Grantee Updates: Translating Research into Impact
Across the Foundation’s portfolios, our investigators are advancing research designed to improve healthcare quality, equity, and value in real-world settings. From payment reform and hospice access to addiction care and health equity, our grantees are addressing some of the most pressing challenges in healthcare delivery. The projects highlighted below reflect Donaghue’s commitment to actionable evidence that informs policy, strengthens care delivery, and generates practical insights that improve outcomes and reinforce value for patients and communities.
Anna D. Sinaiko, PhD| Harvard T.H. Chan School of Public Health
Improving Health Insurance Design to Reduce Racial/Ethnic Inequities in Maternal Health
Dr. Anna Sinaiko and her team completed a multi-year collaboration with Blue Cross Blue Shield of Massachusetts to examine how commercial insurance benefit design contributes to racial and ethnic disparities in maternity care spending and access. Using claims data from more than 87,000 maternity episodes, the team conducted a detailed analysis of cost-sharing structures, enrollment patterns, and clinical outcomes.
The study found that Black, Hispanic, and Asian birthing people with commercial insurance incurred significantly higher out-of-pocket costs for pregnancy and delivery compared to White birthing people, even after adjusting for demographic and clinical factors. These differences were driven in part by plan design features, including higher coinsurance requirements and enrollment in plans with less protective cost-sharing structures.
Although elevated out-of-pocket spending did not directly explain differences in severe maternal morbidity, the research identified a critical pathway: cost-sharing meaningfully affects postpartum care utilization. Individuals with lower or eliminated cost-sharing during the postpartum period were significantly more likely to attend recommended follow-up visits, including preventive and behavioral health services. Even relatively modest financial barriers reduced outpatient engagement during a clinically vulnerable period.
The findings directly informed policy discussions in Massachusetts and contributed to the creation of a commercial insurance rider eliminating maternity cost-sharing. With multiple peer-reviewed publications and national dissemination underway, this work provides actionable evidence that insurance design is not neutral. Benefit structure can either reinforce inequities or serve as a lever to improve maternal health access and outcomes.
Mark Neuman, MD, MSc| University of Pennsylvania
Accelerating De-adoption of Low-Value Sedative Use in Older Surgical Patients
Each year, more than 21 million adults aged 65 and older undergo surgery in the United States. Certain sedative medications, particularly benzodiazepines, are associated with increased risk of postoperative delirium, prolonged cognitive impairment, and other complications in this population. Despite longstanding clinical recommendations to minimize their use in older adults, benzodiazepines remain commonly administered in perioperative settings.
Dr. Mark Neuman partnered with United States Anesthesia Partners to evaluate scalable strategies to reduce potentially inappropriate sedative use. The study included more than 509,000 patients treated across 415 hospitals and ambulatory surgery centers in eight states, representing one of the largest implementation studies of its kind in anesthesia practice.
Investigators tested three approaches: clinician peer-comparison feedback, patient-directed empowerment mailings encouraging discussion about sedative risks, and a combined strategy. While none of the individual interventions produced statistically significant reductions relative to usual care, overall benzodiazepine administration declined substantially over the study period, from 25 percent to 17 percent. Importantly, reductions occurred without compromising patient satisfaction, and adverse events remained rare.
The findings suggest that broader quality improvement infrastructure, performance monitoring, and evolving professional norms may influence clinical practice as effectively as discrete behavioral nudges. The study contributes valuable evidence to the field of de-adoption science, highlighting both the complexity of changing entrenched practice patterns and the potential for system-level approaches to reduce low-value care in high-volume clinical settings.
Ellis Dillon, PhD, and Julie Robison, PhD| University of Connecticut
Improving Hospice Care in Connecticut Nursing Homes
Donaghue grantees Julie Robison and Ellis Dillon recently presented findings from their qualitative study examining hospice use in Connecticut nursing homes and the organizational, clinical, and policy factors shaping access to end-of-life care. Through interviews with nursing home and hospice leaders across nonprofit and for-profit settings, the research team found broad agreement that hospice provides meaningful benefits to residents and families, including stronger symptom management, improved communication, additional staffing support, and reductions in unnecessary hospital transfers.
Despite this consensus, hospice utilization varies considerably across facilities. Leadership buy-in and staff understanding emerged as central drivers of timely referrals and effective integration. Social workers and advanced practice nurses were frequently identified as key champions of hospice discussions, while misconceptions about eligibility, opioid use, and the role of therapy services persist among frontline staff and families. Facilities with structured, early goals-of-care conversations reported stronger collaboration and smoother transitions to hospice.
The study also highlights structural barriers. Medicare eligibility criteria, particularly for residents with dementia, create uncertainty, and the Skilled Nursing Facility benefit can discourage hospice enrollment due to room-and-board payment implications. Regulatory pressures and audit concerns further complicate decision-making.
Robison and Dillon plan to translate these findings into education initiatives, stakeholder engagement, and policy advocacy efforts aimed at improving hospice access and strengthening end-of-life care quality in nursing homes statewide.