Understanding how health determinants shape recovery after critical illness among Virginia Medicaid patients

PROJECT ABSTRACT. Medicaid expansion covers over 18 million low-income patients, including those experiencing an intensive care unit (ICU) stay during serious illness. More than half of ICU survivors have new or worsening problems with cognitive, physical, and mental health. Further, experiences of critical illness

create new health disparities and exacerbate existing ones. This study applies the NIMHD’s Research Framework to understand how sociocultural environment, the built environment, and the health system domains of influence at the patient, interpersonal and community-level, differentially shape ICU survivorship

among patients covered by Medicaid expansion. Such knowledge will enable state and federal policymakers and clinicians to provide improved coordination of medical and social services for Medicaid members at the greatest risk of poor health outcomes. This work will leverage the resources of a well-established partnership between Virginia Medicaid and Virginia

Commonwealth University (VCU) and as well as complementary methods and data sources to better understand how health determinants shape patients’ recovery after an ICU stay. Aim 1 assess how patient- level and community-level sociocultural, built environment and health system domains are associated with

post-ICU hospital free days among Medicaid patients in Virginia using Virginia Medicaid claims data and publicly available community level-data on social deprivation, segregation, rurality, ICU bed and primary care access. Aim 2 uses qualitative research methods to expand beyond what is available in claims data by

interviewing 25 Medicaid patients to explore their perspectives on how health determinants shape their experiences during and after ICU stays at VCU Health System, the largest safety net provider in Virginia. Aim 3 examine whether including health determinants improves machine learning models predicting hospital

readmissions after an ICU stay using electronic health record data from VCU Health System. The proposed research is supported by Virginia Medicaid, aligning with the agency’s commitment to advancing health equity through improving care for complex patients. Ultimately this work will provide much-needed

evidence to policymakers exploring disparities in recovery after serious illness across the sociocultural environment, built environment and health system domains. This application describes an excellent research and training environment for the proposed work, supported by a collaborative multi-disciplinary mentorship

team. This proposal will not only explore a novel research area, the recovery of Medicaid patients after serious illness, but also provide integrated and robust clinical and research training in health-policy translation, qualitative methods and community-engaged research and machine learning to a physician-scientist dedicated

to practicing critical care medicine and pursuing a faculty position with a focus on advancing health equity through health policy.