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Our Research Projects


Developing a Program to Educate and Sensitize Caregivers to Reduce the Inappropriate Prescription Burden in Elderly with Alzheimer’s Disease Study (D-PRESCRIBE-AD)  
 

Funding Agency: National Institute on Aging
Status: Ongoing

Project Overview: Potentially inappropriate prescribing includes the use of medications that may no longer be necessary or that may increase the risk of harm. Inappropriate prescribing is a “morbidity multiplier,” increasing overall symptom burden, and adversely affecting health-related quality of life and function. Inappropriate prescribing of certain drug categories such as sedative/hypnotics, antipsychotics, and highly anticholinergic agents poses particular risks for older adults, and may be more prevalent among those with Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) due to a higher prevalence of multimorbidity and associated polypharmacy. The Developing a PRogram to Educate and Sensitize Caregivers to Reduce the Inappropriate Prescription Burden in Elderly with Alzheimer’s Disease Study (D-PRESCRIBEAD) will test a health plan-based intervention leveraging the NIH Collaboratory's Distributed Research Network, which uses the Food and Drug Administration (FDA) Sentinel Initiative infrastructure. The overarching goal is to develop, implement, and evaluate the effect of a patient/caregiver-centered, multifaceted educational intervention on inappropriate prescribing in patients with AD/ADRD. The research hypothesis is that education on inappropriate prescribing among patients/caregivers and their providers can reduce medication-related morbidity in patients with AD/ADRD and lead to an improvement in medication safety for this vulnerable population. The study population will include community-dwelling patients with AD/ADRD, identified based on a diagnosis of AD/ADRD or use of a medication for Alzheimer’s Disease, who have evidence of inappropriate prescribing. We will evaluate the effect of educational interventions designed to stimulate patient/caregiver-provider communication about medication safety (versus usual care) on the proportion of patients with inappropriate prescribing, the primary outcome of this study. The trial will be health plan-based, conducted in two large, national health plans. The study design will be a prospective, cluster randomized, comparative effectiveness intervention trial with three arms: (1) a combined patient/caregiver and provider educational intervention; (2) a provider only educational intervention; and (3) usual care. A one-year R61 planning phase preceded a four-year R33 implementation phase. During the R33 phase we will sequentially implement two separate pragmatic trials, each enrolling over 11,000 patients, adapting the second trial based on the findings and experience gained in the first. The R33 aims are: (1) to assess the impact of the patient/caregiver educational intervention on inappropriate prescribing to AD/ADRD patients, employing a prospective, cluster randomized trial design with three arms; and (2) to create a plan for disseminating study findings to stakeholders who might implement the intervention or make decisions about its future use.

Multimorbidity and Treatment-Related Outcomes in Older Heart Failure Patients

Funding Agency: National Institute on Aging
Status: Ongoing

Project Overview: Heart failure (HF) is the most common reason for hospitalization in older adults. Over 85% of all patients hospitalized with HF are 65 years of age or older. Multimorbidity, usually defined as the presence of two or more chronic conditions, greatly increases the risk of hospitalization and mortality among older HF patients. In addition, the presence of multiple chronic conditions can greatly complicate the management of HF, especially with regard to pharmacotherapeutic decision-making. While national guidelines exist for the care of patients with HF, it is widely recognized that caution is required in applying established clinical practice guidelines to the care of older adults with multimorbidity, as practitioners are faced with managing not just a single condition, but multiple conditions simultaneously. In the proposed study, we will examine treatment patterns and the net benefits versus harms of selected therapies in patients presenting with HF and multimorbidity. The source population included over 100,000 members from four participating healthcare delivery systems within the Cardiovascular Research Network. Sites included Kaiser Permanente Northern California, Kaiser Permanente Northwest, Kaiser Permanente Southern California, and Fallon Health in Massachusetts. In addition, we will build a bridge to the new era of use of electronic health record data through natural language processing (NLP) technology. As an important, new, and novel approach, we will use NLP systems that will extract key information on adverse outcomes related to the therapies of interest in patients with HF and multimorbidity. 

Strategies to Reduce Injuries and Develop Confidence in Elders Study (STRIDE)

Funding Agency: Grant award from the National Institute on Aging (NIA) in partnership with the Patient-Centered Outcomes Research Institute (PCORI), as part of the Falls Injuries Prevention Partnership of the organizations.
Status: Complete

Project Overview: The STRIDE (Strategies to Reduce Injuries and Develop Confidence in Elders) Study is supported by a The study’s approach differs from others in that it integrates proven falls reduction strategies into a cohesive intervention that can be adopted by many health care systems. The trial is led by Shalender Bhasin, M.D., Brigham and Women’s Hospital, Harvard Medical School, Boston; Thomas Gill, M.D., Yale School of Medicine, New Haven, Connecticut; and David Reuben, M.D., David Geffen School of Medicine at the University of California, Los Angeles. The team includes more than 100 researchers, stakeholders, patients and their representatives at ten clinical health system sites across the country.  Read more about this study here.

Valuing Treatments to Prevent and Effectively Treat Alzheimer's Disease

Funding Agency: National Institute on Aging
Status: Complete

Project Overview: No matter how desirable the availability of highly effective treatments for Alzheimer’s disease may be, the American health care sector is ill prepared to face the challenge of assessing and paying for these future treatments. To date, policy analyses of the challenge of valuing highly-effective treatments for chronic conditions have focused mainly on developing new ways to pay for the anticipated extremely high prices of treatments that provide the possibility of a lifetime of benefit for rare and ultra-rare diseases. Few have considered novel therapies for conditions with applicability to the care of large numbers of older patients, such as those with Alzheimer’s disease. The question remains: how should a fair, value-based price be determined? Evaluating different approaches to calculating and presenting suggested value-based prices will be essential to providing policymakers, payers, health care organizations, and the academic and manufacturer communities with a platform that can reward innovation while supporting a sustainable U.S. health care system. Importantly, this information will ultimately have direct relevance to the care of those with Alzheimer’s disease, particularly in relation to access to effective therapies and shared clinical decision-making efforts among clinicians, patients, and their families.  Read more about this research project here


Post-Hospital Discharge Adverse Events in the Nursing Home Setting

Funding Agency: Agency for Healthcare Research and Quality (AHRQ)
Status: Complete

Project Overview: In this project, we studied adverse events occurring among long-term care residents who transitioned from the nursing home setting to an acute care setting, and were then discharged back to the same facility.  The setting was a representative sample of 32 nursing homes drawn from across the six New England states. The specific aims of the study were to characterize the rates, types, severity, and preventability of adverse events that occur in the 45-day period post-hospital discharge among long-stay nursing home residents (long-stay = >100 days) who were hospitalized and returned to the same facility; to identify demographic, clinical, and functional resident characteristics associated with the occurrence of adverse events; to identify facility-level characteristics associated with the occurrence of adverse events; and to examine the impact of level of facility participation in the New England regional National Nursing Home Quality Care Collaborative on the occurrence of adverse events. Nurse abstractors collected data from resident charts at the 32 homes on a quarterly basis and four physician adjudicators evaluated the adverse events reported by the nurse abstractors.

Main Findings: 555 unique nursing home residents contributed data on 762 hospital discharges with return to the same facility.  Nearly 66% were female, and the mean age was 82.2 years. There were 379 adverse events identified.  Of those 379 events, 197(52.0%) were related to resident care, with pressure ulcers, skin tears, and falls with injury representing the most common types of events in this category.  Health care–acquired infections (108 [28.5%]) and adverse drug events (64 [16.9%]) were the next most common.  In terms of preventability, 267 (70.4%) adverse events were deemed preventable or ameliorable. Adverse events developed in nearly 4 of 10 of discharges from hospital back to LTC. Most were preventable or ameliorable. Standardized reporting of events and better coordination and information transfer across settings are potential ways to prevent adverse events in LTC residents. Read more about our findings here.