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Quantifying Nurse and Physician Clinical Performance for Mechanically Ventilated Patients
Christopher F Chesley1, Yingying Lu2, Rachel Kohn1
1Division of Pulmonary, Allergy, and Critical Care, Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Health Services Research
|July 29, 2026
Summary
Nurse and physician performance in intensive care units (ICUs) independently impacts patient illness severity trajectories. Nurse assignments explained more disease severity variance than physician assignments in mechanically ventilated patients.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Nursing and Medical Practice
Background:
- Value-added modeling is increasingly used for clinician performance measurement.
- Previous research has focused on individual clinician performance, with less emphasis on simultaneous assessment of nurses and physicians.
Purpose of the Study:
- To quantify simultaneous nurse and physician performance in managing mechanically ventilated patients.
- To assess the independent and collective contributions of nurses and physicians to patient illness severity trajectories.
Main Methods:
- Retrospective cohort study across five academic hospitals.
- Utilized multiple linear regression on electronic health record data from 2018-2022.
- Assessed patient illness severity using the Laboratory-based Acute Physiology Score.
Main Results:
- Analysis included 17,082 encounters, 215 physicians, and 1719 nurses.
- Nurse and physician assignments together explained 7% of disease severity variability.
- Nurse assignments accounted for greater variance (6%) than physician assignments (4%).
Conclusions:
- Both individual nurse and physician care significantly contribute to disease severity changes.
- Findings highlight the independent impact of nursing and medical care on patient outcomes in the ICU.
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