{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:44:57Z","timestamp":1782603897884,"version":"3.54.5"},"posted":{"date-parts":[[2026,6,25]]},"group-title":"Respiratory Medicine","reference-count":16,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"funder":[{"DOI":"10.13039\/100000050","name":"NHLBI","doi-asserted-by":"crossref","award":["K01HL171466"],"award-info":[{"award-number":["K01HL171466"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000050","name":"NHLBI","doi-asserted-by":"crossref","award":["R01HL146386"],"award-info":[{"award-number":["R01HL146386"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Rationale<\/jats:title>\n                  <jats:p>Racial disparities in outcomes among patients with acute respiratory failure are well-described, but the contributions of clinicians to these disparities have not been evaluated.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Among mechanically ventilated patients, we evaluated racial disparities in severity of illness trajectories and adapted value-added modeling to quantify nurse and physician relationships with these disparities.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    In a retrospective cohort of mechanically ventilated patients across five hospitals between 2018 and 2022, we used generalized estimating equations to model the change in Laboratory-based Acute Physiology Score version 2 (LAPS) from the start to end of intensive care unit admission (\u0394\n                    <jats:italic>LAPS<\/jats:italic>\n                    ). Consistent with value-added modeling, we randomly allocated the cohort into development and testing partitions, and fit separate multiple linear regression models of \u0394\n                    <jats:italic>LAPS<\/jats:italic>\n                    using concurrent nurse and physician assignments (determined at 4-hour intervals), patient race, and clinician-race interaction terms as fixed effects. Clinician-specific and clinician-race interaction coefficients were extracted to determine race-specific value-add for each clinician. We defined the race-contextual value-add difference (\n                    <jats:italic>RCVAD<\/jats:italic>\n                    ) as a clinician-level measurement of the difference in that clinician\u2019s value-add between Black and White patients in their care; a positive\n                    <jats:italic>RCVAD<\/jats:italic>\n                    indicates a more favorable severity of illness trajectory for Black relative to White patients and vice versa.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Measurement and Main Results<\/jats:title>\n                  <jats:p>\n                    Among 6,555 distinct patients, 7,247 clinical encounters, 405 nurses, and 70 physicians, Black patients accounted for 2,926 (40%) encounters. Overall, Black patients had significantly less improvement in \u0394\n                    <jats:italic>LAPS<\/jats:italic>\n                    than White patients (difference in LAPS decline = 2.26 [0.23, 4.29], p=0.029). In the development partition, median nurse\n                    <jats:italic>RCVAD<\/jats:italic>\n                    was \u22120.10 (interquartile range [IQR]: \u22121.17, 1.14) with 191 (47%) nurses having a positive\n                    <jats:italic>RCVAD<\/jats:italic>\n                    ; median physician\n                    <jats:italic>RCVAD<\/jats:italic>\n                    was - 0.18 (IQR: \u22121.34, 0.56) with 29 (41%) having a positive\n                    <jats:italic>RCVAD<\/jats:italic>\n                    .\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Black mechanically ventilated patients experience less improvement in severity of illness during intensive care unit admission than White patients. While the majority of physicians and nurses were associated with disparities-exacerbating illness trajectories, many other clinicians were associated with disparities-mitigating trajectories. Future work to understand practices associated with disparities-exacerbating and disparities-mitigating care profiles could inform interventions to reduce disparities overall.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.23.26356358","type":"posted-content","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T23:15:15Z","timestamp":1782429315000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinician contributions to disparities in severity of illness trajectories among mechanically ventilated patients"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7921-1879","authenticated-orcid":false,"given":"Christopher F.","family":"Chesley","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine"},{"name":"Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine,"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Yakusheva","sequence":"additional","affiliation":[{"name":"School of Nursing, Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Lu","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Kohn","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine"},{"name":"Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine,"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aerielle","family":"Belk","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Scott","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Halpern","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine"},{"name":"Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine,"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meeta Prasad","family":"Kerlin","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine"},{"name":"Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine,"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026062715450470000_2026.06.23.26356358v1.1","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000001079"},{"key":"2026062715450470000_2026.06.23.26356358v1.2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31824518f2"},{"key":"2026062715450470000_2026.06.23.26356358v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2024.05.004"},{"key":"2026062715450470000_2026.06.23.26356358v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2015.07.007"},{"key":"2026062715450470000_2026.06.23.26356358v1.5","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005269"},{"key":"2026062715450470000_2026.06.23.26356358v1.6","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31819292ea"},{"key":"2026062715450470000_2026.06.23.26356358v1.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2019.11.004"},{"key":"2026062715450470000_2026.06.23.26356358v1.8","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12236"},{"key":"2026062715450470000_2026.06.23.26356358v1.9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0218755"},{"key":"2026062715450470000_2026.06.23.26356358v1.10","unstructured":"Chesley CF , Lu Y , Kohn R , et al. 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