Patients with acute respiratory failure requiring mechanical ventilation are at high risk for morbidity and mortality. Although several recent advances have improved management of such patients, these therapies have been incompletely adopted and patient outcomes continue to vary across hospitals. One factor that may be associated with improved translation of evidence into practice is the experience of the physician provider. Previous studies indirectly provide evidence for this relationship; for example, higher annual hospital volume is associated with reduced mortality. However, there is little direct evidence, physician experience has not been defined, and the capacity of organizational solutions to modify the relationship is unknown. A better understanding of this complex relationship could reveal novel targets for interventions to improve uptake of evidence-based practices of mechanically ventilated patients and ultimately their outcomes. Therefore the overall goal of this proposal is to understand the relationship between physician experience and outcomes for mechanically ventilated patients. Specifically, we will determine (1) if there is an association of physician experience, defined as years since completing of training, with patient outcomes; (2) the relative contributions of physician experience and hospital volume to patient outcomes; and (3) if effects of physician experience are modified by the presence of organizational factors. For this project we will create an innovative database linking multiple publicly available administrative and clinical datasets of patients hospitalized in the state of Pennsylvania with data obtained from a state-wide hospital survey and will use state-of-the-art statistical modeling techniques to advance our understanding of the role of the physician in patient outcomes. This database and career development award will be a foundation for the candidate's future work as an independent clinical researcher with a focus on developing and implementing organizational interventions to improve care of patients with acute respiratory failure. Dr. Meeta Prasad Kerlin has a clinical background in pulmonary and critical care medicine and a Master of Science in Clinical Epidemiology from the University of Pennsylvania. She has demonstrated her interest and aptitude for clinical research through the successful completion of several research projects in the topics of critical care outcomes and education. She has had multiple publications in high-impact journals such as JAMA and Critical Care Medicine. In this proposal, she has developed a career development plan that includes a complementary approach of didactic learning, structured professional development, intensive mentorship, and direct research experience leading the project described above. She has the full support of her department, outstanding mentors who are already the leaders in critical care outcomes research, and access to the vast resources of the University of Pennsylvania. Together, these will ensure her successful development into a leader in her own right.

Public Health Relevance

This project aims to study the relationship between physician experience and outcomes for mechanically ventilated patients. Understanding this complex relationship, which may underlie some of the variation in patient outcomes, may provide insights that will inform health care policies and organizational solutions for the limitations of the curret work force in the care of a patient population with high morbidity and mortality and high variability in care.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Clinical Investigator Award (CIA) (K08)
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Special Emphasis Panel (ZHL1)
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Reineck, Lora A
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University of Pennsylvania
Internal Medicine/Medicine
Schools of Medicine
United States
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Kerlin, Meeta Prasad (2018) 24-Hour Intensivist Staffing Is Not Beneficial for Patients. Crit Care Med 46:152-154
Kerlin, Meeta Prasad; Epstein, Andrew; Kahn, Jeremy M et al. (2018) Physician-Level Variation in Outcomes of Mechanically Ventilated Patients. Ann Am Thorac Soc 15:371-379
Kohn, Rachel; Madden, Vanessa; Kahn, Jeremy M et al. (2017) Diffusion of Evidence-based Intensive Care Unit Organizational Practices. A State-Wide Analysis. Ann Am Thorac Soc 14:254-261
Courtright, Katherine R; Halpern, Scott D; Bayes, Brian et al. (2017) Adaptation of the Acute Organ Failure Score for Use in a Medicare Population. Crit Care Med 45:1863-1870
Kerlin, Meeta Prasad; Halpern, Scott D (2016) Nighttime physician staffing improves patient outcomes: no. Intensive Care Med 42:1469-71
Kohn, Rachel; Halpern, Scott D; Kerlin, Meeta Prasad (2016) The implications of intensive care unit capacity strain for the care of critically ill patients. Rev Bras Ter Intensiva 28:366-368
Weiss, Elliott Mark; Kohn, Rachel; Madden, Vanessa et al. (2016) Procedure-specific consent is the norm in United States intensive care units. Intensive Care Med 42:1637-1638
Kerlin, Meeta Prasad; Weissman, Gary E; Wonneberger, Katherine A et al. (2016) Validation of Administrative Definitions of Invasive Mechanical Ventilation across 30 Intensive Care Units. Am J Respir Crit Care Med 194:1548-1552
Kerlin, Meeta Prasad; Halpern, Scott D (2015) Response. Chest 148:e67-e68
Kerlin, Meeta Prasad; Cooke, Colin R (2015) Understanding Costs When Seeking Value in Critical Care. Ann Am Thorac Soc 12:1743-4

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