PROJECT SUMMARY/ABSTRACT Candidate’s Long-Term Career Goal: To become an independent investigator who uses advanced observational research methods to improve the organization and delivery of critical care. Clinical Problem to be Addressed: Acute respiratory failure leads to 2,000,000 hospitalizations and 400,000 deaths in the US each year. Outcomes vary widely across hospitals, suggesting that improvements to how care is organized and delivered may improve survival. Yet, global changes affecting inpatient care teams have encouraged fragmentation—discontinuous care spread across multiple physicians. Little is known about how fragmented care affects adults with respiratory failure and what hospitals can do to protect patients from harm. Specific Aims: Using advanced methods for causal inference applied to novel data sources, Dr. Admon will 1) compare the causal effects of fragmented care on in-hospital and post-hospital respiratory failure outcomes; 2) determine whether specific complications occur more often in fragmented care and predict poorer outcomes; and 3) test whether specific features of inpatient care are protective against harm when care is fragmented. Candidate’s Background: Dr. Andrew Admon is a Lecturer and Research Fellow in Pulmonary and Critical Care Medicine at the University of Michigan. He has advanced training in public health and health care research. He has 25 total publications, including 17 original research manuscripts, with 7 original research manuscripts as first author. Dr. Admon’s work is supported by an NHLBI NRSA F32 award. Career Development Plan: To meet his long-term career goal, Dr. Admon seeks deep, focused training in causal inference and survey methodology. Accordingly, his 5-year plan includes curated courses that build on his strong foundation in quantitative research, project-based mentoring by experts in critical care epidemiology, causal inference, and survey research, selected career development activities, and specific milestones to ensure a successful transition to independence. Dr. Admon’s primary mentor is Colin Cooke, MD, MS, MSc. His co-mentors are Andrew Ryan, PhD, Sarah Krein, PhD, RN, and Theodore J. Iwashyna, MD, PhD. Deliverables: Completing the research and training in this proposal will generate data informing strategies to mitigate fragmentation while equipping Dr. Admon with advanced skills in observational causal inference and survey methods. In subsequent work, this expertise will prepare him to maximally leverage observational data to generate timely and accurate evidence addressing other research challenges in critical care delivery.

PROJECT NARRATIVE Survival from respiratory failure varies widely across hospitals, suggesting that improvements to the organization and delivery of care to respiratory failure patients may prevent deaths. Yet, recent changes affecting inpatient care have encouraged fragmentation—care that is spread out across multiple physicians during a hospitalization. The overarching goal of this proposal is to understand the impact of fragmented care on adults hospitalized with respiratory failure while identifying specific targets for protecting patients exposed to fragmented care from harm.