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EBD Journal Club: The Variable Impact of Clinical Risk-Adjustment Models to Evaluate Hospital Design

When: January 19, 2024
Time: 11:00am Pacific
Price: FREE

Mead, M., Nanda, U., Ibrahim, A. 2023. Health Environments Research & Design Journal. Vol. 16(3), 146-155. doi.org/10.1177/19375867231154250.



Evidence-Based Design Journal Clubs are formatted for 15-minute presentations and 45-minutes of discussion to provide an opportunity for attendees to interact with authors who recently published EBD papers or articles in peer-reviewed journals such as HERD. Learn as they share ways to put their research into practice.

Attendees will receive a link to the article in their registration confirmation along with the Zoom link to the webinar. Please read the article in advance and submit any questions here for the presenters to prepare.



Objectives: To identify the impact of clinical risk adjustment models for evaluating pain medication consumption differences between private rooms and a multibed ward. 

Background: Views of nature are reported to reduce anxiety and pain for patients. This often leads to prioritizing large windows with views for patient rooms; however, it is not clear how other factors influencing pain (e.g., patient demographics) may confound evaluations of room design. 

Methods: We identified 1,284 patients at the University of Michigan undergoing thyroidectomy where patients recovered in one of the two locations: a private room with a view to nature or a multibed ward with no windows. We used pain medication data from the electronic medical record and risk adjustment models to evaluate pain medication consumption between the room types.

Results: Private room patients did not use more pain medications when measured using unadjusted morphine milligram equivalents (18.3 vs. 15.3 mg, p ¼ .06). Risk adjusting for age, gender, comorbidities, opioid history, and procedure subtype resulted in private room patients demonstrating higher consumption of morphine milliequivalents (17.5 vs. 15.5 mg, p < .01). In contrast, risk adjusting for age, gender, opioid history, and selected comorbidities estimated higher pain medication consumption for multibed ward patients relative to private rooms (16.27 vs. 15.51 mg, p < .05). 

Conclusion: Estimated differences of pain medication consumption for patients in differently designed rooms varied depending on the risk adjustment model. These findings underscore the importance of understanding appropriate clinical measurement and risk adjustment strategies to accurately estimate the impact of design, before applying research into practice.



Presenting Faculty

Andrew M. Ibrahim, MD, MSc, is the Maud T. Lane Research Professor of Surgery, Architecture & Urban Planning and Chief Medical Officer at HOK, a global design and architecture firm. He completed his undergraduate and medical degrees both with Honors at Case Western Reserve University with a year of coursework at University College London and The Bartlett School of Architecture. His research at the interface of healthcare delivery, surgery and architecture is supported by R01s from AHRQ and the NIH. 


Ellen Taylor, PhD, AIA, MBA, EDACbrings more than 30 years of experience in architecture, research, and business to leading The Center’s research team. She is a registered architect and member of the AIA who was recognized by Healthcare Design as the HCD10 Researcher in 2017, an award recognizing significant contributions to the industry.

A nationally and internationally recognized writer and speaker, she has led numerous grant-funded research programs and published numerous peer-reviewed papers. Ellen has a bachelor’s degree in architecture from Cornell University’s College of Architecture, Art and Planning, Global Executive MBA degrees from Columbia University and London Business School, and a PhD in design, patient safety and human factors from Loughborough University in England.

She serves as the Vice Chair for the FGI Health Guidelines Revisions Committee, on the Editorial Advisory Boards of the Health Environments Research & Design Journal (HERD) and American Journal of Infection Control (AJIC), and she was the 2022 President of the AIA Academy of Architecture for Health.