PI: Kusum S. Mathews, MD, MPH
Analysis of ICU triage and impact of these decisions on outcomes for critically ill patients.
Aims: (a) Examine effects of system factors (e.g., census) on ICU admission decisions and subsequent wait time for transfer for critically ill ED patients. (b) Identify clinical and non-clinical factors influencing providers’ assessments of prognosis and likelihood to benefit from ICU care, and test for possible interaction with system factors. (c) Quantify the impact of providers’ assessments and system factors on downstream patient outcomes.
This study uses a three-year cross sectional dataset of ICU consults at Mount Sinai Hospital, containing data from the electronic health record, administrative billing systems, bed management census counts, as well as qualitative analysis of triage documentation. It has been funded by the ATS Foundation Unrestricted Grant in Critical Care (2016).
Mentors/Collaborators: Judy Nelson, MD (Memorial-Sloan Kettering Cancer Center), Lynne Richardson, MD (ED)
Effect of delays in critically ill patient throughput on ICU operations and patient outcomes
Aims: (a) To model the relationship between operational factors (e.g., capacity strain, throughput delays, unit bed sizing) on patient outcomes of wait time for admission and mortality. (b) To develop a conceptual framework for understanding ICU patient throughput.
These efforts have led to the construction of a simulation representing ICU throughput to capture real-world triage and measure effect of different unit sizes and triage policies on admission wait times, utilization, and occupancy.
Mentors/Collaborators: Elisa Long, PhD (UCLA Anderson School of Management)
Effect of hospital operations and quality on ICU Utilization
Using a multi-year, multi-state administrative dataset, we are investigating variability in ICU utilization practices. This is a collaborative effort with faculty at Lally School of Management (SOM), facilitated by the Mount Sinai-Rensselaer Polytechnic Institute partnership.
Aims: (a) To assess variability in ICU utilization for specific conditions and severity, controlling for hospital and patient characteristics. (b) Incorporate measures of ED, ICU, and hospital volume into understanding ICU utilization patterns.
Mentors/Collaborators: Madhu Mazumdar, PhD (ISMMS), Chris McDermott, PhD (RPI Lally SOM), Greg Stock, PhD (University of Colorado at Colorado Springs, College of Business)
PI: Aluko Hope, MD (Montefiore) / Site PI: Kusum S. Mathews, MD MPH
Pre-ICU Frailty and Short-Term Clinical Outcomes in Critically Ill Patients
Aim 1: To develop a definition of pre-ICU frailty using pre-admission diagnoses and living arrangement. Aim 2: To determine if frailty is an independent risk factor for ICU delirium and determine if pre-ICU frailty modifies clinical outcomes of ICU delirium. Aim 3: To examine the association between pre-ICU frailty and short term outcomes in critically ill patients.
Collaborators: Montefiore Medical Center, PIs: Aluko Hope, Jean Hsieh, and Michelle Gong.
PI: Hooman Poor, MD
Implementation of an Acute Pulmonary Embolism Risk Stratification Algorithm
This study will examine the effect of the implementation of an evidence-based risk stratification algorithm and educational initiative on the appropriate risk stratification and resource utilization for patients with acute pulmonary embolism.
PI: Linda Rogers, MD
In collaboration with the Icahn Institute for Genomics and Multiscale Biology
The Asthma Health App and the Asthma Mobile Health Study
The Asthma Health app helps you to track your asthma symptoms, allows you to review trends, gives you feedback on your progress, and provides personalized reminders to take your prescribed medications. The app is a personalized tool that helps you to gain greater insight into your asthma, avoid triggers, adhere to treatment plans, and take charge of your health.
PI: Neil Schachter, MD
In collaboration with the Harvard School of Public Health and the Department of Pediatrics of Columbia School of Medicine
CAPAS: The Children’s Air Pollution Asthma Study (EPRI funded)
This study analyzes levels of Indoor and Outdoor air pollutants as well as other environmental factors by season in Inner City areas of New York City (East Harlem and the South Bronx) and their effects on the respiratory health of children with moderate or severe asthma living in these areas.
PI: Neomi Shah, MD, MPH
Sleep Apnea and ST-Elevation Myocardial Infarction: A Multidisciplinary Translational Study (NHLBI Funded)
This study will determine the effect of sleep apnea on severity and prognosis of myocardial infarction through an integrated assessment of: (1) quantification of myocardial infarct size using cardiac imaging, (2) coronary collateral scoring and (3) biomarkers of hypoxic stress. Our overarching hypothesis is that a cardioprotective influence of intermittent hypoxia from sleep apnea leads to upregulation of angiogenic factors, which in turn triggers the development of coronary collaterals and thereby protects the myocardium during an acute period of severe ischemia.
Measuring Atherosclerotic Plaque Activity using PET/MRI in Individuals with Sleep Apnea (SA) before and after Treatment (American Sleep Medicine Foundation Funded)
This study will measure vascular plaque activity (PET-MRI with 18F-FDG) in subjects with SA and underlying cardiovascular disease before and after SA treatment.
Hispanic Community Health Study/Study of Latinos (NIH Funded)
This is a multi-center observational cohort study of over 16,000 US Hispanics/Latinos designed to determine the role of acculturation in the prevalence and development of disease (including cardiovascular disease, respiratory diseases, diabetes, cognitive impairment, and sleep, hearing, dental, kidney, and liver disorders) and to identify risk factors playing a protective or harmful role in Hispanics/Latinos.
Role: Medical Director, Bronx Site
PI: Andrew Varga, MD
Cognitive consequences of stage-specific sleep apnea
In this project, we use stage-specific CPAP withdrawal in subjects with severe OSA to address questions about how sleep affects spatial navigational memory, and what the contributions are of sleep fragmentation versus intermittent hypoxia associated with OSA.
Brain sleep clearance of amyloid-beta peptides study (Brain SCRAPS)
In the first part of this study, we examine relationships between sleep characteristics and levels of proteins in spinal fluid that are associated with the development of Alzheimer disease in cognitively normal elderly subjects. In the second part, we examine the effects of CPAP withdrawal on levels of proteins in spinal fluid that are associated with the development of Alzheimer disease in subjects with severe OSA.
Molecular mechanisms of sleep-dependent motor learning and memory
In this project, we explore the roles of cortical sleep spindles and signaling pathways that support the synthesis of new neuronal proteins in the sleep-dependent augmentation of motor skill learning in animal models.