Research in the Department of Healthcare Delivery and Population Sciences

Randomized Trial of Assisted Ambulation to Improve Health Outcomes for Older Medical Inpatients

• PIs: Michael Rothberg and Quinn Pack
• Dates: 2022-2027

The “Randomized Trial of Assisted Ambulation to Improve Health Outcomes for Older Medical Inpatients” will test the hypothesis that compared to usual care having a designated mobility technician to provide supervised ambulation up to 3 times daily will improve patients’ mobility at discharge. We will then use prediction modeling to identify which patients benefit most from the intervention. Finally, we will assess the economic impact of the mobility technicians from the health system perspective.

Funding: NIA (R01AG073278)

Stepped Care Versus Center-Based Cardiopulmonary Rehabilitation for Older Frail Adults Living in Rural MA

• PIs: Peter Lindenauer & Liana Fraenkel
• Dates: 2022-2025

There is an urgent need to develop new strategies to improve uptake of cardiac and pulmonary rehabilitation. This is especially true in rural communities where resources are limited and transportation to center-based programs is a major barrier. We propose to examine whether implementing a stepped care model, in which patients have access to a hierarchy of interventions, is more effective than center-based programs.

Funding: NHLBI (R34HL156920)

Improving Outcomes from CR Among Older Adults Through Exercise Testing and Individualized Exercise Intensity Prescriptions.

• PI: Quinn Pack
• Dates: 2022-2027

Regular physical activity is essential for healthy aging of the heart and for older adults with heart disease, participation in cardiac rehabilitation is an ideal opportunity to deliver a highly tailored and personalized exercise prescription. In this project, we will evaluate the impact of a tailored exercise prescription that optimizes exercise intensity in cardiac rehabilitation, compared to usual care, with the goal to maximize fitness gains and long-term physical activity. We anticipate our results will help improve exercise prescription tailoring to help older adults increase their fitness, improve their levels of physical activity, and enjoy both a better quality and quantity of life as they age.

Funding: NIA (R01AG077179)

Implementing Effective Smoking Cessation Pharmacotherapy for Hospitalized Smokers with Cardiopulmonary Disease

• PI: Quinn Pack
• Dates: 2022-2027

Although smoking is the leading cause of premature noncommunicable death in the United States and contributes to millions of hospitalizations annually, most hospitalized smokers are rarely prescribed any kind of smoking cessation medication to help them quit. In this project, we will employ a nurse practitioner-led, hospital-based tobacco treatment team to prescribe effective medications, counsel patients on how to use them properly, and manage a text messaging system to support patients after discharge. Our goal is to maximize medication use, medication adherence, and smoking cessation. We anticipate demonstrating the effectiveness, feasibility, acceptability, cost- effectiveness, and sustainability of this program, so that, in the future, more hospitals will be able to capture the “teachable moment” of hospitalization to help smokers quit permanently.

Funding: NHLBI (R01HL156851)

A mixed methods study to identify and refine implementation strategies to increase use of cardiac rehabilitation for patients with heart failure

• Site PI: Peter Lindenauer
• Dates: 2019-2024

Cardiac rehabilitation (CR), a secondary prevention program that includes exercise training and risk factor education, improves outcomes in patients with heart failure (HF), but few patients with HF participate in CR. Through statistical analyses of the records of Medicare beneficiaries with HF, qualitative interviews, and a Delphi panel of experts, we will describe the organizational strategies and contextual factors that have improved risk-standardized CR participation rates for patients with HF. The results of this study will inform practice, policy, and future research.

Funding: NHLBI (R01HL19014)

Improving Participation in Pulmonary Rehabilitation through Peer-Support and Storytelling

• PI: Peter Lindenauer
• Dates: 2022-2026

Chronic Obstructive Pulmonary Disease (COPD) affects approximately 16 million Americans, and is characterized by recurrent exacerbations that lead to 1.5 million Emergency Department visits and 700,000 hospitalizations annually. Pulmonary rehabilitation (PR) is a structured program of exercise and self-management support that has been proven to relieve shortness of breath and increase quality of life when initiated after an exacerbation, but unfortunately, few eligible patients participate. This project will compare the effectiveness of two novel strategies – one involving video narratives of other patients telling their story of how they overcame challenges and completed PR, the other involving telephonic peer-coaching – to enhanced usual care, and to each other, at increasing patient participation in PR after an exacerbation.

Funding: NHLBI (R33HL157847) [formerly project number R61HL157847]

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

• Site PI: Quinn Pack
• Dates: 2018-2023

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 (1R01HL139985)

De-Implementation of Low Value Imaging in Pulmonary Embolism (DELVE PE)

• PI: Lauren Westafer
• Dates: 2021-2026

Computed tomographic pulmonary angiograms (CTPA) for pulmonary embolism (PE) are ordered in nearly 2% of all 120 million Emergency Department visits in the United States each year; however, many of these are avoidable. Despite prior research in this area, unnecessary testing remains common and subjects patients to additional costs, ionizing radiation, risk of anaphylaxis from contrast dye, and harms from overdiagnosis and overtreatment. To improve the quality and efficiency of care for patients with suspected PE, this investigation will refine, pilot, and evaluate the acceptability and appropriateness of an empirically-derived multi-dimensional strategy that targets unique barriers to de-implementing low-value imaging.

Funding: NHLBI (K23HL155895)

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 (1K08HS025701)

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 (1K08DA045933)

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

• PI: Elizabeth Peacock-Chambers
• Dates: 2020-2024

Evidence-based parenting interventions have the potential to help mothers with opioid use disorders cope with the stress of parenting, improve parent-child relationships, and support their recovery, particularly during the postpartum period when the risk for relapse and overdose is exceedingly high. This investigation will refine an adapted evidence-based parenting intervention for delivery to women with opioid use disorders by integrating it into existing home- based child development services. It will test the feasibility and acceptability of the intervention and study procedures in a pilot feasibility trial in an effort to identify novel and scalable approaches to supporting both the mother's recovery and the child's development during this high-risk postpartum time.

Funding: NIDA (5K23DA050731)

UMass Chan-Baystate

Department of Healthcare Delivery and Population Sciences K-Club. If you are affiliated with UMass Chan-Baystate or the UMass Chan Medical School, you are welcome to attend DHDPS's monthly K-Club. Please email DHDPS@baystatehealth.org for an invitation.

The UMass Chan Medical School Center for Clinical and Translational Science (CCTS)

The UMass Chan Medical School Center for Clinical and Translational Science offers educational programs to expand the critical mass of expert scientists undertaking clinical and translational research through innovative education, training, and mentoring programs. They also offer mentoring support grants (KL2, K12, TL1) fellowships, and forums for junior faculty. This includes:

Research Career & Writing Group "K-Club"

The UMCCTS Research Career & Writing Group (K-Club) was established in 2007. Most individuals who participate and apply for a research career award have been very successful in getting funded (>80% success). K-Club meets every other week to provide information and feedback on academic career development and on preparing a Research Career Award application (NIH K Awards, VA Research Career Awards, CTSA K grants, etc.).

Tufts Clinical and Translational Science Institute

Tufts Clinical and Translational Science Institute (CTSI) offers a wide array of courses, workshops, and seminars in topics such as clinical and translational research, career development, grant writing, quality improvement, and regulatory affairs. They also offer mentoring support grants, fellowships, and a forum for junior faculty.

The Tufts CTSI also offers a Research Collaboration (RC) Team. The RC Team meets monthly and is comprised of Tufts CTSI Navigators and representatives from partner organizations with a wide variety of research and grant writing expertise. The team offers grant critiquing services, known as “Research Studios,” to help researchers hone their research proposals.

Healthcare Cost and Utilization Project (HCUP)

The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of databases, software tools and related products developed through a Federal-State-Industry partnership and sponsored by AHRQ. HCUP databases are derived from administrative data and contain encounter-level, clinical and nonclinical information including all-listed diagnoses and procedures, discharge status, patient demographics, and charges for all patients, regardless of payer (e.g., Medicare, Medicaid, private insurance, uninsured), beginning in 1988. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, State, and local market levels.

Research Data Assistance Center (ResDAC)

The Research Data Assistance Center (ResDAC) provides free assistance to academic and non-profit researchers interested in using Medicare, Medicaid, SCHIP, and Medicare Current Beneficiary Survey (MCBS) data for research. Primary funding for ResDAC comes from a CMS research contract. ResDAC is a consortium of faculty and staff from the University of Minnesota, Boston University, Dartmouth Medical School, and the Morehouse School of Medicine. ResDAC offers a number of services for researchers with all levels of experience using or planning to use CMS data. Services include technical data assistance, information on available data resources, and training.

UMass Chan Medical School–Baystate, 3601 Main Street, 3rd Floor

Physician-investigators, epidemiologists, and biostatisticians on our DHDPS faculty are available to help Baystate faculty develop research protocols, write grants, and design evaluations of health system initiatives intended to improve care quality, value, or reduce disparities.

We are available for consultation by appointment—in person, through videoconference, or phone.

Work with us to:

• Refine your research question
• Develop specific aims and hypotheses
• Choose the right study design
• Plan a data collection strategy
• Conduct sample size and power calculations
• Plan the statistical analysis
• Visualize results

(Photo: Dr. Elizabeth Schoenfeld Receiving New Investigator Award. L to R: Drs. Lindenauer, Baevsky, Schoenfeld, Friedmann)

Schedule a Research Help Session

If you would like to schedule an appointment, please email DHDPS@baystatehealth.org.