# Building a Learning Healthcare System to Understand and Improve Sepsis Outcomes in the VA TeleICU Network

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

Background: Sepsis, the body’s overwhelming systemic response to infection, strikes more than 1 million
patients annually in the United States and is known to impact over 48,000 Veterans every year. Over the past
decade, sepsis survival has continued to improve through a better understanding of effective therapies, early
intervention, and prophylaxis. This has been seen in the private sector and VA with inpatient mortality
dropping from 15% in 2008 to 10% in 2012. However, despite this improvement, a patient with sepsis may
have up to a 100% increased risk of death at 30 days depending on the hospital to which he/she is admitted in
the VA system.
Significance/Impact: This proposal is specifically designed to address three priority domains of the HSR&D
Service - Healthcare Informatics, Quality and Safety of Health Care, and Virtual Care. Through the unique
combination of these three domains we plan to address two significant limitations in understanding sepsis in
the VA; 1) that existing reports may or may not provide insight into the distinguishing characteristics of the
patients that died with sepsis in what are thought to be similar VA ICUs, and 2) in these reports there are
multiple interventions known or suspected to improve outcomes with varying levels of efficacy about which
little or no information is offered.
Innovation: We can use a novel data source (TeleICU) to directly identify the patient level factors associated
with negative outcomes in the septic patient population, quantify the practices of high and low performing
units, and subsequently improve the care provided to septic patients in VA ICUs using this information.
Specific Aims:
Aim #1: Evaluate risk factors of negative outcomes for specificity to sepsis and within sepsis types to
determine best strategies for adjustment and calculate risk-adjusted ICU mortality rates.
Aim #2: Evaluate the incidence of previously unmonitored elements of sepsis care (hypotension, ventilator
management, and antibiotics) and their impact on outcomes cited in SA1a (ICU mortality as primary
outcome) in VA sepsis patients.
Aim #3: Qualitatively examine the management of hypotension, lung protective ventilation, and antibiotic
therapy in sepsis patients at high and low performing sites (based on appropriately adjusted ICU mortality
rates). Evaluations will include documented protocols, clinical workflows, and TeleICU support.
Methodology: We will conduct a mixed methods investigation by merging data from the TeleICU and
Corporate Data Warehouse to first identify high and low performing ICUs in the treatment of sepsis. We will
then perform an ethnographic investigation of 3 high and low performing ICUs in the treatment of sepsis.
Simultaneously, we will examine the management of hypotension, the use of lung protective ventilation, and
the use and efficacy of antibiotics in septic patients in the ICU.
Next Steps/Implementation: We will develop real-time clinical decision support, to provide local clinic...

## Key facts

- **NIH application ID:** 10069821
- **Project number:** 1I01HX002950-01A2
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** James Marlow Blum
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-07-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10069821

## Citation

> US National Institutes of Health, RePORTER application 10069821, Building a Learning Healthcare System to Understand and Improve Sepsis Outcomes in the VA TeleICU Network (1I01HX002950-01A2). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10069821. Licensed CC0.

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