March 2021
Research News
UNC ECHO Joins Nationwide Initiative to Fight COVID-19 in Nursing Homes 

The UNC Nursing Home ECHO is part of the National Nursing Home COVID-19 Action Network supported by the federal Agency for Healthcare Research and Quality (AHRQ) in collaboration with the Institute for Healthcare Improvement (IHI) and Project ECHO. UNC ECHO is an official Training Center for nursing homes.

This program has six goals:

  1. Keep the virus from entering nursing homes.
  2. Find out early if residents and staff have been infected.
  3. Prevent the spread of the virus to staff, residents, and visitors.
  4. Provide safe and appropriate care to residents with mild and asymptomatic cases.
  5. Ensure staff have the knowledge, skills, and confidence to implement best-practice safety measures to protect residents and themselves.
  6. Reduce social isolation for residents, families, and staff.

To do this, the Network embraces an “all teach, all learn” philosophy in which participants both receive education in best practices from renowned experts and learn from their peers. UNC ECHO Team members, led by clinical experts in geriatric care, quality improvement, and infectious disease prevention, including Philip Sloane, MD, MPH and Chrissy Kistler, MD, MASc, will lead 16 virtual learning sessions with nursing home teams in simultaneous cohorts. Each Network session is designed to be interactive — to hear from nursing home staff about the challenges they are facing and provide practical solutions. During each session, nursing home staff will discuss real cases of front-line problems with both experts and their peers.

UNC ECHO at the Sheps Center, led by Sherri Green, PhD, LCSW, has worked with Project ECHO at the University of New Mexico since 2016, first to address the opioid crisis and now also to address other complex health conditions.
Sheps Participates in Large Research Study in Older Adults

The PREVENTABLE trial is the largest randomized trial ever conducted exclusively in older adults 75+. PREVENTABLE tests the effectiveness of statins for the prevention of new dementia or persisting disability. With as many as 20,000 participants at 100 U.S. sites, UNC will participate in recruiting older adults to be randomly assigned to atorvastatin 40 mg daily or matching placebo. Participants will receive the study drug home delivered and free of charge and will be followed through yearly phone calls for close to four years. They will receive cognitive and physical function testing at the clinic, over the phone, or possibly in their homes. Dr. Kistler is the site PI with support from the Program on Aging, Disability, and Long-Term Care.

Pharmacogenomics may allow for improved medication prescribing for older adults. Older adults often receive medications that may either not work or may have increased risk of side effects. Dr. Kistler is the principal investigator on a pilot study funded jointly by the NC TraCS and the Program for Precision Medicine in Health Care. As part of the Program on Aging, Disability, and Long-Term Care, she recruited older adults in a local nursing home to participate in pharmacogenomic testing. This project will determine if pharmacogenomic testing is feasible in the long-term care setting and nursing and resident perspectives on pharmacogenomics. It will also examine the potential risks of medications from each participant’s underlying genomics and the actual risk by comparing their genomic risks with their existing medications. This research will set the groundwork for future studies to improve prescribing in long-term care.
NIA IMPACT Collaboratory
PCRO Core 

Millions of Americans are living with Alzheimer’s disease or other related dementias. People living with dementia (PLWD) often experience uncoordinated and poor-quality care. The incurable and progressive nature of the disease can lead increased financial, physical, and emotional burden for both PLWD and their care partners.

The National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer’s disease (AD) and AD Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory is an innovative research collaboratory that promotes the conduct of embedded pragmatic clinical trials (ePCTs) for PLWD and their care partners. The IMPACT Collaboratory is comprised of 11 multidisciplinary cores and teams that bring together experts from more than 30 institutions across the country.

The Patient and Caregiver Relevant Outcomes (PCRO) Core is based at the Sheps Center and is led by Dr. Laura Hanson, with Sheryl Zimmerman serving as an Executive Committee Member and Kathryn Wessell as the Core Navigator. In the Spring, the PCRO Core will lead a Lived Experience Panel comprised of people living with early stage AD/ADRD, care partners of PLWD, and care partners/family members who can represent the perspective of people living with advance AD/ADRD.
PCRC Measurement Core 

The Palliative Care Research Cooperative (PCRC) Group was established in 2010 through funding from the National Institute of Nursing Research (NINR) to develop a palliative care research infrastructure that supports high-quality palliative care research and provides training and mentorship for investigators interested in palliative care research. The PCRC Measurement Core is led by Drs. Laura Hanson and Antonia Bennett and is focused on supporting palliative care research by ensuring high-quality measurement science, including patient-centered outcomes in all PCRC-supported research protocols, and by promoting investigator development and training in measurement science.

Measurement science in palliative care is uniquely complex, and both conceptual and methodologic challenges must be addressed. Palliative care involves a heterogenous patient population with a wide variety of life-limiting diseases and conditions. People living with a life-limiting illness often experience frequent symptom and functional status changes that can significantly impact their quality of life and ability to respond to questionnaires.

To help address these special considerations, the PCRC Measurement provides free consultations to investigators interested in, or conducting, palliative care related trials and has developed, and annually updates, a Measurement Tool Library that contains close to 200 high-quality instruments that have been validated in palliative care or palliative care relevant populations.

Visit our website for more information about the PCRC Measurement Core and our Measurement Tool Library.
Studying Palliative Care for Patients with Advanced Lung Cancer

The REACH-PC study is a national multisite, randomized control trial led by researchers at Massachusetts General Hospital. The study focuses on providing palliative care for people with advanced non-small-cell lung cancer (NSCLC). Early integration of palliative care in an outpatient setting has proven to be very effective in improving patient-reported and end-of-life care outcomes. This study is looking to expand access to palliative care to patients who do not have easy access to outpatient Palliative Care, by offering care through telehealth.

UNC-CH is one of 20 sites across the country participating in the REACH-PC study. The Sheps Center research team has been enrolling and participating in the trial since its inception in 2018 and works closely with the UNC Outpatient Palliative Care Team and the Thoracic Oncology clinic. The Sheps research team recruits patients with stage IV NSCLC and randomizes participants to receive palliative care in-person at the cancer clinic or via telehealth. The research team coordinates follow-up Palliative Care research visits and participant data collection.

During the pandemic, recruitment has been delayed or stopped at various times for all 20 participating sites, which has proved to be very challenging for the study overall. UNC-CH was well positioned when COVID-19 hit, due to the fact that half of their patients were already receiving telehealth. To date, UNC-CH has been very successful in enrolling on this trial and is currently two-thirds complete with patient enrollment.
Save the date! On March 30th, Tar Heels around the world are going to give back and pay it forward. Join us for Give UNC and help support the causes that make Carolina a place like no other: 

Program on Aging, Disability, and Long-term Care: Current Project Highlights
Sheryl Zimmerman, Philip Sloane, Kimberly Ward, Christopher Wretman, Johanna Silbersack, John Preisser, and colleagues are completing analyses on two current projects that hold promise to improve the quality of care and outcomes for older adults who reside in nursing homes and assisted living communities.
Lighting System Shows Promising Results to Reduce Nighttime Falls

A trial funded by the National Institute on Aging (NIA) evaluated a novel lighting system designed to reduce nighttime falls. Falls are the main cause of fatal and non-fatal injuries among persons 65 years of age and older, including those who reside in assisted living communities. A significant number of falls happen in the evening hours and overnight.

The intervention involved lights that are the intensity of a standard nightlight, installed along the bathroom doorframe of residents’ rooms. This developmental trial, conducted in collaboration with the Mount Sinai Light and Health Research Center at Icahn School of Medicine, enrolled 38 residents from 5 local assisted living communities and installed the lights in their bedrooms. The lights were on from 7 p.m. to 7 a.m., and falls were recorded using an infrared motion-activated camera.

During the lighting condition, there were one-third fewer falls, with no problems or negative effects related to the lighting. The fact that the lights are low burden and require no staff effort indicates that the project is highly pragmatic and likely to be widely embraced if found to be similarly effective in a larger trial. A related proposal has been submitted to the NIA and plans to enroll 390 residents from 42 assisted living communities.
Psychotropic Prescribing in Nursing Homes May Extend
to Prescribing in Assisted Living 

Many persons with Alzheimer’s disease and related dementias exhibit behaviors indicating distress, such as agitation, anxiety, and depression. These behaviors are often treated with antipsychotic and other psychotropic medications, despite the fact that many such medications are ineffective and can have serious side effects and adverse events. In nursing homes, psychoactive medication use has received considerable attention, but less is known about prescribing in assisted living, which is the largest provider of residential care to older adults with dementia.

In this NIA-funded study, 250 representative, randomly selected assisted living communities from seven states were recruited to examine dementia care practices, including psychotropic medication use. Analyses have been completed for one component of this effort: comparing prescribing in assisted living to that in nursing homes.

Results indicate that mean antipsychotic prescribing rates are nominally greater in assisted living than in nursing homes, whereas mean antianxiety prescribing is nominally less in assisted living. Antipsychotic prescribing was less if the assisted living community was affiliated with a nursing home, whereas antianxiety prescribing related to neighboring nursing homes’ prescribing rates. In sum, changing prescribing practices in nursing homes may extend to practices in assisted living.
Sheps Briefs
Informal Caregiving In North Carolina

The National Alliance for Caregiving and the American Association of Retired Persons published Caregiving in the U.S. 2020, which provides comprehensive, population-based data on the experience of caregivers. The report shows that the prevalence of caregiving has risen over the past 5 years, especially among those caring for individuals ages 50+. The report also highlights the experience of rural caregivers, who report higher rates (32%) of difficulty in finding affordable services in their care recipient’s local area than urban caregivers (25%), like meal delivery, transportation, or in-home health services.

In North Carolina, the North Carolina Serious Illness Coalition convened a task force on serious illness care and published a report with state-level recommendations, including a priority recommendation to establish a task force on caregiving for those with serious illness.

At Sheps, the Program on Aging, Disability, and Long-Term Care has conducted numerous studies to understand the experiences of families who provide care for relatives who moved to nursing homes and assisted living. These studies demonstrate how vital caregivers remain as an important part of the healthcare workforce throughout their care recipient’s life. More research and policy attention to this essential care force are needed.
Sheps Center Researchers to Lead Long-Term Care Conference

On March 10, Sheryl Zimmerman and Philip Sloane, co-directors of the Program on Aging, Disability, and Long-Term Care at the Cecil G. Sheps Center for Health Services Research, are hosting and participating in Pragmatic Trials in Long-Term Care: A Consensus Conference. Funded by the National Institute of Aging, the conference will identify priorities and best practices for pragmatic trials in long-term care, with a focus on care for persons with dementia. Speakers include internationally renowned research experts (including Sheps investigator Dr. Laura Hanson), directors of national long-term care organizations, and leaders of national associations and societies. Register today!
New Lecture Celebrates Sheps Researcher

The Inaugural Columbia Street Lecture will be held on April 29th and will be given by Professor Steve Woolf, who is the Professor C. Kenneth and Dianne Wright Distinguished Chair in Population Health and Health Equity Director Emeritus and Senior Advisor, VCU Center on Society and Health. Professor Woolf’s career has been spent at the intersection of medicine and public health.

The purpose of the lecture is to inspire, interrogate, and explore the ideas at the nexus of medicine and public health and to spur actions that move these ideas forward together.

The Columbia Street Lecture is inspired by the main north/south corridor through campus. Columbia Street separates the Schools of Medicine and Public Health at UNC. For several decades, medical and public health faculty and students have crossed Columbia Street to bring the two fields together.

This lecture celebrates Russ Harris, MD, MPH, who helped bring together the worlds of public health and medicine at UNC Chapel Hill and inspired many others to do the same. Dr. Harris led the MD/MPH program at UNC for several years, sat on the United States Preventive Services Taskforce, and is a senior research fellow at Sheps.

At UNC, we pride ourselves in the research collaborations and training that have resulted from crossing Columbia Street, yet we know there are more ways we can work to bring these two fields together.
Sheps Researcher Recognized During Black History Month

As part of Black History Month, the Agency for Healthcare Research and Quality (AHRQ) highlighted research done by Agency grantees to improve care provided to African Americans. One of those recognized was Sheps' own Betsy Sleath, Ph.D. for her work on Improving African American Glaucoma Patient Involvement in Visits and Outcomes.
Upcoming Events
Pragmatic Trials in Long-Term Care: A Consensus Conference
March 10, 2021, 9 a.m. to 4 p.m.

Columbia Street Lecture
April 29, 2021, 4 p.m. to 5:30 p.m.
Presenter: Professor Steve Woolf
The program includes a 40-minute lecture, followed by a panel discussion and audience questions.
Location: Old Clinic Auditorium (room 4008 Old Clinic) and via WebEx

March 5, 2021 at 1 p.m.
Presenter: Joaquin Alfredo-Angel Rubalcaba (UNC Public Policy)
Title: Through no Fault of their Own: The Impact of Immigration Enforcement and Sanctuary Policies on Immigrant Mothers and Infant Health
Location: Zoom link
March 26, 2021 at 1 p.m.
Presenter: Jessica Goldberg (University of Maryland )
Title: Incentivized Peer Referrals for Tuberculosis Screening: Evidence from India
Location: Zoom link

April 9, 2021 at 1 p.m.
Presenter: Jevay Grooms (Howard University)
Location: Zoom link

Advances in Behavioral Health Seminar Series
sponsored by Carolina Seminars

March 4, 2021
Presenter: Siham Sikander, MBBS, FCPS, PhD
Title: Task-shifting for Maternal Mental Health in Pakistan: Lessons & Implications from the Bachpan Cohort Study
Location: Zoom link

March 18, 2021
Presenter: Will Hall, PhD, MSW
Title: Addressing LGBTQ Mental Health Disparities: Findings from a Feasibility Study
Location: Zoom link

April 4, 2021
Presenter: Lisa Bates, ScD
Title: Intimate Partner Violence in South Asia: Consequences and Opportunities for Intervention
Location: Zoom link

Sponsored by Carolina Seminars

March 24, 2021 at 11 a.m.
Presenter: Jan Eberth, PhD
Topic: Rural Cancer

April 21, 2021 at 11 a.m.
Presenters: Margaret Sullivan, MD, MPH and Suzanne Dixon, MD
Topic: Rural Maternal Health
Sheps In the News