# IMPROving care for VEterans with Persistent Critical Illness (IMPROVE PerCI)

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background. The persistently critically ill—patients who remain in the intensive care unit (ICU) for at least 11
days—comprise 5% of ICU patients but account for 21% of ICU bed-days in the Veterans Health
Administration (VHA). Nearly half of patients with persistent critical illness (PerCI) die in the subsequent year,
and survivors are often left with new cognitive and/or physical impairments. There is an urgent need to identify
strategies to improve quality of life (QoL) outcomes and survivorship for Veterans with PerCI. Significance.
IMPROVE PerCI directly aligns with the VHA's Whole Health Initiative and Strategic Priorities for Research by
prioritizing what matters to Veterans and their caregivers. Veteran-centered QoL outcomes are of particular
importance and relevance following a hospitalization with PerCI. We recognize that simply focusing on
mortality fails to acknowledge the impact these prolonged hospitalizations can have on the Veterans QoL.
Identifying how variation in organizational care practices can lead to improved QoL outcomes for Veterans is
essential. Importantly, the VHA provides care across the continuum from inpatient hospitalizations to outpatient
follow-up visits, offering opportunities to identify innovative strategies to delivering Veteran centered care which
improves their QoL. Innovation and Impact. IMPROVE PerCI is innovative in four specific ways. First, this will
be the first national study of Veterans with PerCI and their caregivers to evaluate their QoL outcomes. Second,
we will evaluate organizational mechanisms that differ among high- and low- performing VHA hospitals. Third,
we will evaluate organizational practices at high performing survivorship VHAs through an implementation
framework to readily translate practices into actionable recommendations. Lastly, we will use an innovative
causal modeling approach, coincidence analysis, to evaluate the causality of the multifaceted practices
implemented within VHA hospitals. Specific Aims. (A1) Identify high- and low-performing VHA hospitals for
survival among Veterans with PerCI and understand the extent to which organizational factors differ. (A2) Elicit
Veteran- and caregiver-survivorship experiences and QoL outcomes. (A3) Identify and define `best practices' at
high-performing QoL VHA hospitals through detailed contextual hospital assessments and an innovative causal
modeling approach (coincidence analysis). Methodology. Using VHA data from 2013-2022, we will calculate
risk- and reliability-adjusted hospital-level 90-day post-discharge survival after a PerCI hospitalization. Among
the 10 highest-and 10-lowest- 90-day post-discharge survival hospitals, we will assess if the organizational
factors that are hypothesized to contribute to improved survivorship (e.g., closed ICU units) differ. We will
empanel the 10-highest and 10-lowest 90-day post-discharge survival VHA hospitals (N=20) which will be used
for the prospective survey collection in Aim 2. Prospective te...

## Key facts

- **NIH application ID:** 10992466
- **Project number:** 1I01HX003851-01A1
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Elizabeth Marie Viglianti
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-10-01 → 2028-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10992466

## Citation

> US National Institutes of Health, RePORTER application 10992466, IMPROving care for VEterans with Persistent Critical Illness (IMPROVE PerCI) (1I01HX003851-01A1). Retrieved via MORVS 2026-10-25 from https://api.morvs.ai/grant/nih/10992466. Licensed CC0.

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