The Role of Ambulatory Care in Reducing the Burden of Respiratory Failure

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PROJECT SUMMARY/ABSTRACT Clinical Problem to be Addressed: Respiratory failure leads to 800,000 hospitalizations per year and leaves survivors in a vulnerable state marked by high rates of rehospitalization, disability, and death. To date, improvements in respiratory failure outcomes have come largely through hospital-based interventions. The ambulatory care environment may represent an additional opportunity to further improve rates of morbidity and mortality stemming from this disease, though prior work examining this relationship has been limited. The overall hypothesis of this work is that the use of ambulatory care reduces the impact of respiratory failure at two key time points: by reducing rates of respiratory failure among patients at risk and by improving post- hospitalization outcomes among survivors. Specific Aims: In aim 1, Dr. Admon will quantify the individual-level association between characteristics of ambulatory care use and rates of respiratory failure among patients at risk. In order to accomplish this, he will apply survival analysis to a dataset of linked inpatient and outpatient Medicare claims while adjusting for patient, hospital, and region-level confounders. In aim 2, Dr. Admon will evaluate whether post-discharge ambulatory care access and utilization influence rates of readmission among survivors of respiratory failure. To assess this, he will apply modern epidemiological methods to the unique, longitudinal survey data in the Health and Retirement Study with linked Medicare claims. Ultimately, accomplishing these aims will lay the foundation for subsequent work developing an ambulatory care-based intervention that reduces the impact of respiratory failure. Fellowship Training Plan and Environment: Dr. Admon’s long-term goal is to become an independent physician-scientist who improves the care of patients with respiratory failure through critical care health services research. The proposed fellowship will support this goal by allowing him to engage in intensive mentored research, didactic coursework, and curated development activities, all chosen in consultation with his mentors to support his particular academic goals. In doing so, he will build on a strong foundation by developing expertise in advanced statistical and epidemiological methods, longitudinal survey data, and ambulatory claims. His mentors are experienced in helping junior faculty members achieve independent academic careers and are personally committed to supporting his academic and professional growth.