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Selected IHDPS Projects


Current Projects


Identifying effective strategies used by Medicare Accountable Care Organizations to improve outcomes for patients with heart failure: A mixed-methods study

  • PI: Tara Lagu
  • Dates: 2018-2022

Accountable Care Organization (ACO) enrollment is expected to expand rapidly in upcoming years, resulting in an urgent need to understand the impact that ACOs have on processes of care and outcomes for the more than 5.7 million Americans with heart failure (HF). Through statistical analyses of the records of Medicare beneficiaries with HF, qualitative interviews, and a survey of all ACOs participating in the Medicare Shared Savings Program (MSSP), this study will describe the organizational strategies and contextual factors of ACOs that have, over time, reduced their risk-standardized acute admission rates for patients with HF. The results of this study will inform policymakers and health system and ACO leaders as they develop and refine novel organizational strategies for improving care for patients with HF.

Funding: NHLBI


Developing strategies to improve the use of evidence-based approaches for the diagnosis of venous thromboembolism in the ED setting

  • PI: Lauren Westafer
  • Dates: 2018-2020

Testing for pulmonary embolism using computed tomographic pulmonary angiogram (CTPA) has exploded over the past two decades despite recommendations from major medical societies to employ risk stratification tools prior to CTPA, including PERC, the Wells score, and the d-dimer. These validated risk stratification tools remain underutilized 10-15 years after their introduction. The goal of this project is to design targeted theory-based implementation strategies to increase the utilization of risk stratification tools in patients with suspected PE in the ED.

Funding: UMMS MA Consortium for Cardiopulmonary Implementation Science Scholars


Integrating a Parenting Intervention for Mothers with Opioid Use Disorders into Child Development Services

  • PI: Elizabeth Peacock-Chambers
  • Dates: 2018-2020

This KL2 focuses on a strategic approach to adapting a parenting intervention for mothers with opioid use disorders for delivery through a child-focused system, termed Early Intervention. The number of infants born to mothers with opioid use disorders has more than tripled in the past 15 years and the first year postpartum is an extremely high risk time for maternal overdose and death. Although Early Intervention provides a strong system of child development services to substance-exposed infants during the first year of life, targeted interventions for parents with opioid use disorders are note routinely available. Mothering from the Inside Out is an evidence-based intervention for parents with opioid use disorders proven to decrease the rate of relapse and improve parent-child interactions. However, this intervention is currently delivered through addiction treatment centers to parents of children over 11 months of age. Dr. Peacock-Chambers’ research and training plan will allow her to gain critical data through formative evaluations in order to optimally integrate Mothering from the Inside Out into the Early Intervention system.

Funding: Tufts CTSI

 


Shared Decision-Making for the Promotion of Patient-Centered Imaging in the Emergency Department: Suspected Kidney Stones

  • PI: Elizabeth Schoenfeld
  • Dates: 2018-2023

The use of advanced diagnostic imaging has risen dramatically in the past decade, to over 70 million CT scans performed annually, or approximately one CT scan performed each year for every 4.2 Americans. Although appropriate in many cases, CT scans increase health care costs and Emergency Department length of stay, expose patients to ionizing radiation, and increase patients’ risk of future cancer. As patients with kidney stones are at high risk for repeated exposure to radiation, this project aims to increase patients’ participation in decision-making and safely decrease CT utilization for this population, decreasing their exposure to radiation and therefore reducing their future cancer risk.

Funding: AHRQ

 


SPOiLER: Safer Prescribing of Legal Opioids from the Emergency Room

  • PI: William Soares
  • Dates: 2018-2023

Prescription opioid medications, although an important treatment option for acute painful conditions, have contributed to the opioid epidemic through nonmedical use, dependence and addiction. Despite attempts to regulate opioids, including state legislation such as the 2016 Massachusetts (MA) Opioid Law that restricts initial opioid prescriptions, there remains a lack of evidence to adequately assess the impact of such controls, in part because the factors that influence opioid prescribing behaviors and subsequent adverse patient outcomes remain poorly understood. Using the theory of planned behavior, the proposed mentored research project will evaluate how factors, including provider characteristics, cultural and social norms, and external controls like the 2016 MA Opioid Law, influence opioid prescribing behaviors and the development of patient- level opioid related adverse clinical events for emergency department patients presenting with an acute painful condition.

Funding: NIDA

 


Improving Access to Care for Patients with Lower Limb Mobility Impairment

  • PI: Tara Lagu
  • Dates: 2017-2019

Dr. Lagu is continuing her prior work to ensure that patients with disabilities have access to care. For this pilot project for which she has received an internal grant from Baystate Health, she is working with Baystate Community Health Centers to improve experience of care for patients with mobility impairment. The goals of this project are 1.) to identify the prevalence of disability in a community health center with a high percentage of patients who are dual-eligible for both Medicaid and Medicare; 2.) to develop an intervention to improve the experience of care for patients with lower limb mobility impairment; 3.) to develop an evaluation tool for this intervention; 4.) to assess feasibility and enrollment rates; and 5.) to gather pilot data needed for a multi-site stepped wedge cluster randomized trial.

Funding: Baystate Health


A Mixed Methods Study to Analyze the Use of Pulmonary Rehabilitation Following Hospitalization for COPD, and to Identify Effective Strategies for Increasing Rates of Participation

  • PI: Peter Lindenauer
  • Dates: 2017-2021

Chronic obstructive pulmonary disease (COPD) affects as many as 24 million individuals in the US and is responsible for more than 800,000 hospitalizations each year. Patients who require hospitalization suffer profound reductions in functional status and health-related quality of life that can take months to recover from. Pulmonary rehabilitation (PR) is a structured set of interventions that includes exercise training, education, behavior change and support, designed to improve the physical and psychological well-being of patients with chronic respiratory disease. Our long-term goal is to improve the quality of life of patients with COPD by optimizing participation in PR. The objective of this R01 is to analyze the translation of PR into routine clinical practice among Medicare beneficiaries following hospitalization for COPD, and to identify the factors and strategies that enable some hospitals to achieve higher rates of participation than others.

Funding: NHLBI


Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE)

  • PI: Peter Friedmann
  • Dates: 2017-2020

HIV, HCV, overdose, and sexually transmitted infections are important, treatable causes of morbidity and/or mortality for persons who inject drugs (PWID) in rural areas, where access to specialty care and services is limited. This two-stage, mixed-methods study will examine epidemiology, infectious consequences and service accessibility among young PWID in 15 rural counties in Maine, New Hampshire and Vermont, and then implement an integrated telemedicine approach to treat OUD and reduce HIV, other infectious complications and overdose. It will inform efforts to improve access to services for PWID and reduce the toll of the opioid crisis in rural areas of the United States.

Funding: NIDA

 


Identifying Effective Strategies to Improve Participation in Cardiac Rehabilitation after an Acute Cardiac Hospitalization

  • PI: Quinn Pack
  • Dates: 2017-2021

Cardiac Rehabilitation (CR) is an effective exercise-based lifestyle program for patients with heart disease; but, despite strong recommendations for CR in clinical guidelines, as few as 20% of patients participate after discharge from the hospital. Although the hospital is a logical place to assure referral and facilitate CR participation, little is known about how hospital processes of care influence CR participation after hospital discharge. Through statistical analysis of the records of Medicare beneficiaries and a national survey of hospitals, this study seeks to identify the most powerful strategies that hospitals can implement to maximize participation in CR and, in so doing, improve the health and well-being of their patients.

Funding: NHLBI

 


Maternal Perceptions of Opiate Addiction and Child Development Services from Pregnancy Through the First Year Postpartum

  • Co-PI: Elizabeth Peacock-Chambers
  • Dates: 2017-2018

Qualitative study to identify perceptions of addiction, health, and child development services in relation to continuity and gaps from pregnancy to one year postpartum.

Funding: Community Partnership Grant from The Center for Research on Families at the University of Massachusetts Amherst 

 


High Flow Nasal Cannula Oxygen Utilization and Effectiveness in Hospitalized Patients with Respiratory Failure

  • PI: Tidswell; co-investigator: Mihaela Stefan
  • Dates: 2016-2018

Within the last decade there has been increasing interest on delivering oxygen through high flow nasal cannula oxygen (HFNC) although only few RCT have demonstrated its efficacy. In a retrospective study performed in Baystate Medical Center we have found that over a 7 year-period the use of HFNC had increased dramatically in patients with cardiopulmonary conditions.

In a Pilot Randomized Controlled Study, we are comparing HFNC with noninvasive ventilation delivered by helmet for patients with acute respiratory failure. In future studies, we hope to assess the efficacy of HFNC in preventing postextubation failure in patients at high risk for reintubation.

Funding: Baystate Health


Research and Mentoring in Comparative Effectiveness and Implementation Science

  • PI: Peter Lindenauer
  • Dates: 2016-2021

COPD affects as many as 24 million individuals in the US and is responsible for more than 800,000 hospitalizations each year, leading to increased morbidity, mortality and costs. The goals of this K24 are to conduct patient-oriented research focused on improving care for patients hospitalized for COPD, and to train new investigators in the fields of comparative effectiveness research and implementation science. The ultimate goal of these activities is to expand research capacity and knowledge in this area, thereby improving care for patients with lung disease.

Funding: NHLBI


Identifying Factors Associated With High Quality Pediatric Primary Care

  • PI: Sarah Goff
  • Dates: 2015-2019

Dr. Goff received this career development grant from the National Institute of Child Health and Human Development. The goal of this study is to conduct a positive deviance study of high performing ambulatory pediatric practices to determine organizational and structural factors associated with care quality. As part of the career development plan, Dr. Goff will be pursuing a Ph.D. in Public Health, focused on dissemination and implementation theory and methodology.

Funding: NICHD


Implementation to Motivate Physician Response to Opioid Dependence in HIV Settings

  • Co-PI: Peter Friedmann
  • Dates: 2014-2019

A national implementation study to test academic detailing to increase prescribing of naloxone and buprenorphine in HIV treatment settings.

Funding: NIDA


Impact of Health Reform on Outpatient Substance Abuse Treatment Programs

  • PI: Peter Friedmann
  • Dates: 2013-2018

A national study of the addiction treatment system to examine the impact of health reform on outpatient drug abuse organizational structure, process, financing, technology and outcomes.

Funding: NIDA


Shared Decision Making - Renal Palliative Care

  • PI: Lewis Cohen; co-investigator: Sarah Goff
  • Dates: 2013-2018

This study assessed how patient-centered discussions about preferences for care impact decisions about Hospice care for dialysis patients with limited life-expectancy.

Funding: PCORI


Defining Optimal Clinical Strategies for Critically Ill Heart Failure Patients

  • PI: Tara Lagu
  • Dates: 2013-2018

Dr. Lagu received this career development grant from the National Heart, Lung, and Blood Institute. The goal of the project is to use statistical analyses and qualitative interviews at a diverse set of hospitals to develop knowledge of the strategies that lead to improved outcomes for patients with heart failure. The team first developed and internally validated a multivariable prediction model for patients hospitalized with acute exacerbations of heart failure. They then compared the performance of their model to five published clinical inpatient mortality prediction models and found that the new (“Premier”) model exhibited excellent performance (c statistic 0.81) compared to the clinical models (which had c statistics in the 0.70 range). This work was published in Circulation: Heart Failure. In a subsequent analysis, Dr. Lagu and the team found that the model performed similarly to clinical models when describing hospital mortality rates among patients with heart failure. The team is now working on the third aim of this study: at selected hospitals with low mortality rates, they are conducting qualitative interviews about the care of patients admitted with exacerbations of heart failure.

Funding: NHLBI


Completed Projects


Implementation and Outcomes of Noninvasive Ventilation in COPD

  • PI: Peter Lindenauer
  • Dates: 2011-2017

For the roughly 500,000 individuals hospitalized each year in the US for exacerbations of chronic obstructive pulmonary disease, the discovery of noninvasive forms of mechanical ventilation in the 1990s represented a treatment breakthrough that offered an alternative to being placed on an invasive mechanical ventilator in the intensive care unit, where the risks of prolonged hospitalization, complications, and death are substantial. Yet nearly a decade after its discovery, little is known about the use or outcomes of noninvasive ventilation in routine clinical setting, and if the experience of other biomedical innovations holds true, there are reasons to be concerned that translation of these research findings into day-to-day practice may be occurring slowly and unevenly. Through statistical analyses of records from a representative sample of more than 600 US hospitals, and through interviews and surveys with a diverse set of hospital personnel, we will close the gap in our understanding of the adoption of noninvasive ventilation in the US, and will identify effective strategies that can help speed the implementation process.

Funding: NHLBI


Project ACCCES: A Collaboration to build Capacity for Community-Engaged research in Springfield

  • PI: Sarah Goff
  • Dates: 2015-2017

This study is a partnership between Baystate Medical and several key stakeholders. The goal of the project is to develop a coalition of patients, stakeholders and investigators who are informed about community-engaged research tenets and will work together to develop comparative effectiveness research proposals that will benefit patients who suffer from health disparities.

Funding: PCORI

 


Website characteristics and physician reviews on commercial physician-rating websites

  • PI: Tara Lagu
  • Dates: 2015-2017

Physician rating websites, such as Vitals.com and Healthgrades, have marketed themselves as a method for allowing patients to rate and discuss physician quality in the same way that travel websites allow guests to review restaurants and hotels. In a follow-up study to one she published in 2009, Dr. Lagu and colleagues examined reviews of 600 physicians from 3 metropolitan areas across the US on 28 different physician-rating websites. The authors found that although the total number of overall reviews increased substantially from prior studies, the increase in number of reviews observed was not meaningful; most physicians in 2016 still had no more than one review on any site. Among physicians with reviews, the median number on the most used sites was 4 reviews. These results, which were published in JAMA, suggest that it is difficult for a prospective patient to find (for any given physician on any commercial physician-rating website) a quantity of reviews that would accurately relay the experience of care with that physician. Because of increasing demand by consumers for online reviews, these findings suggest that that other methods for publishing patient feedback will emerge.

Funding: NHLBI

 


Physician Perspectives Regarding the Use of Shared Decision-Making in the Emergency Department

  • PI: Elizabeth Schoenfeld
  • Dates: 2015-2017

Emergency Departments (ED) in the US treat millions of patients per year. Shared decision-making (SDM) is a method of giving ED patients a voice in their own healthcare decisions. Improving the use of Shared Decision- Making in the ED has the potential to increase patient engagement, improve the communication of risk, enhance patient safety, and improve outcomes and quality of care. This study will measure ED physicians’ perceived barriers and facilitators to SDM to ultimately identify how best to implement SDM in the ED.

Funding: AHRQ

 


Healthcare Use and Outcomes Among Children and Adolescents with ADHD

  • PI: Natalia Shcherbakova
  • Dates: 2016-2017

One out of every ten children aged 4-17 years in the U.S. is diagnosed with attention deficit hyperactivity disorder (ADHD), and over half are prescribed pharmacologic agents within one year of diagnosis. Small observational studies showed a protective effect of stimulant use against development of depressive, disruptive behavior and anxiety disorders. At the same time, however, other studies point to a possibility of induction of mania and/or psychosis in a subset of ADHD children treated with stimulants. The overall objective of this study is to assess longitudinally the differences in the rate of occurrence of new psychiatric diagnoses and the addition of psychotropic medications in children diagnosed with ADHD and treated with pharmacotherapy, as compared to non-medicated children with ADHD. The central hypothesis is that children with ADHD on pharmacotherapy are at a higher risk of developing new psychiatric comorbidities and exposure to psychotropic polypharmacy than children with ADHD not on medication. The long-term goal is to develop a clinical support algorithm for clinicians to prospectively identify ADHD children at high risk of new psychiatric diagnosis induction or psychotropic polypharmacy.

Funding: N/A

 


Patterns of Healthcare Utilization, Treatment Persistence and Costs Among Patients with Hepatitis C Initiating Direct Acting Antivirals

  • PI: Natalia Shcherbakova
  • Dates: 2016-2017

Introduction of the first direct-acting antiviral agent (DAA) sofosbuvir at the end of 2013 changed the treatment landscape of chronic hepatitis C. At present, there are over half a dozen direct acting antiviral agents available. While the cure rate of DAAs is on average at 90% or higher, the associated cost of treatment per patient is in the range of $90,000 to $180,000 for 12 or 24 weeks of therapy, respectively. As such, DAAs have presented budgetary challenges to US healthcare payers both in private and public sectors. Limited real-world data are available on patterns of healthcare use of patients initiating direct acting antivirals. For example, only few small studies examined whether patients completed a physician-prescribed course of therapy. This study aims to examine treatment completion rates among patients with hepatitis C covered under a regional health plan in western Massachusetts and initiating a DAA-containing regimen. The study will also assess clinical, healthcare delivery & demographic factors associated with therapy completion as well as pharmacy, medical and total treatment costs.

Funding: N/A

 


Opioid Prescribing Patterns for Emergency Department Providers Discharging Patients with Acute Painful Conditions

  • PI: William Soares
  • Dates: 2016-2017

Prescription opioid medications, although an effective treatment for acute pain, carry a risk of misuse, addiction, and overdose. Recent efforts to regulate opioid prescriptions have focused on limiting the total number of opioid pills per prescription for patients discharged from the emergency department with a new acute painful condition. However, no study has evaluated providers’ probability of writing an opioid prescription for patients discharged from the emergency department. Understanding providers’ prescribing variability will help guide feedback and education, leading to more standardized practice among providers and hospitals beyond simple pill limits mandated by law. Utilizing a retrospective chart review format, we propose a study to profile emergency providers’ probability of prescribing opioid medications on discharge from the emergency department. We hope to describe the variability of prescribing patterns at Baystate Health, as well as evaluate certain provider and patient level covariates that may be related to discharge opioid prescriptions.

Funding: NA

 


The Effectiveness of Noninvasive Ventilation in Patients Hospitalized with Acute Respiratory Failure

  • PI: Mihaela Stefan
  • Dates: 2013-2017

Acute respiratory failure is a common and serious complication of hospitalized patients; in severe cases patients may require mechanical ventilation. We have performed several comprehensive studies to examine ventilation practices and to compare the effectiveness of noninvasive and invasive mechanical ventilation among patients with acute respiratory failure due to asthma, COPD and pneumonia. In an ongoing project we are developing a risk prediction model for noninvasive ventilation failure using an electronic medical record dataset.

Funding: NHLBI


Center of Innovation in Long Term Services & Supports for Vulnerable Veterans

  • PI: Peter Friedmann
  • Dates: 2013-2016

The goal of this center was to conduct high-quality, partnered health services research in long term services and supports that will benefit both Veteran and civilian populations.

Funding: Veterans’ Affairs/HSR&D


IDEAS for a Healthy Baby: Reducing Disparities in Consumer Use of Quality Data

  • PI: Sarah Goff
  • Dates: 2012-2016

Efforts to increase transparency of healthcare quality data are guided in part by the belief that access to these data will enable consumers to make more informed healthcare choices. Although the amount of quality of care information made available to consumers through websites and other channels has grown tremendously, impact on consumer choices remains low. Barriers to using these data, which may contribute to the low impact, include limited knowledge of the existence of public reporting websites and the challenge of interpreting the complex information the websites present. Patient navigators are healthcare workers who assist patients in ‘navigating’ the complex healthcare system and at the same time ‘activate’ patients to participate in management of their own healthcare. The objective of this randomized controlled trial, “IDEAS for a Healthy Baby” is to evaluate the efficacy of in-person sessions with a patient navigator that are designed to increase the impact of publicly reported quality information on the choice of pediatrician amongst low income women during pregnancy.

Funding: AHRQ


Treatment Persistence among Patients with Opioid Use Disorder Newly Initiated on Buprenorphine-containing Substitution Pharmacotherapy

  • PI: Natalia Shcherbakova
  • Dates: 2015-2016

Opioid dependence is a significant public health problem affecting over 15 million individuals across the globe. In the USA, about 2.6 million people are estimated to suffer from abuse or addiction to opioids, including 2.1 million due to prescription opioids and 0.5 million due to heroin. Maintenance pharmacotherapy for opioid use disorder is an effective approach to stabilize opioid dependent individuals and reduce their illicit drug use. Maintenance pharmacotherapy includes use of partial or complete opioid agonist agents or, alternatively, use of opioid antagonists. Buprenorphine, a partial opioid receptor agonist, can be administered at home and does not have requirements for direct observation and supervision, with prescriptions commonly filled in community pharmacies. Continuation of partial agonist pharmacotherapy therapy with buprenorphine has been associated with reduced likelihood of return to use of illicit opioids as well as opioid containing prescription analgesics such as oxycodone. Therefore, persistence, defined as “the duration of time from initiation to discontinuation of therapy” is an important outcome in the context of opioid use disorder treatment with buprenorphine-containing regimens. This study focused on evaluating one-year persistence as well as factors associated with persistence among patients with opioid use disorder covered under a regional health plan in western Massachusetts and newly initiated on buprenorphine-containing pharmacotherapy.

Funding: NA


Frailty and Outcomes of Hospitalized Patients

  • PI: Mihaela Stefan
  • Dates: 2013-2015

Frailty, a "state of risk" for subsequent disproportionate declines in health status following new exposure to a physiologic stressor has been identified as a risk factor for poor outcomes in adults. Funded by an internal grant, we have collected frailty data on more than 500 medical and surgical hospitalized patients. Specific projects include assessing the association between frailty and in-hospital outcomes, analyzing the impact of frailty on the discharge site, and on long-term outcomes. In future studies we will assess frailty in critical ill patients started on noninvasive mechanical ventilation and evaluate if an intervention aimed at frailty recognition soon after NIV is initiated may assist patients and surrogates in shared decision-making, conveying prognostic estimates using frailty, an easy to understand concept.

Funding: Health New England (Baystate Insurance Company)


Clinical pharmacist home visits and 30-day readmissions in Medicare Advantage beneficiaries

  • PI: Natalia Shcherbakova
  • Dates: 2013-2014

Twenty percent of all hospitalizations in patients 65 years and older result in a readmission within 30 days post-discharge. Preventing avoidable readmissions is an important quality improvement goal for both hospitals and public and private healthcare payers. To date, multiple transitions of care programs have been developed with the aim to reduce preventable readmissions. Several such programs have been developed to involve pharmacists as key providers to deliver transition of care interventions. Key components of transitions of care programs delivered by pharmacists have included medication reconciliation, medication and disease education, as well as collaboration with primary care providers to ensure suggested therapy modifications are timely communicated and implemented. These programs have been delivered by pharmacists at discharge in the hospital, post-discharge at ambulatory setting, post-discharge via telephone or at discharge with a follow-up phone call. In addition, several pharmacist-delivered transition of care interventions were delivered at patients’ homes. This project was a retrospective cohort study assessing the impact on reduction in readmissions of clinical pharmacist home visits to Medicare Advantage beneficiaries of a regional health plan.

Funding: NA


Hospital Leaders’ Views on the Public Reporting of Health Care Quality

  • PI: Peter Lindenauer
  • Dates: 2011-2014

Public reporting of health care quality is a strategy to improve the quality of health care and to empower patients to make more informed health care choices. Providing information about quality is believed to stimulate improvement activity by appealing directly to the professionalism of clinicians and hospital administrative leaders, and indirectly through the risk that patients might use the data to choose between providers. Despite the dramatic growth of public reporting programs over the past 2 decades, evidence that these efforts have resulted in improved quality or better outcomes is limited. Despite the growth of public reporting programs little is known about the views of hospital based physicians or hospital administrative leaders about the value of current publicly reported measures of hospital quality, or about how they use these measures at their hospitals. We conducted a survey of hospital administrative leaders to assess their views and use of current measures that can be found on the CMS Hospital Compare Website.