Investigating Mechanisms of Disparities for Critically Ill Patients with Acute Respiratory Failure and Sepsis

Inequitable clinical outcomes are well documented for minoritized patients with acute respiratory failure (ARF) and sepsis, but interventions mitigating them are lacking. In part, this is due to a limited understanding of the salient mechanisms most influential to disparities. Among them, harms mediated through socioeconomic disadvantage (defined as access to poor quality socioeconomic resources) and care characteristics related to hospitals that serve the largest proportions of minority patients (often described as minority serving hospitals, or MSHs) are particularly likely to play causal roles. Thus, this project aims to clarify the mechanistic roles of these underexplored determinants of health disparities in the context of ARF and sepsis.

This project’s research objectives are to:

1. characterize the mechanistic role of neighborhood socioeconomic disadvantage on clinical outcome disparities among critically ill patients;
2. describe the clinical processes that influence length of stay disparities for critically ill patients hospitalized at MSHs; and
3. identify barriers and facilitators of implementing interventions that are designed to reduce hospital readmissions among critically ill patients at MSHs.

This project will examine relationships between minority identity and clinical outcomes of nearly 200,000 patients across 16 U.S. hospitals. After geocoding previously identified and clinically impactful forms of socioeconomic disadvantage, we will use mediation analyses to elucidate causal roles for these measures.

Additionally, this project will adapt research frameworks across human factors, ergonomics, implementation science, and sociology to describe the clinical processes that most strongly influence hospital length of stay disparities using semi-structured interviews and direct observation of clinical activities. Lastly, semi-structured interviews will identify barriers and facilitators to implementing systems-level interventions that have previously been recommended by the Centers of Medicare and Medicaid Services. This work will clarify the relative importance of out-of-hospital contributor to health outcomes among patients facing critical and serious acute illness.

National Heart, Lung, and Blood Institute