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Research Studies is a compilation of published research articles funded by ´óÏóÊÓƵor authored by ´óÏóÊÓƵresearchers.

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1 to 25 of 187 Research Studies Displayed
LaPrete CR, Ahmed SM, Toth DJA
A theoretical framework to quantify the tradeoff between individual and population benefits of expanded antibiotic use.
This study explored scenarios where expanded antibiotic treatment can be advantageous for both individual and population health during a disease outbreak. The authors developed a mathematical framework to assess the impacts on outbreak dynamics of choosing to treat moderate infections not treated under current guidelines, focusing on cholera as a case study. They identified identify two critical thresholds: the Outbreak Prevention Threshold (OPT), where expanded treatment reduces the reproductive number below 1 and halts transmission, and the Dose Utilization Threshold (DUT), where expanded treatment results in fewer total antibiotic doses used than under current guidelines. For cholera, they found that treating moderate infections can feasibly stop an outbreak when the untreated reproductive number is less than 1.42 and will result in fewer doses used compared to current guidelines when the untreated reproductive number is less than 1.53. These findings also extend to other pathogens and outbreak scenarios, suggesting potential targets for optimized treatment strategies that balance public health benefits and antibiotic stewardship.
AHRQ-funded; HS026530.
Citation: LaPrete CR, Ahmed SM, Toth DJA . A theoretical framework to quantify the tradeoff between individual and population benefits of expanded antibiotic use. Bull Math Biol 2025 Apr 30; 87(6):68. doi: 10.1007/s11538-025-01432-2.
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Public Health
Etz RS, Solid CA, Gonzalez MM
Is primary care ready for a potential new public health emergency in the wake of the COVID-19 pandemic, now subsided?
A study examining primary care capacity and demand from March 2020 to March 2022 surveyed approximately 937 clinicians per survey across multiple specialties. Findings revealed increased patient health burdens, including worsened chronic care management and elevated mental health needs. Clinicians reported longer wait times, staffing shortages, and difficulty meeting patient demands. Many respondents indicated intentions to leave the profession, suggesting an urgent need to address primary care system support to maintain adequate healthcare delivery.
AHRQ-funded; HS028253.
Citation: Etz RS, Solid CA, Gonzalez MM . Is primary care ready for a potential new public health emergency in the wake of the COVID-19 pandemic, now subsided? Fam Pract 2024 Oct 8; 41(5):732-39. doi: 10.1093/fampra/cmae005..
Keywords: COVID-19, Primary Care, Public Health
Levison JH, Fung V, Wilson A
Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities.
The objective of this study was to identify correlates of COVID-19 and related hospitalizations among people with intellectual and/or developmental disabilities (ID/DD) in group homes in Massachusetts. The results showed that, compared with Massachusetts residents, group home residents had higher age-adjusted rates of COVID-19 and of hospitalization in the first two waves of the pandemic. COVID-19 infections and hospitalizations were more likely among residents aged over 65 and in group homes with more than six resident beds and recent infection among staff and residents. The authors concluded that aggressive efforts to decrease resident density, staff-to-resident ratios, and staff infections may reduce COVID-19 and related hospitalizations in people with ID/DD living in group homes.
AHRQ-funded; HS000063.
Citation: Levison JH, Fung V, Wilson A . Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities. Disabil Health J 2024 Oct; 17(4):101645. doi: 10.1016/j.dhjo.2024.101645..
Keywords: COVID-19, Disabilities, Hospitalization, Vulnerable Populations, Public Health
Decker SL, Zuvekas SH
´óÏóÊÓƵAuthor: Decker SL, Zuvekas SH
A nationally representative summary of 2020 changes in the use of health care in the United States.
The authors used Medical Expenditure Panel Survey data to summarize changes in all types of health care from 2018 to 2020. The results showed that outpatient and emergency department visits, as well as inpatient admissions each fell ~35% in April 2020; dental visits fell by over 80%, and mammograms 82%. By the end of 2020, specialist physician visits recovered, though primary care and dental visits remained 12% lower than in 2019. Psychiatric visits, however, rose slightly.
AHRQ-authored.
Citation: Decker SL, Zuvekas SH . A nationally representative summary of 2020 changes in the use of health care in the United States. J Ambul Care Manage 2024 Apr-Jun; 47(2):64-83. doi: 10.1097/jac.0000000000000488.
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Healthcare Delivery, Public Health
Bartsch SM, O'Shea KJ, John DC
The potential epidemiologic, clinical, and economic value of a universal coronavirus vaccine: a modelling study.
This paper’s objective was to develop a modelling study on the potential epidemiologic, clinical, and economic value of a universal coronavirus vaccine to be used in the U.S. The authors used a computational model representing the US population, the spread of SARS-CoV-2, and the various clinical and economic outcomes of COVID-19 such as hospitalizations, deaths, quality-adjusted life years (QALYs) lost, productivity losses, direct medical costs, and total societal costs, to explore the impact of a universal vaccine under different circumstances. They developed and populated this model using data reported by the CDC as well as observational studies conducted during the COVID-19 pandemic. The pan-coronavirus vaccine would be cost-saving as long as its vaccine efficacy is ≥10% and vaccination coverage is ≥10%. They estimated that every 1% increase in efficacy between 10% and 50% could avert an additional 395,000 infections and save $1.0 billion in total societal costs ($45.3 million in productivity losses, $1.1 billion in direct medical costs). Even when a strain-specific coronavirus virus becomes available it would remain cost-saving, as long as it takes at least 2-3 months to develop, test, and bring that more specific vaccine to the market.
AHRQ-funded; R01HS028165.
Citation: Bartsch SM, O'Shea KJ, John DC . The potential epidemiologic, clinical, and economic value of a universal coronavirus vaccine: a modelling study. EClinicalMedicine 2024 Feb; 68:102369. doi: 10.1016/j.eclinm.2023.102369..
Keywords: COVID-19, Vaccination, Public Health
Atkinson MK, Biddinger PD, Chughtai MA
Assessing health care leadership and management for resilience and performance during crisis: the HERO-36.
The authors developed a Healthcare Emergency Response Optimization survey to examine health care organizations’ resilience and performance during crisis. The survey was administered to health care administrators and frontline staff involved in hospitals’ emergency response during the COVID-19 pandemic. Eight measures emerged to assess crisis leadership and management; informal practices mattered most for resilience, while formal practices mattered for performance. The authors identified specific practices for resilience and performance. They concluded that organizations using these measures may modify their preparedness and planning approaches to improve management in future crises.
AHRQ-funded; HS028240.
Citation: Atkinson MK, Biddinger PD, Chughtai MA . Assessing health care leadership and management for resilience and performance during crisis: the HERO-36. Health Care Manage Rev 2024 Jan-Mar; 49(1):14-22. doi: 10.1097/hmr.0000000000000387..
Keywords: COVID-19, Public Health
Adams DR
Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic.
The goal of this study was to assess the availability of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. A comprehensive sample of Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) received a 5-minute survey approximately one year after the beginning of the COVID-19 pandemic. The response indicated that 10% of health centers had closed and 20% reported that they were not offering outpatient mental health services. Reported wait times were longer at CMHCs than FQHCs. The author concluded that these findings suggested that online directories such as the SAMHSA Treatment Locator are often inaccurate or out-of-date.
AHRQ-funded; HS000084.
Citation: Adams DR . Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic. Community Ment Health J 2024 Jan; 60(1):88-97. doi: 10.1007/s10597-023-01127-9..
Keywords: Children/Adolescents, Behavioral Health, Access to Care, COVID-19, Public Health
MacMartin M, Zeng A, Chelen J
'The burden of wanting to make it right': thematic analysis of semistructured interviews to explore experiences of planning for crisis standards of care and ventilator allocation during the COVID-19 pandemic in the USA.
The objective of this study was to examine the experience of healthcare professionals who created policies for crisis standards of care. Researchers conducted semistructured interviews with healthcare professionals involved in institutional planning for resource shortages in the setting of the COVID-19 pandemic, specifically regarding the allocation of ventilators in the event of a shortage. One overarching theme developed: planning for resource shortages imposed a psychological burden on many planners. Four subthemes that influenced that burden were also identified. The researchers concluded that improved leadership strategies and cross-institutional collaboration can reduce the psychological burden of planning and can facilitate the update of plans in anticipation of future shortages.
AHRQ-funded; HS024075.
Citation: MacMartin M, Zeng A, Chelen J . 'The burden of wanting to make it right': thematic analysis of semistructured interviews to explore experiences of planning for crisis standards of care and ventilator allocation during the COVID-19 pandemic in the USA. BMJ Open 2023 Nov 9; 13(11):e076674. doi: 10.1136/bmjopen-2023-076674..
Keywords: COVID-19, Public Health, Policy
Simpson SA, Loh R, Elliott L
A mortality surveillance collaboration between a health system and public health department.
The authors described a collaboration between a health system and public health department to create a mortality surveillance system that enabled the health system to identify more than six times the number of deaths identified through local system medical records. They concluded that this epidemiological process that combined nuanced data captured through clinical care in health systems with subsequent data on mortality can be of particular benefit to underserved communities.
AHRQ-funded; HS027389.
Citation: Simpson SA, Loh R, Elliott L . A mortality surveillance collaboration between a health system and public health department. Am J Public Health 2023 Sep; 113(9):943-46. doi: 10.2105/ajph.2023.307335..
Keywords: Public Health, Health Systems
Kilaru AS, Scheulen JJ, Harbertson CA
Boarding in US academic emergency departments during the COVID-19 pandemic.
The purpose of this retrospective study was to characterize changes in emergency department (ED) boarding among U.S. academic EDs across the duration of the COVID-19 pandemic. From January 2019 to December 2021 the researchers utilized a convenience sample of academic departments of emergency medicine to conduct an analysis of monthly data. The primary outcome was total boarding hours, and secondary outcomes included patient volume stratified by ED disposition. Of the 73 academic departments of emergency medicine contacted, 46.6% participated, a total of 43 individual EDs in 25 states. The study found that the adjusted mean total boarding hours per month were significantly lower during the second quarter of 2020 compared to the first quarter of 2019. Beginning in the second quarter of 2021, total boarding hours were significantly higher than pre-pandemic levels, peaking during the fourth quarter of 2021.
AHRQ-funded; HS026372.
Citation: Kilaru AS, Scheulen JJ, Harbertson CA . Boarding in US academic emergency departments during the COVID-19 pandemic. Ann Emerg Med 2023 Sep; 82(3):247-54. doi: 10.1016/j.annemergmed.2022.12.004..
Keywords: COVID-19, Emergency Department, Public Health
Amaefule AQ, Litvintchouk A, de Cordova P
Reevaluating the significance of infection preventionists and infection prevention and control departments in the post-COVID-19 era.
Infection preventionists are specialized health care professionals responsible for infection control policy development and implementation, prevention education for staff and patients, and investigation of outbreaks. The role of infection preventionists in creating effective methods for infection prevention and control became even more critical during the COVID-19 pandemic. The purpose of this paper was to increase awareness of the importance for health care systems and health care institutions to integrate lessons learned, improve infection prevention and control resources, and increase the workforce of infection preventionists to better prepare for pandemic events in the future.
AHRQ-funded; HS029023.
Citation: Amaefule AQ, Litvintchouk A, de Cordova P . Reevaluating the significance of infection preventionists and infection prevention and control departments in the post-COVID-19 era. Am J Med Qual 2023 Jul-Aug; 38(4):206-08. doi: 10.1097/jmq.0000000000000132..
Keywords: COVID-19, Infectious Diseases, Public Health
Patel M, Berlin H, Rajkumar A
Barriers to telemedicine use: qualitative analysis of provider perspectives during the COVID-19 pandemic.
The objective of this study was to describe perceived barriers and facilitators to the use of web-based visits to inform quality improvement efforts and promote sustainability. Medical providers at a large, midwestern academic institution were surveyed. Four overarching categories of provider experience with web-based visits emerged: quality of care, patient rapport, visit flow, and equity. The authors concluded that their findings demonstrated key barriers to the maintenance of telemedicine services following the COVID pandemic, and that these findings might help to prioritize impactful methods of sustaining and expanding telemedicine availability for patients.
AHRQ-funded; HS027632.
Citation: Patel M, Berlin H, Rajkumar A . Barriers to telemedicine use: qualitative analysis of provider perspectives during the COVID-19 pandemic. JMIR Hum Factors 2023 Jun 26; 10:e39249. doi: 10.2196/39249..
Keywords: Telehealth, COVID-19, Public Health, Health Information Technology (HIT), Provider: Health Personnel
Mahmud A, Cushing-Haugen K, Wellman R
Understanding the relationship between social risk factors and COVID-19 contacts.
The purpose of this study was to facilitate researchers’ understanding of the prevalence of patients' social risk factors during the pandemic and recognize how social risks may intensify COVID-19. Between January and September 2020, the researchers conducted a national survey of Kaiser Permanente members and analyzed only the data from those who responded to a set of COVID-19 survey items. The survey included questions on their experiences with social risks, whether they knew of people with COVID-19, if COVID-19 affected their emotional and mental health, and their preferred type of assistance. The study found that 62% of respondents reported social risks, with 38% reporting having 2 or more social risks. The most common response was financial strain (45%). One third of respondents reported one or more contact types with COVID-19. respondents with 2 or more COVID-19 contact types reported higher rates of housing instability, financial strain, food insecurity, and social isolation than those with fewer contacts. Fifty percent of respondents reported that COVID-19 affected their emotional, mental health negatively, and 19% of respondents noted that it affected their ability to maintain a job.
AHRQ-funded; HS013853.
Citation: Mahmud A, Cushing-Haugen K, Wellman R . Understanding the relationship between social risk factors and COVID-19 contacts. Perm J 2023 Jun 15; 27(2):18-22. doi: 10.7812/tpp/22.146..
Keywords: COVID-19, Risk, Public Health, Infectious Diseases
Mooney AC, Jackson KE, Hamad R
Experiences of distress and gaps in government safety net supports among parents of young children during the COVID-19 pandemic: a qualitative study.
This study examined the experiences and challenges of families with low incomes caring for young children during the COVID-19 pandemic. The authors conducted semi-structured qualitative interviews from August 2020 to January 2021 with 34 parents of young children in California that were then analyzed using thematic analysis. They identified three key themes related to parents' experiences during the pandemic: (1) positive experiences with government support programs, (2) challenging experiences with government support programs, and (3) distress resulting from insufficient support for childcare disruptions. Program expansions helped alleviate food insecurity, and those attending community colleges reported accessing a range of supports through supportive counselors. However, there were many reported gaps in childcare and distance learning support, pre-existing housing instability, and parenting stressors.
AHRQ-funded; HS022241.
Citation: Mooney AC, Jackson KE, Hamad R . Experiences of distress and gaps in government safety net supports among parents of young children during the COVID-19 pandemic: a qualitative study. BMC Public Health 2023 Jun 7; 23(1):1099. doi: 10.1186/s12889-023-16037-4..
Keywords: Children/Adolescents, COVID-19, Public Health
Acolin J, Fishman P
Beyond the biomedical, towards the agentic: a paradigm shift for population health science.
Life expectancy in the United States is decreasing. Health disparities are widening. Growing evidence for and integration of social and structural determinants into theory and practice has not yet improved outcomes. The COVID-19 pandemic reinforced the fact. The purpose of this paper was to contend that the biomedical model and its core scientific paradigm of causal determinism, is unable to meet population health needs. The researchers offer that this paper advances the field of medicine by transcending criticism to recognize the need for a paradigm shift. The authors apply the experience of the COVID-19 pandemic to exemplify the practical applications of their framework.
AHRQ-funded; HS013853.
Citation: Acolin J, Fishman P . Beyond the biomedical, towards the agentic: a paradigm shift for population health science. Soc Sci Med 2023 Jun; 326:115950. doi: 10.1016/j.socscimed.2023.115950..
Keywords: COVID-19, Public Health
Jenkins JL, Hsu EB, Zhang A
Current evidence for infection prevention and control interventions in emergency medical services: a scoping review.
This study’s aim was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians. A database search was conducted for literature published January 2006 through March 15, 2022 to search for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing and less frequent hand hygiene after glove use were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity and virus 2 (SARS-CoV-2) seropositivity. Workers were more likely to be vaccinated against influenza if their employer offered the vaccine. Vaccination rates for H1N1 influenza increased with the use of active, targeted education modules.
AHRQ-funded; 75Q80120D00003.
Citation: Jenkins JL, Hsu EB, Zhang A . Current evidence for infection prevention and control interventions in emergency medical services: a scoping review. Prehosp Disaster Med 2023 Jun; 38(3):371-77. doi: 10.1017/s1049023x23000389..
Keywords: COVID-19, Emergency Department, Evidence-Based Practice, Prevention, Public Health, Infectious Diseases
Lee BY, Greene D, Scannell SA
The need for systems approaches for precision communications in public health.
This paper discusses the major challenges in communicating health-related information due to the involvement of multiple complex systems from the creation of the information to the sources and channels of dispersion to the information users themselves. The virality of COVID-19 misinformation and disinformation brought this issue to light very prominently. The authors discuss a range of systems approaches and methods, such as systems mapping and systems modeling, that can help better elucidate complex systems. They believe using these methods to better characterize the various systems involved in communicating public health-related information can lead to the development of more tailored, precise, and proactive communications. Their hope is that proceeding in an iterative manner to help design, implement, and adjust such communications strategies can increase impact and leave less opportunity for misinformation and disinformation to spread.
AHRQ-funded; HS028165.
Citation: Lee BY, Greene D, Scannell SA . The need for systems approaches for precision communications in public health. J Health Commun 2023 Apr 7; 28(sup1):13-24. doi: 10.1080/10810730.2023.2220668..
Keywords: Communication, Public Health
AA Payán, DD Brown, TT
´óÏóÊÓƵAuthor: Tierney
Telehealth use, care continuity, and quality: diabetes and hypertension care in community health centers before and during the COVID-19 pandemic.
In a cohort study, researchers examined the association of care continuity with diabetes and hypertension care quality in community health centers (CHCs) before and during COVID-19, and the mediating effect of telehealth. Patients with diabetes and/or hypertension with at least 2 encounters per year during 2019 and 2020 were identified via electronic health record data from 166 CHCs; multivariable logistic regression models estimated the association of care continuity with telehealth use and care processes. The results showed that higher care continuity was associated with telehealth use and A1c testing, and lower A1c and blood pressure. The researchers concluded that care continuity might facilitate telehealth use and resilient performance on process measures.
AHRQ-funded; HS022241.
Citation: AA Payán, DD Brown, TT . Telehealth use, care continuity, and quality: diabetes and hypertension care in community health centers before and during the COVID-19 pandemic. Med Care 2023 Apr 1;61(Suppl 1):S62-s69. doi: 10.1097/mlr.0000000000001811.
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Diabetes, Blood Pressure, Community-Based Practice, Public Health
Kempker JA, Stearns E, Peterson EN
U.S. adult critical care beds per capita: a 2021 county-level cross-sectional study.
This study used November 2021 hospital data from the Department of Health and Human Services' Protect Public Data Hub to describe the per capita distribution of staffed adult critical care beds across the US. There was a high percentage of hospitals reporting (98.6%). A total of 4,846 adult hospitals accounted for 79,876 adult critical care beds in the US and its’ territories. The authors crudely aggregated the data at the national-level to 0.31 adult critical care beds per 1,000 adults. The median crude per capita density of adult critical care beds per 1,000 adults across U.S. counties was 0.00 per 1,000 adults. Spatially smoothed county-level estimates were obtained using Empirical Bayes and Spatial Empirical Bayes approaches, resulting in an estimated 0.18 adult critical care beds per 1,000 adults. Counties in the upper quartile had higher average adult population counts (mean 159,000 vs 32,000 adults per county) compared to counties in the lower quartile of adult critical care bed density.
AHRQ-funded; HS025240.
Citation: Kempker JA, Stearns E, Peterson EN . U.S. adult critical care beds per capita: a 2021 county-level cross-sectional study. Crit Care Explor 2023 Mar;5(3):e0868. doi: 10.1097/cce.0000000000000868.
Keywords: Critical Care, Public Health
Blebu BE, Kuppermann M, Coleman-Phox K
A qualitative exploration of experiences accessing community and social services among pregnant low-income people of color during the COVID-19 pandemic.
The COVID-19 pandemic has led to heightened social and economic stressors for expectant individuals. Although community and social services exist to alleviate stressors during pregnancy (e.g., food insecurity and financial difficulties) and decrease the likelihood of negative maternal outcomes, it remains uncertain how the pandemic influenced access to these resources, especially among low-income communities of color. The purpose of this study was to explore the experiences of low-income pregnant individuals of color in accessing community and social service resources during the COVID-19 pandemic. This qualitative study on COVID-related factors recruited participants from two sources—a prospective comparative effectiveness study comparing two enhanced prenatal care models and the California Black Infant Health Program between August and November 2020. The researchers conducted 62 interviews with Medicaid-eligible participants in California's Central Valley, asking them to describe their pregnancy-related experiences and the perceived impact of the pandemic on these experiences. The study identified two overarching themes: obstacles in accessing community and social service resources during the pandemic and potential avenues for enhancing access to these resources. Sub-themes regarding challenges encountered encompassed issues with remote access, complex registration procedures for community and social services, and concerns specific to COVID-19 resources (e.g., testing). Sub-themes associated with opportunities for improved access included capitalizing on instrumental support from perinatal staff and informational (e.g., practical) support from other community programs and pregnant peers. Participants suggested improved client experiences could be achieved through increased transparency and enhanced patient-provider communication.
AHRQ-funded; HS026407
Citation: Blebu BE, Kuppermann M, Coleman-Phox K . A qualitative exploration of experiences accessing community and social services among pregnant low-income people of color during the COVID-19 pandemic. Womens Health 2023 Jan-Dec;19:17455057231156792. doi: 10.1177/17455057231156792.
Keywords: COVID-19, Racial and Ethnic Minorities, Low-Income, Women, Pregnancy, Public Health
Auty SG, Aswani MS, Wahbi RN
Changes in health care access by race, income, and Medicaid expansion during the COVID-19 pandemic.
This study examined changes in access to care during the COVID-19 pandemic, stratified by race/ethnicity, household income, and state Medicaid expansion status. Data were extracted for all adults (N = 1,731,699) aged 18-64 surveyed in the 2015-2020 Behavioral Risk Factor Surveillance System from all 50 states and the District of Columbia. The pandemic was associated with a 1.2 percentage point decline in uninsurance for Medicaid expansion states, with reductions concentrated among respondents who were Black, multiracial, or low income. Rates of uninsurance were generally stable in nonexpansion states. Rates of avoided care because of cost fell by 3.5 percentage points in Medicaid expansion states, and by 3.6 percentage points in nonexpansion states. These declines were also concentrated among minority or low-income respondents.
AHRQ-funded; HS026395.
Citation: Auty SG, Aswani MS, Wahbi RN . Changes in health care access by race, income, and Medicaid expansion during the COVID-19 pandemic. Med Care 2023 Jan;61(1):45-49. doi: 10.1097/mlr.0000000000001788..
Keywords: COVID-19, Access to Care, Medicaid, Public Health, Racial and Ethnic Minorities, Low-Income
Sirkin JT, Flanagan E, Tong ST
´óÏóÊÓƵAuthor: Tong ST, McNellis RJ, Bierman AS
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
The purpose of this paper was to review the ´óÏóÊÓƵ’s (AHRQ) learning community organized to engage and support primary care in responding to COVID-19 and provide an opportunity for participants to communicate learning and peer support, improve understanding of the stressors and challenges faced by practices, determine needs, and identify possible solutions to challenges of the pandemic. The researchers identified challenges, responses, and innovations that occurred through the engagement and information sharing of the learning community and categorized them across 5 domains, including: patient-centeredness, clinician and practice, systems and infrastructure, community and public health; and health equity which cut across each of the other domains. The authors concluded that the learning community provided valuable insights for future research and policy, primary care delivery improvement, and ensuring greater preparedness for future challenges.
AHRQ-authored.
Citation: Sirkin JT, Flanagan E, Tong ST . Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community. Ann Fam Med 2023 Jan-Feb; 21(1):76-82. doi: 10.1370/afm.2904..
Keywords: COVID-19, Primary Care, Learning Health Systems, Health Systems, Evidence-Based Practice, Public Health
Meyer AND, Singh H, Zimolzak AJ
Cancer evaluations during the COVID-19 pandemic: an observational study using National Veterans Affairs data.
This observational study examined the reasons why fewer cancer diagnoses have been made during the COVID-19 pandemic using electronic health record data from the Department of Veterans Affairs before (March 10, 2019-March 7, 2020) and during (March 8, 2020-March 6, 2021) the pandemic. Electronic triggers were applied to 8,021,406 veterans' electronic health records to identify follow-up delays for abnormal results warranting evaluation for 5 cancers: bladder, breast, colorectal, liver, and lung cancers. Between the prepandemic and pandemic periods, test quantities decreased by 12.6%-27.8%, and proportions of abnormal results lacking follow-up decreased for urinalyses by 0.8%, increased by 2.3% for fecal occult blood tests/fecal immunochemical test and 1.8% for chest imaging, and remained constant for the other diagnostic tests (mammograms for breast cancer and elevated alpha-fetoprotein for liver cancer). This significant decrease in diagnostic testing may have led to reduced cancer rates.
AHRQ-funded; HS027363.
Citation: Meyer AND, Singh H, Zimolzak AJ . Cancer evaluations during the COVID-19 pandemic: an observational study using National Veterans Affairs data. Am J Prev Med 2022 Dec;63(6):1026-30. doi: 10.1016/j.amepre.2022.07.004..
Keywords: COVID-19, Cancer, Public Health
Crnich CJ
Reimagining infection control in U.S. nursing homes in the era of COVID-19.
This paper provides an overview of nursing home (NH) infection and control, reviews the 2016 CMS changes to federal regulations, and proposes recommendations to sustain improvements. COVID-19 put further pressure on nursing homes who were already strained by rising numbers of infections from C. difficile and multidrug-resistant organisms. The author puts out a call for reimagining infection prevention and control using the Systems Engineering Initiative for Patient Safety framework. Additional recommendations are made to enhance NH infection prevention and control programs in the areas of people, tasks, tools, organization, built environment, and external environment.
AHRQ-funded; HS022465.
Citation: Crnich CJ . Reimagining infection control in U.S. nursing homes in the era of COVID-19. J Am Med Dir Assoc 2022 Dec;23(12):1909-15. doi: 10.1016/j.jamda.2022.10.022..
Keywords: Elderly, COVID-19, Public Health, Infectious Diseases, Nursing Homes, Healthcare-Associated Infections (HAIs), Prevention
Shover CL, Rosen A, Mata J
Engaging same-day peer ambassadors to increase coronavirus disease 2019 vaccination among people experiencing unsheltered homelessness in Los Angeles County: a hybrid feasibility-evaluation study.
This study’s goal was to evaluate the feasibility and acceptability of engaging unhoused peer ambassadors (PAs) in COVID-19 vaccination efforts to reach people experiencing unsheltered homelessness in Los Angeles County. A total of 117 PAs were enrolled at 103 events, participating for an average of 2 hours. Findings showed that 197 additional people were vaccinated over 167 PA hours, accounting for >25% of all vaccines given at these events, indicating that recruiting same-day unhoused PAs is a feasible, acceptable, and preliminarily effective technique to increase COVID-19 vaccination in unsheltered settings.
AHRQ-funded; HS026407.
Citation: Shover CL, Rosen A, Mata J . Engaging same-day peer ambassadors to increase coronavirus disease 2019 vaccination among people experiencing unsheltered homelessness in Los Angeles County: a hybrid feasibility-evaluation study. J Infect Dis 2022 Oct 7;226(suppl 3):S346-s52. doi: 10.1093/infdis/jiac291..
Keywords: COVID-19, Vaccination, Vulnerable Populations, Public Health

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