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Research

The Health Policy and Management Program (HPM), CRISMA, oversees a number of federally funded research projects designed to improve outcomes in critical illness. Our goal is to provide patients, clinicians and policy makers with actionable information on how to best organize and manage acute care services in the United States and abroad.

CURRENT PROJECTS

Contributors to Effective Critical Care Telemedicine (ConnECCT)

The goal of ConnECCT is to identify the key clinical and organizational factors associated with ICU telemedicine effectiveness. Using both qualitative and quantitative methods, ConnECCT will both identify a core set of telemedicine "best practices", ultimately leading to a toolkit that can be used to optimize the effectiveness and efficiency of ICU telemedicine in the United States.

 

Determinants of Effective Long Term Acute Care (DELTA)

The goal of DELTA is to identify the key clinical and organizational factors associated with long-term acute care effectiveness. Using both qualitative and quantitative methods, DELTA will both identify a core set of LTACH “best practices.”

 

Patient Oriented Research and Mentoring in Critical Care Implementation Science

Over 700,000 Americans receive invasive mechanical ventilation in an ICU each year. Many of these patients do not receive evidence-based therapies proven to save lives, leading to preventable morbidity and mortality. Innovative strategies to overcome the barriers to evidence-based practice and speed knowledge translation in the ICU are urgently needed. This K24 award will provide the primary investigator with the necessary structure, resources, and protected time to train scientists in patient- oriented research with a focus on knowledge translation in acute respiratory failure, helping new treatments reach the bedside more quickly and leading to improved outcomes for critically ill patients.

 

Novel approaches to profiling hospitals on critical illness mortality

Because of the high clinical burden of critical illness, the ICU is an increasingly important area for quality improvement and comparative effectiveness research. However, current efforts are hindered by the lack of a robust measure of hospital performance for critically ill patients. We will use a unique state-wide hospital dataset from Pennsylvania containing detailed clinical and administrative data, as well as innovative statistical models that account for care transitions and  have not yet been applied to the field of performance assessment. Our results will provide clinicians, researchers and policy makers with novel measurement techniques for assessing critical care performance on a national scale, addressing a critical barrier to progress in the fields of comparative effectiveness research and T2 translation.

 

UNITED: UNderstanding Intensive care Team Effectiveness and Dynamics

The UNITED Study aims to identify the organizational factors associated with the use of evidence-based practices for mechanically ventilated patients. Efficient translation of evidence into practice is an enduring problem in critical care, with many patients not receiving therapies proven to save lives, particularly complex therapies that require the coordinated efforts of an inter-professional care team.

The UNITED study hypothesizes that the function of the ICU team is critical determinant of evidence-based practice use. To examine this issue we are surveying ICU team members about their perceptions of the team and linking the survey responses to patient level clinical data. In addition, we are directly observing ICU rounds, adding qualitative insight into organizational behavior with an eye towards developing interventions to improve implementation of care practices.

Ultimately, these results will provide clinicians, hospital administrators and policy makers with actionable data to most effectively coordinate ICU care of mechanically ventilated patients.

 

Understanding Regional Critical Care Delivery in Acute Respiratory Failure

Regionalized critical care delivery is a quality improvement strategy where select patients admitted to small resource-poor hospitals are triaged to large regional referral centers. This approach creates an opportunity to increase access to high-quality critical care for patients with high severity of illness, such as those requiring mechanical ventilation. Although there is enthusiasm for regionalized care of high-risk critically ill patients, there is little data to directly support widespread implementation.

The project empirically evaluates mortality benefit of regionalized critical care for patients with acute respiratory failure. The evaluation will inform efforts to reorganize critical care and improve outcomes for this high-risk patient population.

 

COMPLETED PROJECTS

Optimizing Utilization and Rural Emergency Access for Children (OUTREACH)

OUTREACH seeks to improve the quality of pediatric emergency care in rural communities through a combination of education, protocolized care and emergency telemedicine.

The role of long-term acute care hospitals in prolonged mechanical ventilation

This project uses Medicare claims data to examine the role of LTACs for patients with chronic critical illness. Specifically, we are studying the effect of LTAC utilization on individual patient outcomes and health care costs, the effects of different LTAC organizational styles on patient outcomes, and spillover effects of LTACs on other types of ICU utilization and outcomes.

Critical Care Organization and Outcomes Project (CO-OP)

Very little is known about the mechanisms by which intensivists improve outcomes, or how to export the benefits of this staffing model to small, community ICUs. This project is a prospective cohort study examining the link between critical care organization and patient outcomes.