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)
Agency for Healthcare Research and Quality (AHRQ)
Clinical Investigator Award (CIA) (K08)
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Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Willis, Tamara
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University of Michigan Ann Arbor
Internal Medicine/Medicine
Schools of Medicine
Ann Arbor
United States
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Admon, Andrew J; Gupta, Ashwin; Williams, Margaret et al. (2018) Appraising the Evidence Supporting Choosing Wisely® Recommendations. J Hosp Med 13:688-691
Valley, Thomas S; Nallamothu, Brahmajee K; Heung, Michael et al. (2018) Hospital Variation in Renal Replacement Therapy for Sepsis in the United States. Crit Care Med 46:e158-e165
Valley, Thomas S; Walkey, Allan J; Lindenauer, Peter K et al. (2017) The authors reply. Crit Care Med 45:e466-e467
Sinha, Shashank S; Sjoding, Michael W; Sukul, Devraj et al. (2017) Changes in Primary Noncardiac Diagnoses Over Time Among Elderly Cardiac Intensive Care Unit Patients in the United States. Circ Cardiovasc Qual Outcomes 10:e003616
Admon, Andrew J; Wunsch, Hannah; Iwashyna, Theodore J et al. (2017) Hospital Contributions to Variability in the Use of ICUs Among Elderly Medicare Recipients. Crit Care Med 45:75-84
Valley, Thomas S; Sjoding, Michael W; Ryan, Andrew M et al. (2017) Intensive Care Unit Admission and Survival among Older Patients with Chronic Obstructive Pulmonary Disease, Heart Failure, or Myocardial Infarction. Ann Am Thorac Soc 14:943-951
Valley, Thomas S; Walkey, Allan J; Lindenauer, Peter K et al. (2017) Association Between Noninvasive Ventilation and Mortality Among Older Patients With Pneumonia. Crit Care Med 45:e246-e254
Mehta, Anuj B; Cooke, Colin R; Wiener, Renda Soylemez et al. (2016) Hospital Variation in Early Tracheostomy in the United States: A Population-Based Study. Crit Care Med 44:1506-14
Walkey, Allan J; Weinberg, Janice; Wiener, Renda Soylemez et al. (2016) Association of Do-Not-Resuscitate Orders and Hospital Mortality Rate Among Patients With Pneumonia. JAMA Intern Med 176:97-104
Wunsch, Hannah; Gershengorn, Hayley B; Cooke, Colin R et al. (2016) Use of Intensive Care Services for Medicare Beneficiaries Undergoing Major Surgical Procedures. Anesthesiology 124:899-907

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