Improving Risk-Stratification in Patients with Prolonged ICU Stays

Project Summary
Candidate’s Long-Term Career Goal: To become an independently funded physician-scientist with a clinical
expertise in persistent critical illness and bioethics with a methodological expertise in longitudinal surveys.
Clinical Problem: Patients with prolonged ICU stays are costly, increasing in prevalence, and resulting in
long-term morbidity. Unfortunately, we have not been able to identify this cohort of patients early and
subsequently have not been able to institute evidence-based processes to prevent its development.
Candidate Background and Achievements: Dr. Viglianti is a Lecturer in Pulmonary and Critical Care
Medicine at the University of Michigan (UM). She received her MD from Duke University, MPH from the
University of North Carolina Chapel Hill, and MSc from UM. To date she has published 23 papers, including 14
original peer-reviewed manuscripts; 7 of which she is first author. She won a minority grant award from the
American Thoracic Society, an F32 and loan repayment award from NHLBI, and an institutional K12.
Regardless of the outcome of this proposal, her department anticipates she will be appointed to an assistant
professor on or before July 1, 2021, with a start-up package including $250,000 of discretionary research fund.
Career Development Plan: Dr. Viglianti proposes to develop new expertise in longitudinal survey
methodology and analysis, and bioethics through formal coursework and mentored research. Her primary
mentor is Dr. Theodore J. Iwashyna at UM, who has mentored 7 clinician-scientists on K awards, including 4 to
R-level funding. She will be co-mentored by Dr. Mick Couper a research professor at the Institute of Social
Research at UM who is an expert in design and implementation of longitudinal surveys.
Aims: Using both prospective and retrospective surveys and secondary data, she will 1) Determine the
accuracy of physicians to prognosticate new late-onset shock and acute hypoxic respiratory failure; 2) Develop
hypotheses about sources of prognostication accuracy and inaccuracy by exploring heuristics, cognitive biases
and bioethical principles and values; 3) Determine the extent to which variation in hospital rates of persistent
critical illness are explained by new late-onset organ failures and palliative care utilization.
Deliverables from Aims: The proposed aims will lead to at least 4 publications and prepare Dr. Viglianti to
write 2 R01 proposals: 1) Develop and validate a new risk-prediction tool; 2) Identification of evidence-based
practices utilized by high performing hospitals in the prevention and management of late-onset organ failures.