Andrew Admon: Addressing gaps in continuity of care among hospitalized patients

Andrew Admon, M.D., M.P.H., M.Sc., Clinical Lecturer in the Division of Pulmonary & Critical Care Medicine, is passionate about improving the quality of hospital care for critically ill patients, including those with sepsis and respiratory failure. Dr. Admon is a graduate of the Pulmonary & Critical Care Medicine Fellowship Training Program at Michigan Medicine, where he also completed his internal medicine residency and served as Chief Medical Resident. 

In addition to caring for his patients, Dr. Admon is an avid researcher and is a member of the Institute for Healthcare Policy and Innovation (IHPI), Michigan Center for Integrative Research in Critical Care (MCIRCC), and Michigan Institute for Data Science (MIDAS). As a researcher, he seeks to understand how hospital care can be better organized and delivered in order to make it safer, more effective, and more patient-centered for patients with severe illnesses. Dr. Admon is also actively involved in COVID-19 research, and is working with several national and international teams to identify specific risk factors for COVID-19-related complications, generate rapid evidence to guide bedside treatment decisions, and improve health system planning for future pandemics and other high-strain events.

Behind the Scenes with Dr. Andrew Admon

Originally published by the Michigan Medicine Department of Internal Medicine.

What is your research about?

Broadly, I’m interested in using data to improve care for hospitalized patients. A lot of our care as physicians and other clinicians is captured electronically in health records, claims databases, and disease registries. I apply modern methods from epidemiology, biostatistics, and economics in order to understand disease epidemiology, compare treatment decisions, and understand how best to organize and deliver care. Because it’s often easy to get the wrong answer using observational data, a big part of this work focuses on characterizing the types of statistical methods that work best to answer a particular research question. Most recently, I’ve been focused on how continuity and fragmentation on inpatient care teams impacts patients with serious illnesses like respiratory failure.

Why does this area of research speak to you?

One of the favorite parts of my job as an outpatient physician is getting to know my patients. Over time, my experiences with a patient help me to choose treatments that are customized to their lives and to their unique illness. On the inpatient side, though, my patients often move throughout the hospital – from the intensive care unit, to our intermediate care unit, and later to our general medicine floor – depending on the amount and type of care they need. I became interested in continuity and fragmentation when I started thinking about how to bring the best things about continuity on the outpatient side of medicine to inpatient care.

Dr. Admon is the lead author of “A Framework for Improving Post-Critical Illness Recovery Through Primary Care," which was published in The Lancet Respiratory Medicine.

Tell us more about the research work you are conducting on COVID-19. 

I am involved in several COVID-related projects. Given my background and interest in advanced methods for observational research, I have been asked to participate in several national and international studies that are researching the epidemiology of COVID-19. Broadly, these studies have sought to understand who gets sick from COVID-19, how their illness evolves while they are in the hospital, and whether certain strategies for providing care to these patients are helpful or harmful.

Dr. Admon is co-author on a study that identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19: “Factors Associated with Death in Critically Ill Patients with Coronavirus Disease 2019 in the US."

I am also involved in a survey of American hospitals seeking to understand how the health system responded to the influx of critically ill COVID-19 patients. The goal of this study is to learn whether specific response strategies were better than others and enabling care while under strain. I’m hopeful that this knowledge will inform health system planning for subsequent pandemic waves or other sudden surges in the numbers of critically ill patients.

Finally, I am involved in an exciting team effort with others at MCIRCC to predictsevere illness among patients hospitalized with COVID-19. An important challenge in providing care to patients with COVID-19 has been the wide range of trajectories that individual patients can experience. This can range from mild or even asymptomatic illness to severe respiratory failure. By using clinical data to make predictions about which inpatients are going to get sicker and when, our PICTURE-COVID-19 project seeks to help clinicians stay a step ahead of the virus.

Dr. Admon is a collaborator on the MCIRCC PICTURE-COVID-19 project. In May 2020, the team received a MIDAS COVID-19 Propelling Original Data Science (PODS) Grant Award to help advance their research. He is a member of the MCIRCC Data-Driven Diagnostic and Surveillance Platform project that will leverage recently developed analytical approaches to predict deterioration in COVID-19 patients.

What are your clinical interests and what about them appeals to you?

I enjoy meeting and taking care of patients with pulmonary diseases in my clinic, and also taking care of patients with a wide range of acute illnesses on our general medicine floors, intermediate care units, and intensive care units.

As a medical student and then later as a resident and chief resident, I really enjoyed all of internal medicine, including both inpatient and outpatient care. As I’ve gotten to practice in our clinics, general floors, intermediate care units, and intensive care units, I've enjoyed the fact that thinking about care in one area informs my care and helps me to be more effective in other areas.

Another reason I enjoy working in such diverse settings is that I have the joy and privilege getting to work with a wide-ranging group of trainees including medical students, interns, residents, and pulmonary fellows. I’ve learned a lot from each of them. 

How do you spend your day when you are seeing patients? 

My clinic is in the Brighton Center for Specialty Care, where I spend my day seeing patients and going over test results, talking through their pulmonary function testing, chest x-rays, and CT scans. I really love this part of my job. For many of my new patients, it’s their first time seeing what their body looks like on the inside or thinking about what their test results tell us about their physiology!

As an inpatient physician at the University Hospital, I typically spend my morning reviewing my patients’ charts, overnight lab results, and vital signs while preparing teaching points for rounds. I’ll then round with others on my team, including medical students, trainee physicians, and pharmacists or pharmacy students. If I’m in the intermediate care unit or intensive care unit, the team includes nurses, nutrition specialists, and others. I’ll then spend the afternoon visiting my patients and reviewing their test results before circling back with the team at the end of the day for clinical updates. The afternoons will sometimes include supervising procedures or meeting with consultant physicians to discuss a patient’s care.

What was your role in Michigan Medicine’s preparation and caring for patients with COVID-19?

With a newborn at home, my role was mostly in outpatient virtual clinics, helping to coordinate ICU triage, and working with our transfer team while helping to support our Division’s research response.

What accomplishment are you most proud of?

A recent accomplishment that is very meaningful to me was getting appointed to the ‘research methods’ team for a large, multicenter COVID-related observational research study. Although it’s not an award or accomplishment in the traditional sense, it was nice to be recognized as an early career critical care epidemiologist and to have a voice among senior people in my field designing and conducting a series of studies that could improve care for patients with COVID-19. It’s also given me the opportunity to work closely with and learn from a phenomenal group of experts from across the country.

What advice would you give to someone who is considering specializing in pulmonary medicine?

Do it! Pulmonary medicine offers the unique opportunity to work in the intensive care unit in the morning and in an outpatient clinic in the afternoon. You work closely with consultants on extremely complex cases and meet and counsel patients and their families during some of the most challenging experiences they’ll ever face. And I have some of the most fantastic colleagues, both at Michigan Medicine and around the world. I would make the same decision again in a heartbeat.

What parts of your job give you the most satisfaction?
I love collaboration in all of its forms and am lucky that it is a big part of my job. In my academic work, I enjoy sharing and receiving feedback on my work from a diverse, interprofessional group of colleagues. As a physician, I enjoy spending time talking with and getting to know my patients and their families, and sharing what I’ve learned about their health with them.

Who has inspired you the most?
I know this sounds cliché, but my parents. My mom and dad separately immigrated to the U.S. in the early 80s under challenging circumstances. Although neither of them attended college, they encouraged me to pursue a career doing what I loved. Growing up, they frequently needed to work two jobs, nights and weekends, in order to support my ability to go to school and get into college. I reflect often on the incredible privilege I have to work at a place like Michigan Medicine, in a role that I enjoy so much among incredible colleagues, and how I owe a lot of this opportunity to them.

How do you balance your work and personal life?
It’s a work in progress. As first-time parents to a 9-month-old, my partner (also in medicine as an early career physician-scientist) and I have both needed to set strict boundaries on when and where we can each work. Though these boundaries pose a challenge when trying to get a big project wrapped up or when trying to stay academically productive during a busy period of clinical service, they’ve helped us reserve time to spend with our kiddo and with one another.

More about Dr. Admon: 
You can find all of his publications and read more about his research at Michigan Research Experts. 

You can keep up with what he's doing on twitter @ajadmon.