact of nurse education, staffing, skill mix, and work environment on trajectories of care and outcome for people living with Alzheimer’s disease and related dementia’s.

The Impact of Nursing on In-Hospital Cardiac Arrest Patient Outcomes

Funded by the National Institute of Health
CHOPR Principal Investigator: Matthew D. McHugh, PhD, JD, MPH, RN, CRNP, FAAN

This three-year NIH funded project explores in-hospital cardiac arrests, focusing on the relationship between nursing and post-arrest outcomes. Findings from this study hold promise for reducing high rates of hospital readmissions and prolonged inpatient stays for heart failure patients thus saving money and avoiding adverse outcomes associated with hospitalization of the frail elderly.

Neonatal Intensive Care Unit (NICU) Performance: Missed Nursing Care and Infant Outcomes

Funded by the Agency for Healthcare Research and Quality (AHRQ)
CHOPR Principal Investigator: Eileen T. Lake, PhD, RN, FAAN

Infants with very low birth weights (VBLW) are among the most vulnerable hospitalized infants.  This project will address missed nursing care, for critically ill infants. The overarching goal of the proposed research is to improve NICU patient outcomes and parental satisfaction for VLBW infants by developing evidence about the association of missed care to infant outcomes and parental satisfaction, and the nurse workload and NICU factors associated with care being missed.

Disparities in the Outcomes and Processes of Care for In-Hospital Cardiac Arrest (IHCA): The Role of Differences in the Organization and Delivery of Nursing 

Funded by the National Institute on Minority Health and Health Disparities
Study Principal Investigator: J. Margo Brooks Carthon, PhD, RN, FAAN

This study examines the institutional mechanisms underlying IHCA disparities through a focused examination of front line care providers. In the hospital, nurses are the primary clinical surveillance system and play an integral role in the initiation and delivery of emergency responses. Nurses are responsible for early warning system monitoring; they have direct knowledge of patient conditions and changes in conditions and are often the first on the scene of a cardiac arrest.

Health services research on legislated nurse-to-patient ratios in Queensland, Australia

Funded by Queensland Health, Australia
CHOPR Principal Investigators: Linda H. Aiken, PhD, RN, FAAN,  Matthew McHugh, PhD, JD, MPH, RN, CRNP, FAAN
Partner Institution: Queensland University of Technology

The scope of the overall project is to provide research and evaluation services to support the implementation of mandated nurse-to-patient ratios and workload provisions across the Queensland public hospital system. Our evaluation will obtain nurse survey data and administrative data related to patients and hospitals from three groups of hospitals at multiple points in time. 


See the Research Projects page for additional ongoing research projects.

Featured CHOPR Publications

Nurses’ and patients’ appraisals show patient safety in hospitals remains a concern.

Journal: Health Affairs
Authors: Aiken LH, Sloane DM, Barnes H, Cimiotti J.

“Our findings confirm that patient safety remains a serious concern. Failure to substantially improve clinical work environments in most hospitals, as recommended by the Institute of Medicine, may be hampering progress toward improving patient safety.”

Rural and non-rural primary care physician practices increasingly rely on nurse practitioners.

Journal: Health Affairs
Authors: Barnes H, Richards MR, Martsolf G, & McHugh MD.

“Adding nurse practitioners is a useful way for practices to align themselves with contemporary efforts to improve access and performance. Our findings imply that primary care practices are embracing a more diverse provider configuration, which may strengthen health care delivery overall.” 

The Association of the Nurse Work Environment and Patient Safety in Pediatric Acute Care.

Journal: Journal of Patient Safety
Authors: Lake ET, Roberts KE, Agosto PD, Ely E, Bettencourt A,Schierholz ES, Frankenberger WD, Catania G, Aiken LH.

“The development of a culture of patient safety in acute inpatient pediatric settings has not been uniformly achieved and is seriously deficient in many institutions, risking harm to vulnerable children. Improving clinical work environments in hospitals holds promise for achieving a culture of patient safety that increases the reliability of care and prevents harm “

Quality of end of life care and its association with nurse practice environments in US hospitals.

Journal: Journal of the American Geriatrics Society
Authors: Lasater K, McHugh MD, Sloane DM, Aiken LH.

“Quality of end‐of‐life care in US hospitals is imperfect and is significantly worse in hospitals with poor nurse practice environments than in hospitals with the best environments. This study reinforces the importance of nurses in providing high‐quality end‐of‐life care.”

Effect of changes in hospital nursing resources on improvements in patient safety and quality of care: A panel study. 

Journal: Medical Care
Authors: Sloane DM, Smith HL, McHugh MD, Aiken LH.

“Improvements within hospitals in work environments, nurse staffing, and educational composition of nurses coincide with improvements in quality of care and patient safety. Cross-sectional results closely approximate longitudinal panel results.”


See the Publications page for a complete listing of author publications.