I am a critical care physician and health services researcher bringing the tools of social science and outcomes research to improve the care of patients with critical illnesses. I am currently on sabbatical at Monash University in Melbourne. In the US, I practice as an intensivist at the University of Michigan’s and the Ann Arbor VA's Critical Care Medicine units, where we work to bring the latest science and the best of clinical practice to patients from our local community and those transferred from throughout the region, from dense urban areas to Michigan’s sparsely populated northern reaches.
My research seeks to understand the context of critical illness, both how critical illness influences a patient’s life course, and how the organizational environment influences the effectiveness of the care that a patient receives. My clinical work emphasizes medical critical care, including severe sepsis, ARDS and high complexity patients.
A major focus of our current work is to define the experience of survivorship after critical illness, particularly severe sepsis. Evidence increasingly suggests that severe sepsis is not only life-threatening, but also life-altering. How does severe sepsis reshape the lives of patients? What can be done to lessen the adverse consequences among those who survive? In collaboration with the Health and Retirement Study and others, we are working to measure long-term functional, cognitive and health care outcomes after severe sepsis. Further, we are establishing the mechanisms by which these long-term changes occur, with an eye to interventions, particularly hospital-based, that can improve the lives of survivors.
At the same time, the organization of care is at the heart of critical care as specialty, rather than a focus on specific organ dysfunction. A continuing focus of my work is on the organization of critical care services. Hospitals vary substantially in the quality of the critical care they provide. We are interested in two related problems. First, how can we better evaluate the quality of care that hospitals provide, using techniques that are fair and patient-centered. Second, can we integrate such information with already existing informal inter hospital transfer networks, to use existing resources more effectively.
Methodologically, our group combines the traditional tools of health services research (including analysis of administrative databases and multi-level modeling) with emerging techniques in network analysis and longitudinal data analysis.