Hospital adaptation and resiliency for infected and uninfected patients during respiratory viral surge events: from seasonal influenza to COVID-19

Project Summary / Abstract My long-term career goal is to become a leading independent investigator developing and evaluating surveillance, preparedness, and operations response strategies to combat the public health burdens from respiratory viral surge events. Respiratory viral surge events, in which hospitals face capacity strain from an influx of infected patients, range from annual respiratory viral seasons dominated by seasonal influenza to rarer and more severe epidemics such as due to novel influenzas (e.g., H1N1) and coronaviruses (e.g., COVID-19, SARS, MERS). Optimizing outcomes for both infected patients and uninfected patients admitted during viral surges (i.e., "bystander patients"), requires that hospitals display: (1) adaptation-the ability to improve care and outcomes for infected patients by implementing new care processes based on accumulated experience, and (2) resiliency-the ability to continue to deliver high quality care to uninfected patients despite the presence of a surge event. However, it is unknown what enables hospitals to display adaptation and resiliency, thereby threatening care quality for all patients during viral surges. I am an Instructor of Medicine in the Division of Pulmonary, Allergy, and Critical Care at the University of Pennsylvania Perelman School of Medicine. My preparations for this career path include masters degrees in clinical epidemiology and biomedical ethics, mentored research training resulting in high-impact first-author publications serving as preliminary data, national invited talks at universities and academic conferences, and clinical work as a pulmonologist and medical intensivist at a major academic referral center. This grant application seeks to combine my and my mentorship team's experience in defining and studying healthcare capacity strain with purposefully selected career development activities to achieve my complementary training and research goals including methodologic training in advanced statistical modeling, qualitative research methods, implementation science, and cost-effectiveness analysis. The specific aims of this grant are to: (1) Quantify adaptation by determining how hospitals' cumulative seasonal experiences with influenza affect processes of care and clinical outcomes among high acuity patients with influenza. (2) Measure resiliency by determining how hospitals' daily capacity strain and cumulative experience during respiratory viral surges affect processes of care and clinical outcomes among bystander patients (i.e., without infection) at risk for acute respiratory failure. (3) Identify organizational characteristics that may influence how hospitals achieve, or struggle to achieve, adaptation and resiliency in the face of a respiratory viral surge event. At the end of the proposed K23 award, I expect to understand how care delivery and outcomes change over the course of a respiratory viral surge event and what organizational factors may account for observed differences in hospital adaptation and resiliency. These findings will have substantial positive impact by facilitating testing organizational interventions to improve hospital adaptation and resiliency, which will be the focus of my initial R01 applications at the conclusion of the K23 award.