Hospital adaptation and resiliency for infected and uninfected patients during respiratory viral surge events: from seasonal influenza to COVID-19

项目摘要/摘要 我的长期职业目标是成为一名领先的独立调查员，开发和评估 监测、防备和行动应对战略，以应对来自 呼吸道病毒激增事件。呼吸道病毒激增事件，医院面临来自 感染患者的涌入，范围从以季节性流感为主的年度呼吸道病毒季节到 更罕见和更严重的流行病，例如由于新的流感病毒(例如H1N1)和冠状病毒(例如， 新冠肺炎、非典、中东呼吸综合征)。优化入院的感染患者和非感染患者的结局 在病毒激增期间(即“旁观者”)，要求医院表现出：(1)适应--有能力 通过实施基于累积的新护理流程来改善感染患者的护理和预后 体验，以及(2)弹性--能够继续为未感染的患者提供高质量的护理，尽管 浪涌事件的出现。然而，目前尚不清楚是什么使医院能够表现出适应和 因此，在病毒激增期间威胁到所有患者的护理质量。我是一名医学讲师 宾夕法尼亚大学佩雷尔曼学院肺、过敏和重症监护科 医学。我为这条职业道路做的准备包括临床流行病学和生物医学硕士学位 伦理，有指导的研究培训，使高影响力的第一作者出版物成为初步数据， 在大学和学术会议上的国家特邀演讲，以及作为肺科医生和 在一家主要的学术转介中心做医学强化治疗。这项拨款申请旨在将我的和我的 导师团队在定义和研究医疗能力压力方面的经验，有目的地选择 为实现互补的培训和研究目标而开展的职业发展活动包括 高级统计建模、定性研究方法、实施科学、 和成本-效果分析。这笔赠款的具体目标是：(1)通过确定 医院累积的流感季节性经历如何影响护理过程和临床结果 在高敏感度的流感患者中。(2)通过确定医院的日常能力来衡量弹性 呼吸道病毒激增期间的菌株和累积经验影响护理过程和临床结果 在有急性呼吸衰竭风险的旁观者中(即，没有感染)。(3)确定组织机构 可能影响医院如何实现或努力实现适应和恢复能力的特征 面对呼吸道病毒激增事件。在建议的K23奖结束时，我希望了解如何 在呼吸道病毒激增事件的过程中，护理提供和结果会发生变化，以及哪些组织 这些因素可能解释了观察到的医院适应和复原力的差异。这些发现将会有 通过促进测试组织干预措施来改善医院适应和 弹性，这将是我在K23奖项结束时最初申请R01的重点。

Project Summary / Abstract My long-term career goal is to become a leading independent investigator developing and evaluating surveillance, preparedness, and operations response strategies to combat the public health burdens from respiratory viral surge events. Respiratory viral surge events, in which hospitals face capacity strain from an influx of infected patients, range from annual respiratory viral seasons dominated by seasonal influenza to rarer and more severe epidemics such as due to novel influenzas (e.g., H1N1) and coronaviruses (e.g., COVID-19, SARS, MERS). Optimizing outcomes for both infected patients and uninfected patients admitted during viral surges (i.e., “bystander patients”), requires that hospitals display: (1) adaptation—the ability to improve care and outcomes for infected patients by implementing new care processes based on accumulated experience, and (2) resiliency—the ability to continue to deliver high quality care to uninfected patients despite the presence of a surge event. However, it is unknown what enables hospitals to display adaptation and resiliency, thereby threatening care quality for all patients during viral surges. I am an Instructor of Medicine in the Division of Pulmonary, Allergy, and Critical Care at the University of Pennsylvania Perelman School of Medicine. My preparations for this career path include masters degrees in clinical epidemiology and biomedical ethics, mentored research training resulting in high-impact first-author publications serving as preliminary data, national invited talks at universities and academic conferences, and clinical work as a pulmonologist and medical intensivist at a major academic referral center. This grant application seeks to combine my and my mentorship team’s experience in defining and studying healthcare capacity strain with purposefully selected career development activities to achieve my complementary training and research goals including methodologic training in advanced statistical modeling, qualitative research methods, implementation science, and cost-effectiveness analysis. The specific aims of this grant are to: (1) Quantify adaptation by determining how hospitals’ cumulative seasonal experiences with influenza affect processes of care and clinical outcomes among high acuity patients with influenza. (2) Measure resiliency by determining how hospitals’ daily capacity strain and cumulative experience during respiratory viral surges affect processes of care and clinical outcomes among bystander patients (i.e., without infection) at risk for acute respiratory failure. (3) Identify organizational characteristics that may influence how hospitals achieve, or struggle to achieve, adaptation and resiliency in the face of a respiratory viral surge event. At the end of the proposed K23 award, I expect to understand how care delivery and outcomes change over the course of a respiratory viral surge event and what organizational factors may account for observed differences in hospital adaptation and resiliency. These findings will have substantial positive impact by facilitating testing organizational interventions to improve hospital adaptation and resiliency, which will be the focus of my initial R01 applications at the conclusion of the K23 award.