2016 Another Look Awardees

Moving Research Beyond Journals We recently ran across a blog post by Leslie Curry, PhD, Senior Research Scientist, Yale Global Health Leadership Institute and a reviewer for Donaghue’s Another Look grant program. With Dr. Curry’s permission, we’re reprinting her post that makes the case for all of us to think #beyondjournals. Well-intentioned and smart scientists devote their careers to generating new knowledge they hope will benefit the health and well-being of the population, and ultimately, save lives. The discouraging reality is that only a small fraction (14%) of original research findings are published in scientific journals, and those findings take an average of 17 years to integrate into health care practice and policy. Scientists are growing impatient with the gap between research and practice, and have begun to question whether traditional journals are the best way to accomplish this goal, especially in an era of rapid information dissemination through online and social media outlets. Long publication processes can render findings obsolete before they are even known, the narrow readership of journals consists mostly of like-minded scientists and the static, one-way medium prevents constructive critique and debate that is essential for good science. What can be done to reach appropriate and wider audiences with research findings in a timely manner? The good news is that, in addition to journals reinventing themselves, there are alternatives. First, digital communication provides extraordinary opportunities to reach large diverse audiences through dynamic formats such as social media, websites, blogs and online platforms like Tumblr and YouTube. In addition, the emerging scientific disciplines of knowledge translation and implementation science focus on how to move science out of the lab and into the world. Finally, where advocacy has historically been forbidden among scientists, many are mobilizing to bring pressure for research to be more transparent and widely accessible. As a research community, it is our responsibility to leverage these three trends — digital communication, the field of implementation science, and advocacy — to shrink the gap between research and practice and make our research matter.

Now in its fourth year, the Another Look – Better Health for Elders in Care Facilities program has recently awarded grants for five research projects for a total of $771,000.

Another Look was established to provide funding for research projects that can improve the quality of care for the elderly population in nursing homes or other care facilities. Researchers must use data that already exists for their study. In addition, researchers applying for this grant must identify a stakeholder in the care delivery or policy arena with whom they will either consult or collaborate and who is willing to work with the researcher to develop a research product that may be readily used to improve care.

Letters of intent were reviewed in a manner that was blinded as to the principal investigator and his or her institution. Thirty-five LOIs were received and reviewed, and of those 18 full applications were requested and then reviewed by the science review committee. At the science review phase, information about the applicants, their expertise and institutions is available to the reviewers. Donaghue expects to have a fifth cycle of Another Look in 2017.

Donovan Maust, MD
University of Michigan
“Unintended Effects of Antipsychotic Reduction in Nursing Homes”
Stakeholder Organizations: Centers for Medicare and Medicaid; Michigan Great Lakes Chapter of the Alzheimer’s Association

While evidence suggests that the rate of antipsychotic use for the behavioral and psychological symptoms of dementia in long-term care has decreased, anecdotal evidence suggests that prescribers may have simply shifted to alternative but unmeasured agents such as valproic acid or benzodiazepines to help control the behaviors. Unfortunately, these antipsychotic alternatives have their own associated harms and even less evidence of benefit for the problematic behaviors. So, while antipsychotic use has dropped, the replacements may be even worse. This study will use Medicare data from 2008-2013 to examine whether the recent reduction in antipsychotic use among long-term care residents has been accompanied by increased use of alternative psychotropic medications. This information is critically important for policymakers so they can learn whether the strong emphasis on reducing antipsychotic use, when implemented in the absence of an equally strong strategy to improve non-pharmacological behavioral management, simply caused a shift in prescribing to even worse agents.

Helen Temkin-Greener, PhD
University of Rochester
“Improving the Quality of Mental Health in Nursing Homes”
Stakeholder Organization: Finger Lakes Health System Agency

Although nursing home residents are characterized by high and increasing prevalence of mental health disorders, the delivery of mental health services in nursing homes has been described as inadequate due to insufficiently trained staff, insufficient specialty psychiatric care resources, problematic practices such as inappropriate and often excessive use of antipsychotic and anti-depressive medications, and a high rate of hospitalizations among residents with dementia or mental health disorders. The overall goal of this study is to identify and develop process and outcome-based measures of care quality for nursing home residents with mental health and behavioral disorders and to explain variations in these measures across facilities and regions or states. Nationally, these findings will help fill knowledge gaps and provide research direction to help inform the near-term development of clinical and policy interventions for this population. Regionally, these findings will inform nursing home care by developing and disseminating benchmark performance measures for all Finger Lakes Performing Provider System nursing homes.

Kenneth Boockvar, MD
The New Jewish Home Research Institute on Aging
“Adverse Effects of Diuretics in Nursing Home Residents with Dementia”
Stakeholder Organization: Continuing Care Leadership Coalition/Greater New York Hospital Association

Nearly half of all nursing home residents with hypertension are prescribed diuretics, but diuretics’ adverse effects (e.g., water loss, urinary incontinence, and falls) may be especially problematic for these residents. The objective of this study is to examine the use and effects of diuretics in this population. Specifically, it will describe the prevalence of diuretic use in nursing home residents with hypertension and dementia; examine predictors of diuretic use including resident characteristics, prescriber characteristics, and organization characteristics; and determine the association between diuretic use and adverse outcomes including urinary incontinence, dehydration, falls, and hospital and emergency department use, as compared with use of other hypertension medications. This project will create knowledge that could improve health for nursing home residents with dementia and hypertension by helping providers make prescribing decisions according to symptoms and function, a key principal of geriatrics and palliative care.

David C. Grabowski, PhD
Harvard Medical School
“The Impact of Enhanced Primary Care in Nursing Homes”
Stakeholder Organization: OptumCare

Many long-stay nursing home residents have very poor access to primary care, which often leads to unnecessary health care utilization and poor health outcomes. The Evercare Model, offered by UnitedHealthCare as a Medicare Advantage plan to nursing home residents, provides a treat-in-place model of care for enrollees through the use of nurse practitioners. The objective of this study is to understand the impact of the Evercare Model on outcomes for long-stay nursing home residents, including emergency department and acute care inpatient utilization, rates of readmission, as well as the amount Medicare spends on care. This study will provide the first large-scale evaluation of whether an Medicare Advantage plan with an increased clinical presence can improve outcomes, which may have a profound impact on the delivery of services to the nearly one-million long-stay nursing home residents in this country.

Carrie H. Colla, PhD
Geisel Medical School at Dartmouth College
“Transforming Nursing Home Care Under the ACO Model”
Stakeholder Organization: Federal Coordinated Health Care Office

Nursing home residents require complex care coordination across a range of settings, providers, benefit plans, and payment models. As a result, nursing home residents are particularly susceptible to fragmented care that can be high in cost and low in quality. Accountable care organizations (ACO) present a payment and delivery model with the potential to improve quality and reduce costs for nursing home residents through an enhanced focus on care coordination and provider integration. With an aging population increasing the national demand for high quality nursing home services, there is an urgent need for research to determine the impact of the ACO model on this unique population. Medicare claims data will be linked to Minimum Data Set assessments to evaluate the performance of ACOs in managing nursing home residents across measures of spending, utilization, outcomes, and quality, as well as examine how treatment patterns for nursing home residents, including the types of physicians and settings from which they seek care, affect attribution to ACOs. This research will provide nursing facilities, ACOs, and policymakers with timely, actionable information on innovative care coordination strategies and characteristics of successful ACO-nursing home relationships to directly improve the health of nursing
home residents.