Funded by National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI)
Description: Each year, an estimated 10,000 U.S deaths from pneumonia could have been avoided if the ICU had been used. Efforts to prevent those deaths are limited by the 20-fold variation in ICU admission rates across U.S. hospitals. Thus, there is a critical need to identify the patients who will benefit from ICU care and ensure they receive it. The overall hypothesis of this proposal is that there are definable characteristics of patients who could benefit from ICU care but do not receive it, that those characteristics are often not incorporated into existing physician models of decision-making around ICU care, and that even when those models are accurate, there are hospital factors that prevent physicians from providing potentially life-saving ICU care to those patients. The overall goal of this proposal is to characterize the mechanisms driving the underuse of ICU care for select pneumonia patients—mechanisms at the patient-, physician-, and organization-level. To accomplish this, I propose to develop and validate a prediction model to identify patients with pneumonia who should be admitted to the ICU, but often are not; to empirically identify key decision-making models of physicians about ICU admission; and to characterize barriers and facilitators at the organizational-level to improving ICU use.
PI: Thomas Valley, MD, MSc