Agency for Healthcare Research and Quality (AHRQ) 

Dr. Amy Vogelsmeier and Dr. Lori Popejoy from the University of Missouri School of Nursing received a $1.9 million grant from the Agency for Healthcare Research and Quality (AHRQ) to learn from the experiences of staff and resident in nursing homes during the COVID pandemic.  This longitudinal mixed-methods study’s goal is to develop knowledge and recommendations to improve US nursing homes’ ability to respond to respiratory healthcare associated infections (HAI). 

The grant funded over 4 years (2021-2025) has 4 aims.  In aim 1, the research team interviewed key stakeholders from the Missouri Department of Health and Senior Services and the Quality Improvement Program for Missouri (QIPMO) team. In addition, the team interviewed leaders, staff, residents and families from 24 purposively sampled nursing homes to assess for each nursing home’s diverse pandemic response, including enactment of federal guidance. In aim 2, the researchers are leveraging statistical data from the Minimum Data Set (MDS), a standardized assessment collected on all nursing home residents, to determine the effects of the COVID-19 response on resident clinical, functional, and psychosocial outcomes. In aim 3, findings from aims 1 and 2 are being combined to identify relationships between contextual differences in nursing homes’ responses and resident health outcomes to describe practices and strategies that either mitigated or contributed to adverse outcomes. Finally, in aim 4 the team will conduct a systematic review of the literature and will convene an expert panel to review and recommend updates to current nursing home HAI guidelines with the goal to identify new practices and strategies that will enhance nursing homes’ capacity to respond to infectious disease outbreaks.

The COVID-19 pandemic highlighted the vulnerability of the nearly 1.4 million nursing home residents to respiratory healthcare infections such as COVID-19. By August 2023, there were over 1.6 million cumulative confirmed cases of COVID-19 with some residents having multiple infections and 167,341 reported resident deaths. Nursing home residents are vulnerable to respiratory HAI because of multiple comorbidities and physical and cognitive frailty. These vulnerabilities are compounded by an institutional environment of common caregivers, shared living spaces, and a setting with a history of being under-resourced and ill-prepared to manage infection outbreaks.  

Other members of the team include Steven Miller as Project Coordinator and MU co-investigators Drs. David Mehr, Greg Petroski, and Marilyn Rantz. Dr. Christelle Ilboudo, Medical Director of Infection and Prevention, Children’s Mercy Hospital, Kansas City, MO also serves as co-investigator. Dr. Lona Mody, University of Michigan, is as a consultant on the grant.