Dr. Stefan is an academic hospitalist at Baystate Medical Center and an Assistant Professor of Medicine at the Tufts University School of Medicine in Boston, MA. Her goal is to become an independent clinician scientist focused on applying rigorous research methods to the identification and implementation of effective treatment strategies for patients hospitalized with respiratory disease. The proposed career development plan incorporates advanced training in epidemiology, clinical trials, and implementation and dissemination research as part of a PhD in Clinical and Translational Science, as well as a closely mentored research experience. Dr. Stefan has assembled a group of highly skilled mentors who will guide her development. Dr. Lindenauer, the primary mentor, has significant mentorship experience, and is an accomplished investigator currently supported through RC2 and R18 awards from NHLBI to study outcomes in patients with COPD, as well as R18 funding from AHRQ. Dr. Stefan works within a supportive research environment that has an established track record of success and experience mentoring investigators toward independent research careers. In 2009, Acute Respiratory Failure (ARF) was associated with 1.9 million hospitalizations in the US and accounted for approximately 320,000 deaths and more than $50 billion dollars in hospital spending. Given its enormous impact and high associated mortality there is a critical need for research efforts focused on identifying interventions to improve the outcomes of patients with ARF. In this career development award Dr. Stefan will perform a retrospective observational study of patients with ARF in a large registry of more than 100 hospitals throughout the US using clinical data derived directly from the hospitals'electronic medical records.
The specific aims of this project are: 1) to characterize current ventilation management practices in ARF and identify patient and hospital factors associated with the choice of ventilation therapy;2) to compare the effectiveness of noninvasive and invasive forms of mechanical ventilation in patients hospitalized for the most common causes of ARF;3) to identify predictors for noninvasive ventilation success/failure. To limit the threat of confounding she will employ diverse and powerful analytical methods including logistic regression, high- dimensional propensity technique, and instrumental variable approach. This research speaks directly to the NHLBI Strategic Plan Goal III: """"""""To generate an improved understanding of the processes involved in translating research into practice and use that understanding to enable improvements in public health and stimulate further scientific discovery."""""""" It is also responsive to the AHRQ Comparative Effectiveness Review on NIV in ARF which highlights the paucity of comparative effectiveness studies and the limited data for patients with ARF not due to COPD or cardiogenic pulmonary edema.

Public Health Relevance

Acute respiratory failure, a severe complication of several common medical conditions, is associated with substantial morbidity, mortality and high costs. Despite its significant impact, little is known about the use of available ventilation treatment strategies or their effects on hospital outcomes. This proposal will compare the effectiveness of noninvasive and invasive forms of mechanical ventilation in patients with acute respiratory failure and will identify predictors for noninvasive ventilation success, to foster better clinical decision making and improve patient outcomes.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Scientist Development Award - Research & Training (K01)
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Special Emphasis Panel (ZHL1)
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Colombini-Hatch, Sandra
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Baystate Medical Center
United States
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Stefan, Mihaela S; Nathanson, Brian H; Lagu, Tara et al. (2016) Outcomes of Noninvasive and Invasive Ventilation in Patients Hospitalized with Asthma Exacerbation. Ann Am Thorac Soc 13:1096-104
DiNino, Ernest; Stefan, Mihaela S; Priya, Aruna et al. (2016) The Trajectory of Dyspnea in Hospitalized Patients. J Pain Symptom Manage 51:682-689.e1
Stefan, Mihaela S; Nathanson, Brian H; Priya, Aruna et al. (2016) Hospitals' Patterns of Use of Noninvasive Ventilation in Patients With Asthma Exacerbation. Chest 149:729-36
Lagu, Tara; Pekow, Penelope S; Shieh, Meng-Shiou et al. (2016) Validation and Comparison of Seven Mortality Prediction Models for Hospitalized Patients With Acute Decompensated Heart Failure. Circ Heart Fail 9:
Lagu, Tara; Zilberberg, Marya D; Tjia, Jennifer et al. (2016) Dementia and Outcomes of Mechanical Ventilation. J Am Geriatr Soc 64:e63-e66
Stefan, Mihaela S; Nathanson, Brian H; Higgins, Thomas L et al. (2015) Comparative Effectiveness of Noninvasive and Invasive Ventilation in Critically Ill Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Crit Care Med 43:1386-94
Stefan, Mihaela S; Shieh, Meng-Shiou; Pekow, Penelope S et al. (2015) Trends in mechanical ventilation among patients hospitalized with acute exacerbations of COPD in the United States, 2001 to 2011. Chest 147:959-68
Stefan, Mihaela S; Jaber, Randa; Lindenauer, Peter K et al. (2015) Death among patients hospitalized with pneumonia: implications for hospital outcome measures. JAMA Intern Med 175:851-3
Fisher, Kimberly A; Stefan, Mihaela S; Darling, Chad et al. (2015) Impact of COPD on the mortality and treatment of patients hospitalized with acute decompensated heart failure: the Worcester Heart Failure Study. Chest 147:637-45
Joshi, Kirti K; Tiru, Mihaela; Chin, Thomas et al. (2015) Postoperative atrial fibrillation in patients undergoing non-cardiac non-thoracic surgery: A practical approach for the hospitalist. Hosp Pract (1995) 43:235-44

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