Mechanisms Contributing to Functional Recovery across the Care Cascade for Respiratory Failure

About This Grant

PROJECT SUMMARY Respiratory failure is a life-threatening condition affecting millions of individuals in the United States annually. Although mortality rates for respiratory failure have decreased, survivors frequently experience persistent physical impairments and decreased quality of life. Little is known about how factors experienced across the course of critical illness, such as receipt of specific care processes (e.g., early mobilization) or post-discharge setting (e.g., neighborhood environment) influence functional recovery and quality of life. To identify targets for intervention on disparities in recovery from respiratory failure, it is critical to examine the sequential impact of social determinants before hospitalization, care processes during hospitalization, and living environments following hospitalization. The goal of the proposed research is to generate evidence to inform interventions promoting recovery of function following hospitalization with respiratory failure. The central hypothesis of this proposal is that patient-level social determinants, unit-level care processes, and community-level environmental factors produce disparities in long-term outcomes among survivors of respiratory failure. In this research, the applicant aims to: 1) examine the influence of social determinants recorded at hospital admission on functional recovery over time among survivors of respiratory insufficiency and failure; 2) characterize the barriers to providing early mobilization in two high-volume medical intensive care units (MICU); and 3) evaluate the influence of neighborhood environments on long-term recovery among survivors of respiratory failure. The proposed research will take place at New York University (NYU), which provides a robust research infrastructure that supports proposal development and fosters research engagement among NYU faculty and students. Training goals throughout the fellowship award include (1) build advanced methodological skills in state-of- the-art longitudinal modeling techniques applied to complex real-word data; (2) advance capabilities in qualitative data collection and analysis using gold-standard methods from the social sciences and implementation science; (3) develop analytical skills in Bayesian analysis; (4) develop a comprehensive knowledge of key theories, frameworks, and concepts that explain health disparities; (5) strengthen skills in scientific writing and dissemination; and (6) study and practice the responsible conduct of research. Mentorship and supervision from Sponsor, Co-Sponsors, and Contributor will occur regularly throughout the fellowship award to augment all aspects of training. The F31 will also provide crucial protected time to advance toward the goal of a productive career as an independent research career as an epidemiologist of function.