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NIH grant 1IK2RD000424-01A2: Learning Health System Assessment and Refinement within VA Intensive Care Units (LEARN-ICU)
Institute: {'code': 'VA', 'abbreviation': 'VA', 'name': 'Veterans Affairs', 'admin_org_id': '12500964', 'admin_funding_url': ''}. PI: Justin Rucci. Award: $.
Start: 2026-10-01T00:00:00.
Significance to VA: Over 58,000 Veterans are admitted annually to VA intensive care units (ICUs), where
they face complex, life-threatening illnesses and organ failures. These Veterans are at high risk of death, with
mortality rates as high as 21% for severe sepsis and 37% for respiratory failure requiring mechanical
ventilation. Despite advances in critical care medicine, there are still significant evidence gaps, wide practice
pattern variation, and poor adoption of evidence-based practices, indicating the need for solutions to improve
critical care delivery. Applying learning health system (LHS) principles in the ICU is a powerful strategy to fill
evidence gaps, standardize care around best practices, and improve Veteran outcomes. While VA has
successfully applied LHS approaches to enhance care in outpatient settings, the application of the LHS model
in the high-acuity ICU environment is limited and understudied. To remedy this shortcoming, VA needs a better
understanding of how core LHS domains are currently applied across VA ICUs, the impact of LHS principles
on ICU outcomes, and successful strategies to foster LHS adoption in the ICU. The proposed research will
apply a mixed methods approach pairing national and local survey data and in-depth qualitative interviews to
address these knowledge gaps and support application of the LHS model in VA ICUs. The work will 1) create
an instrument that VA ICUs can use to measure their performance as an LHS now and in the future, 2)
prioritize ICU LHS efforts by identifying which LHS domains most strongly associate with improved outcomes,
and 3) characterize structures and processes that support a successful ICU LHS.
Innovation and Impact: The proposal supports the VA Secretary’s priorities to improve VA’s direct healthcare
capabilities, as well as his renewed emphasis on advancing the EHR Modernization (EHRM) effort. VA health
systems research (HSR) has established the LHS model as its guiding principle. This CDA directly responds to
HSR’s call for research that discovers and optimizes the foundational methods needed to support the VA LHS,
and draws upon an innovative combination of HSR strategic methodologies: data science (applying ICU data
to create knowledge), implementation science (bringing critical care evidence to practice), engagement science
(achieving buy-in from ICU shareholders), and systems science (how the ICU LHS fits into the larger VA LHS).
Specific Aims: Aim 1: Adapt and validate a survey tool to measure the extent to which VA ICUs apply LHS
principles. Aim 2: Evaluate how maturity in LHS domains associates with ICU quality and safety outcomes.
Aim 3: Characterize factors that support application of LHS principles.
Methodology: Aim 1: An existing survey evaluating the maturity of outpatient learning health systems will be
adapted to the ICU setting and validated using psychometric analyses. Aim 2: Survey results from leaders at
all VA ICUs (n=240) will be used to evaluate how maturity in specific LHS domains, or combinations of
domains (i.e., “LHS phenotypes,” as determined by unsupervised clustering of ICUs by survey responses),
associate with important ICU outcomes. Aim 3: At four high-performing ICUs (based on Aim 2 results) relevant
items from the Aim 1 survey will be fielded to frontline ICU clinicians, and semi-structured interviews conducted
with multiple ICU shareholders, to understand structures and processes that support a successful ICU LHS.
Path to Translation/Implementation: This work will lead to submission of two IIR proposals. IIR #1 will use
mixed methods to characterize current best practices and areas for improvement in the collection,
organization, and reporting of VA ICU data, and then design and test interventions to foster ICU data
management strategies that are compatible with the new Federal EHR. IIR #2 will use CDA findings to apply
LHS principles to co-design (with ICU shareholders and Veterans) and test an intervention seeking to promote
opioid-sparing analgesia practices in VA ICUs. These future initiatives further support the Secretary initiative to
advance EHRM, and Congressional priorities to mitigate opioid use disorder among Veterans (CARA Act).document fetched 2026-10-24 02:46