“IMPACT-C will establish the infrastructure and expertise to develop and evaluate SARS-CoV-2 vaccination strategies for SNFs that are compassionate and culturally sensitive, but at the same time, are nimble enough to respond to rapid advances in testing modalities and vaccine development.”
Sarah Berry, MD, MPH, is a geriatrician and clinical researcher with expertise in falls and fractures, particularly in frail older adults. Her current funding includes an NIA award to conduct a large, observational study to determine the safest drugs to treat older adults with hypertension and diabetes. She is presently involved in several clinical trials including a pilot study to develop and implement an effective program to prevent injurious falls in the nursing home, a pragmatic trial of a multipronged intervention to improve COVID-19 vaccine uptake among nursing home residents and staff, and a multisite clinical trial of testosterone and exercise in older women following a hip fracture.
Vincent Mor, PhD, is a professor of health services, policy & practice and Florence Pirce Grant Professor in the Brown University School of Public Health, and has been principal investigator of 40+ NIH-funded grants focusing on use of health services and outcomes of frail and chronically ill people. He has evaluated the impact of programs and policies including Medicare funding of hospice, changes in Medicare nursing home payment, and the introduction of nursing home quality measures. He co-authored the Congressionally-mandated Minimum Data Set (MDS) and was architect of an integrated Medicare claims and clinical assessment data structure used for policy analysis, pharmaco-epidemiology and population outcome measurement. Dr. Mor developed summary measures using MDS data to characterize residents’ physical, cognitive and psycho-social functioning. These data resources are the heart of Dr. Mor’s NIA- funded Program Project Grant, “Changing Long Term Care in America,” which examines the impact of Medicaid and Medicare policies on long-term care. These data are also at the core of a series of large, pragmatic cluster randomized trials of novel nursing home-based interventions led by Dr. Mor.
RATIONALE: COVID-19 has disproportionately affected skilled nursing facilities’ (SNF) residents and workers, and is the biggest challenge U.S. SNFs have faced in decades. COVID-19 has magnified long-standing health disparities in the quality and outcomes of care among minority SNF residents. Equitable, universal testing and vaccination strategies that include SNF residents and workers is essential to containing viral spread in this setting.
OBJECTIVE: Our goal is to leverage the foundation of the NIA IMPACT Collaboratory to establish IMPACT-COVID-19 (IMPACT-C), which will be dedicated to developing and evaluating SARS-CoV-2 testing and vaccination strategies among highly vulnerable SNF residents and workers.
AIMS: 1) Describe disparities in SARS-CoV-2 testing, and identify resident, facility and policy characteristics associated with COVID-19 outbreaks and outcomes; 2) Engage key stakeholders to develop culturally sensitive SARS-CoV-2 testing and vaccination strategies; and 3) Design and conduct a cluster randomized clinical trial (RCT) of a “high touch” SARS-CoV-2 vaccination intervention embedded in SNF heath systems.
POPULATION: SNF residents and healthcare workers.
DESIGN: The organizational, administrative, and expertise components for IMPACT-C will include: leadership, regulatory structures, dissemination, and investigators. We will leverage IMPACT Collaboratory’s Data Sharing Collaborative that includes 11 national companies with >1,000 SNFs. We have established the infrastructure to securely and regularly receive daily EMR and COVID-19 data from this consortium and link it to Medicare claims and Minimum Data Set assessments. Using this rich and representative database, we will conduct a series of models to inform policies on SARS-CoV-2 testing and vaccination and to forecast outbreaks. We have additionally designed a cluster RCT of ~160 facilities to compare the effect of a “high touch” vaccination intervention versus enhanced usual care on the uptake COVID-19 vaccinations among residents and staff. Data will be shared with the RADx-UP Coordination and Data Collection Center.
OUTCOMES: Leverage IMPACT’s resources to develop a diverse and engaged group of stakeholders who will identify barriers to SARS-CoV-2 testing and vaccination in SNFs, develop solutions, and inform the development of future vaccination strategies to be evaluated in a cluster RCT.
IMPACT: IMPACT-C will establish the infrastructure and expertise to develop and evaluate SARS-CoV-2 testing and vaccination strategies for SNFs that are compassionate and culturally sensitive, but at the same time, are nimble enough to respond to rapid advances in testing modalities and vaccine development. Ultimately, IMPACT-C will be well-poised to inform future vaccination strategies across SNFs aimed at equitable uptake for residents and staff.