This K08 award will provide an opportunity for the candidate, Dr. Colin R. Cooke, to become an independent physician scientist focused on increasing the value and efficiency in the organization, delivery, and financing of critical care. Over the last 20 years the use of critical care services has grown rapidly in the United States, while at the same its current use varies widely across geographic regions. To date, very little is known about the underlying drivers and implications of such growth and variation. This scientist development application describes Dr. Cooke's comprehensive plan to accomplish the following primary goals: 1) to better identify the causes and implications of growth and variation critical care utilization, and 2) to develop an independent health services research career. To achieve these goals, Dr. Cooke proposes an integrated curriculum consisting of practical experience in designing, conducting and publishing policy-relevant health services research projects;coursework designed to supplement his previous research training in epidemiology and biostatistics consisting of advanced biostatistics, health financing and policy, and econometrics;intensive mentoring by experts in health care efficiency, critical care policy, and health economics;and participating in national scientific meetings. The rich academic environment at the University of Michigan is ideal for Dr. Cooke's training and has allowed him to assemble a mentorship committee whose members possess expertise in critical care quality, health policy, economics, and biostatistics. Dr. Cooke will analyze fee-for-service Medicare patients over 6 years to: 1) identify the types of patients and the health system and policy- level factors that underlie temporal and geographic variation in critical care utilization, and 2) determine the effec of regional critical care practice patterns on mortality, re-hospitalizations, and costs. Finally, r. Cooke will examine a statewide surgical quality collaborative to determine how critical care practice patterns impact post-operative clinical outcomes. Completion of the proposed research will inform policies aimed at improving the efficiency of critical care in inpatient facilities andthe coordination of care for critically ill patients across the health system. In addition this projectwill facilitate the candidate's transition to an independent health services investigator focused on understanding and improving the efficiency of critical care.

Public Health Relevance

The overarching goal of this proposal is to characterize the patient, health system, and policy-level drivers and implications of growth and variation in the use of critical care services. Our results will prove immediately relevant for policymakers strivin to align payer and hospital incentives to encourage the use of critical care services in ways that support societal goals of maximum effectiveness for minimum costs.

National Institute of Health (NIH)
Clinical Investigator Award (CIA) (K08)
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HSR Health Care Research Training SS (HCRT)
Program Officer
Anderson, Kay
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University of Michigan Ann Arbor
Internal Medicine/Medicine
Schools of Medicine
Ann Arbor
United States
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Cooke, Colin R; Iwashyna, Theodore J (2014) Sepsis mandates: improving inpatient care while advancing quality improvement. JAMA 312:1397-8
Lyon, Sarah M; Douglas, Ivor S; Cooke, Colin R (2014) Medicaid expansion under the Affordable Care Act. Implications for insurance-related disparities in pulmonary, critical care, and sleep. Ann Am Thorac Soc 11:661-7
Cooke, Colin R; Feemster, Laura C; Wiener, Renda Soylemez et al. (2014) Aggressiveness of intensive care use among patients with lung cancer in the Surveillance, Epidemiology, and End Results-Medicare registry. Chest 146:916-23
Lyon, Sarah M; Wunsch, Hannah; Asch, David A et al. (2014) Use of intensive care services and associated hospital mortality after Massachusetts healthcare reform*. Crit Care Med 42:763-70
Sjoding, Michael W; Cooke, Colin R (2014) Readmission penalties for chronic obstructive pulmonary disease will further stress hospitals caring for vulnerable patient populations. Am J Respir Crit Care Med 190:1072-4
Admon, Andrew J; Cooke, Colin R (2014) Will Choosing Wisely® improve quality and lower costs of care for patients with critical illness? Ann Am Thorac Soc 11:823-7
Cooke, Colin R; Watkins, Timothy R (2013) Variation in the incidence and timing of acute lung injury: the role of race. Chest 143:881-2
Cooke, Colin R; Iwashyna, Theodore J (2013) Using existing data to address important clinical questions in critical care. Crit Care Med 41:886-96
Prescott, Hallie C; Cooke, Colin R (2013) Trends in mortality and early central line placement in septic shock: true, true, and related?*. Crit Care Med 41:1577-8
Cooke, Colin R (2013) Improving the efficiency of ICU admission decisions. Crit Care Med 41:662-3