Funded by the Research Seed Fund, University projects examine effects on nursing homes and medical care.

WITH THE ASSISTANCE of the University’s COVID-19 Research Seed Fund, some research groups have focused their microscopes on the viral particles behind the infection, while others have built technology to approach the pandemic’s challenges from various angles. Another set of University projects is gathering data—from nursing home employees and patients’ health records—to assess COVID-19’s macroscopic effects on the state and national population.

Their ultimate goal? To translate these findings into better medical policy and practice.

Addressing Nursing Home Outbreaks

Since the onset of the COVID-19 pandemic, a significant portion of COVID-19 cases have originated in nursing homes—compact environments where the virus can spread quickly, and often fatally. Many homes have struggled to contain outbreaks.

As of early July, “about 10,000 out of 15,000 nursing homes across the country (were) experiencing outbreaks,” said Elizabeth White, a geriatric nurse practitioner and an investigator at the Center for Gerontology and Healthcare Research in the School of Public Health. Almost half of all COVID-19-related deaths have been in nursing homes and other long-term care facilities, White said. These cases have taken their toll on the staff as well as the residents, yet the news has tended to put nursing homes in a negative light.

To shine a spotlight on previously unheard perspectives, a University research team funded by the Seed awards has invited frontline workers from nursing homes and long-term care centers to share their experiences in a survey administered via social media. They hope the stories they gather will inform new policies by highlighting which efforts have been most effective.

“We wanted to capture the voices of frontline workers … to understand both the best practices, if any, that we might be able to spread rapidly, (and) also to characterize their experiences and begin to understand the intervention needs that are going to arise,” said Rosa Baier MPH’04, director of the Center for Long-Term Care Quality and Innovation. Baier is the principal investigator of the research group, leading the study alongside White. Professor of Health Services, Policy and Practice Terrie Fox Wetle is the project’s co-investigator.

The Center for Long-Term Care Quality and Innovation is part of a partnership “with nursing homes and other post-acute and long-term care providers to establish the evidence base for promising interventions,” Baier said.

The researchers have been compiling data from the survey and are releasing key findings in the form of issue briefs. Concerns raised thus far have included the shortage of personal protective equipment, risks of contracting COVID-19 at work and “how the situation affects their day-to- day lives,” White said.

The Seed funding helped propel the project by allowing researchers to gather data quickly, but this data has further potential to feed future interventional research and policies.

The work has been a “balance of being able to use research to identify problems but then also simultaneously pair that with advocacy and intervention work … in a way that can be relevant given the speed and the acuity of the pandemic,” White said.

Prospects of Current Medical Practice

Since the COVID-19 pandemic began, numerous medical centers have resorted to telemedicine—medical consultations administered over video or phone calls—as many in-person visits have been canceled. Studying the number and outcomes of the medical visits that have continued may indicate the importance of annual visits.

Another University research team led by Ira Wilson, chair and professor of health services, policy and practice and professor of medicine, is using data on medical visits and mortality rates to study medical care more broadly.

The researchers under Wilson aim to analyze insurance claims, the statements sent to health care insurers following a visit that detail the purpose of the visit and treatment received that is being billed for. Although not as thorough as an electronic health record, claims—or the lack thereof can reveal when a person visited a specific doctor and the kind of care they did or didn’t receive. The researchers can use this information to determine how visiting the doctor now, or avoiding a visit, relates to future outcomes, like the patients’ future emergency room visits or death, if applicable.

This study’s particular cohort of claims comes from the Neighborhood Health Plan of Rhode Island, which commonly serves Medicaid patients and therefore reflects a low-income population. The data not only includes information from current visits but also extends back to 2017 for the same patients, providing a point of comparison for 2020.

It is “very clear there are just strikingly dramatic drops” in physician visits in March and April of this year compared with the past three, Wilson said. But questions the researchers have sought to explore include whether a person’s medical history impacts how much their health deteriorates with fewer medical visits, as well as how the reduction in visits has differed between primary care doctors versus specialists.

While this research would likely require obtaining data from health records, it “might tell us what kind of things we can do less of, safely,” in medical practice, Wilson said.

The co-investigators of the project are Associate Professor of Health Services, Policy and Practice Omar Galarraga and Professor of Health Services, Policy and Practice and Professor of Medicine Amal Trivedi. The former Vice President of Healthcare Analytics and Chief Analytics Officer at Neighborhood Health Plan Amanda Davis is also a collaborator.

The researchers’ prior work on the multidimensional factors that affect health care have made them interested “in basically using our research to improve the health of Rhode Islanders” through this COVID-19-focused project, Wilson said.

Originally printed by the Brown Daily Herald on September 10, 2020.
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