# Determining disparities in care quality for patients with acute respiratory failure and sepsis: the role of hospital-wide capacity strain

> **NIH NIH F32** · UNIVERSITY OF PENNSYLVANIA · 2021 · $81,122

## Abstract

Abstract
Patients who are racial and ethnic minorities share excessive burden of disease and worse outcomes for critical
illness. Black patients in particular are not only at higher risk of developing diseases such as acute respiratory
failure (ARF) and sepsis, but also at increased risk of mortality. Patients with ARF or sepsis generally receive
medical care in either the intensive care unit (ICU) or the general medicine ward. Typically, most would believe
that the decision for triage location would only be based on illness severity. However, hospital level factors may
influence triage decisions. Capacity strain, defined as a limitation in a care unit's ability to deliver high-quality
care to patients due to resources, has been associated with healthcare decision making. Capacity strain is an
important systems phenomenon because it is (1) common to all acute healthcare systems, (2) readily perceivable
by healthcare providers, and (3) associated with poor clinical outcomes. Despite growing literature demonstrating
the role of capacity strain in healthcare operations, no previous study has been designed to identify the
relationship between capacity strain, disparities, and clinical outcomes for racial and ethnic minority patients.
Determining the role of capacity strain and healthcare disparities for critically ill patients is crucial to (1) fully
characterize the relationship between capacity strain, critical illness, and patient outcomes, (2) develop a
framework for understanding how intrahospital operations may contribute to the development of disparities due
to structural limitations, and (3) identify system-level targets for implementation initiatives designed to reduce
healthcare disparities. Such analyses could be pivotal in reframing common understanding of disparities in
critical illness by emphasizing the importance of intrahospital risk factors for their development. This would
contrast to current interpretations that focus primarily on between-hospital factors that define high-performing
and low-performing critical illness care centers.
The goals of this study are to (1) understand the relationship between hospital-wide capacity strain, ICU triage,
and racial/ethnic disparities in a population of patients with ARF and sepsis, and (2) assess for disparities
between races/ethnicities in benefits due to ICU triage among patients with ARF and sepsis. First, I aim to use
multivariable modeling techniques to identify important sociodemographic variables and assess for effect
modification between various capacity strain metrics and patient race/ethnicity. Next, I aim to use causal effect
methods to assess for ICU benefits among different patient race/ethnicities.
This project will provide essential preliminary data for a planned NIH K-series Career Development Award that
will (1) assess for the cumulative impact of capacity strain throughout a patients clinical care in the emergency
department, ICU, and ward, (2) assess for economic dispariti...

## Key facts

- **NIH application ID:** 10315785
- **Project number:** 1F32HL160166-01
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Christopher Francis Chesley
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $81,122
- **Award type:** 1
- **Project period:** 2022-01-01 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10315785

## Citation

> US National Institutes of Health, RePORTER application 10315785, Determining disparities in care quality for patients with acute respiratory failure and sepsis: the role of hospital-wide capacity strain (1F32HL160166-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10315785. Licensed CC0.

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