Grant List
Represents Grant table in the DB
GET /v1/grants?page%5Bnumber%5D=1424&sort=-award_amount
{ "links": { "first": "https://cic-apps.datascience.columbia.edu/v1/grants?page%5Bnumber%5D=1&sort=-award_amount", "last": "https://cic-apps.datascience.columbia.edu/v1/grants?page%5Bnumber%5D=1424&sort=-award_amount", "next": null, "prev": "https://cic-apps.datascience.columbia.edu/v1/grants?page%5Bnumber%5D=1423&sort=-award_amount" }, "data": [ { "type": "Grant", "id": "11939", "attributes": { "award_id": "5I21RX003898-02", "title": "Pandemic Acceptance and Commitment Therapy (Pan-ACT): Feasibility and Acceptability of Telehealth Delivery with Older Veterans", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2022-07-01", "end_date": "2024-06-30", "award_amount": null, "principal_investigator": { "id": 25523, "first_name": "LORI L.", "last_name": "DAVIS", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1699, "ror": "", "name": "TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR", "address": "", "city": "", "state": "AL", "zip": "", "country": "United States", "approved": true }, "abstract": "Significance: Accounting for over 80% of COVID-19 related deaths in the United States, adults ages 65 and older have been disproportionately impacted by this pandemic more than any other age group. As a result, they may bear a heavy psychological burden in the months and years to come. Older adults have been labeled “vulnerable” to COVID-19 and strongly encouraged to adhere to “social distancing.” This prevention measure is meant to mitigate the spread of the virus but has increased older adults’ risk of social isolation and loneliness, which are two known correlates of increased morbidity and mortality in late life. Pandemic-related restrictions have decreased older adults’ life-space mobility and negatively affected their physical and nutritional well- being, impairing their quality of life and potentially increasing their vulnerability to poorer outcomes if exposed to COVID-19. Research has documented a plethora of pandemic-related stressors that are common among older adults (e.g., fear of infection, loss of loved ones, financial repercussions) and the culminating psychological impact. Telehealth-adapted evidence-based psychological interventions are needed to address the psychosocial and physical toll of the pandemic among older Veterans. Acceptance and Commitment Therapy (ACT) decreases emotional suffering, improves well-being, promotes and supports healthy behavior changes, and treats a wide range of diagnoses by increasing psychological flexibility through mindfulness, acceptance, and values-based behaviors. Higher psychological flexibility has been associated with pandemic- related coping and well-being. Randomized studies of ACT with older adults are few but promising, and most research studies with this population have used a group format. While research on telehealth delivery of ACT for older adults is limited, preliminary results indicate it is feasible and as effective as ACT delivered in person. Specific Aim: The proposed study will pilot a 10-session telehealth Pandemic ACT group intervention (i.e., Pan-ACT group) with Veterans ages 65 and older who are experiencing pandemic-related emotional and physical distress. Methods and Procedures: Twenty-five older Veterans will be enrolled in this single-arm feasibility pilot trial. The intervention will be delivered weekly in 90-minute sessions of groups of {four} to five Veterans. {Feasibility and acceptability of study procedures will be measured by referred-to-enrolled rate, telehealth access and capability, electronic data collection of outcome measures, and qualitative feedback on data collection procedures and measures. Feasibility and acceptability of the intervention will be measured by attendance; attrition; homework completion; participant ratings of the intervention’s feasibility, acceptability, and fit; qualitative feedback; and treatment fidelity.} Preliminary responsiveness of outcomes measures will be explored. Participants will complete measures of pandemic-related emotional and physical distress, psychological flexibility, depression, anxiety, social connectedness, perceived health, {functional impairment}, and meaningful engagement {at baseline, posttreatment, and one-month follow-up. A brief midpoint assessment at week 5 of the group will consist of measures of social connectedness and functional impairment. Qualitative data will be gathered on perceived efficacy to implement intervention skills and specific emotional or behavioral changes participants have noticed in themselves as a result of the intervention.} Conclusion: {This proposal directly aligns with the RR&D RFA to examine COVID-19-specific rehabilitation interventions. The telehealth Pan-ACT Group is a mental and behavioral health rehabilitation intervention that focuses on helping older Veterans develop or recover coping skills that were lost or are no longer effective during the ongoing COVID-19 pandemic.} The proposed study leverages the investigators’ strengths and expertise to address a major research and clinical gap, gather new knowledge for an urgent need, and inform the development of a full-scale randomized controlled trial to evaluate the intervention’s effectiveness.", "keywords": [ "Accounting", "Address", "Adult", "Aftercare", "Aging", "Anxiety", "Attention", "Behavior", "Behavioral", "COVID-19", "COVID-19 mortality", "COVID-19 pandemic", "Climacteric", "Clinical", "Cognitive Therapy", "Coping Skills", "Data", "Data Collection", "Development", "Diagnosis", "Distress", "Effectiveness", "Effectiveness of Interventions", "Elderly", "Emotional", "Enrollment", "Feedback", "Fright", "Health", "Impairment", "Infection", "Influenza vaccination", "Intervention", "Knowledge", "Label", "Life", "Loneliness", "Measures", "Medical", "Mental Depression", "Mental Health", "Method Acceptability", "Methods", "Modality", "Modeling", "Morbidity - disease rate", "Nutritional", "Outcome", "Outcome Measure", "Participant", "Personal Satisfaction", "Persons", "Pilot Projects", "Population", "Prevention Measures", "Procedures", "Protocols documentation", "Psychological Impact", "Quality of life", "Quasi-experiment", "Randomized", "Randomized Controlled Trials", "Recovery", "Rehabilitation therapy", "Research", "Research Personnel", "Risk", "Risk Factors", "SARS-CoV-2 exposure", "Sampling", "Schedule", "Science", "Self Efficacy", "Social Distance", "Social isolation", "Suicide", "United States", "Veterans", "Virus", "Well in self", "acceptability and feasibility", "age group", "arm", "behavior change", "behavioral health", "chronic pain", "cohort", "coping", "design", "effective therapy", "electronic data", "emotional distress", "evidence base", "experience", "flexibility", "follow-up", "functional disability", "group intervention", "human old age (65+)", "improved", "improved outcome", "infancy", "insight", "invention", "loved ones", "male", "medical appointment", "military veteran", "mindfulness", "mortality", "negative affect", "pandemic disease", "pandemic impact", "pilot trial", "post-pandemic", "psychiatric comorbidity", "psychologic", "psychosocial", "research study", "skills", "social", "stay-at-home order", "stressor", "suicide rate", "telehealth", "timeline", "treatment effect", "willingness" ], "approved": true } }, { "type": "Grant", "id": "12073", "attributes": { "award_id": "1I21HX003503-01A1", "title": "Understanding and Improving Video-Based Primary Care Delivery to Veterans", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-09-01", "end_date": "2025-02-28", "award_amount": null, "principal_investigator": { "id": 27925, "first_name": "Claudia", "last_name": "Der-Martirosian", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1708, "ror": "https://ror.org/05xcarb80", "name": "VA Greater Los Angeles Healthcare System", "address": "", "city": "", "state": "CA", "zip": "", "country": "United States", "approved": true }, "abstract": "Background: [With the onset of the COVID-19 pandemic, VA primary care (PC) experienced a substantial increase in video-based encounters, nationwide. This rapid uptake of video-based care in PC clinics, however, varied by site. Given that the VA is committed to continue expanding VA Video Connect (VVC), which is the main videoconferencing platform at the VA, more research is needed to comprehensively examine why and how VVC was successfully adopted at some sites and understand why VVC expansion was limited at other sites.] Significance/Impact: [Barriers and facilitators to video-based care are many and multifaceted. This study will examine patient, provider, and site-level characteristics of VVC use in PC at high and low VVC sites, and identify patient-centered, provider-recommended, and leadership supported VVC guidelines that are context-specific for PC clinics. This study will contribute more generally to our understanding of what is needed to achieve acceptance of video technology. Such knowledge will be helpful for VA, as well as the delivery of healthcare in general. In-depth understanding about challenges and successes of VVC use will inform future improvements of VVC policies, processes, and procedures for all Veterans, across all VA facilities.] Innovation: This study will examine Veterans’ perspectives about how VVC in PC can be improved to better meet their needs when using video-based care. This is an understudied topic. Furthermore, by learning about the providers’ and leadership’s perspectives on how VVC can be implemented more effectively, we will better understand the full context of VA video care. [This 18-month pilot study will create context-specific VVC playbook for high and low VVC using sites that will be patient-centered, provider-recommended, and leadership supported. This will help improve delivery of video-based primary care and patient outcomes at the VA.] Specific Aims: This pilot study’s overall objective is to identify strategies to improve VVC use for all Veterans. 1) Identify PC clinic sites in the top 5% and bottom 5% of VVC use nationally by examining patient, provider, and site-level variations in VVC use since the onset of COVID-19 (March 2020-March 2024, aka study period). 2) Characterize patient-, provider-, site-specific factors associated with VVC use in PC, nationwide, during the study period. 3) Evaluate barriers and facilitators to using VVC in PC from patients, providers, and leadership (VISN/VAMC/CBOC) perspectives at 3 high and 3 low VVC using sites in PC (identified in Aims 1 & 2). Methodology: [The non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework will be used for all aspects of the proposed study (data collection, analyses, synthesis of quantitative and qualitative findings). Two sequential, mixed methods approaches will be used, where quantitative analyses (Aims 1 & 2) will first inform the sampling and data collection for the qualitative interviews (Aim 3, n=60) at 3 high and 3 low VVC sites with patients, providers, and leadership. Using the explanatory mixed methods, the qualitative data will then help explain quantitative findings. In addition to in-depth interviews, the qualitative research will include document reviews on video-based care and VVC use for all 6 study sites After completing all analyses, quantitative and qualitative study findings will be mapped into the NASSS framework, which will help inform the development of patient-centered, provider-recommended, leadership-supported, and context-specific VVC playbook for PC clinics. The playbook will include strategies on how to improve VVC for high and low VVC sites. In close collaboration with all study operation partners (OCC, OPC, VEO), study Co-Investigators, and Veteran Engagement Groups (VEG), the playbook will be assessed for feasibility and usability.] Next Steps/Implementation: [To assess the effectiveness of the VVC playbook, future studies can pilot test the playbook at PC clinics at multiple VA sites. Pilot testing the playbook will provide the opportunity to receive feedback from different sites on how best to make the playbook suitable for all sites at the VA, nationally.]", "keywords": [ "Adopted", "Ambulatory Care", "COVID-19", "COVID-19 pandemic", "Caregivers", "Caring", "Characteristics", "Clinical", "Collaborations", "Data", "Data Collection", "Development", "Effectiveness", "Equipment", "Familiarity", "Feedback", "Future", "Guidelines", "Health", "Health Personnel", "Health Services Accessibility", "Home", "Individual", "Interruption", "Intervention", "Interview", "Knowledge", "Leadership", "Learning", "Literature", "Logistics", "Maps", "Methodology", "Methods", "Modality", "Patient-Focused Outcomes", "Patients", "Persons", "Pilot Projects", "Policies", "Primary Care", "Procedures", "Process", "Provider", "Qualitative Research", "Recommendation", "Regression Analysis", "Research", "Research Personnel", "Schedule", "Site", "Structure", "Technology", "Telephone", "Time", "Time Series Analysis", "Training and Education", "Update", "Variant", "Veterans", "Videoconferencing", "Visit", "Work", "care delivery", "care outcomes", "effectiveness evaluation", "experience", "health care delivery", "improved", "innovation", "operation", "pandemic disease", "patient oriented", "pilot test", "preference", "primary care clinic", "primary care patient", "sample collection", "scale up", "success", "sustainability framework", "telehealth", "uptake", "usability", "video delivery", "virtual", "willingness" ], "approved": true } }, { "type": "Grant", "id": "12090", "attributes": { "award_id": "1I01HX003635-01A1", "title": "Leveraging COVID-19 to modernize depression care for VA primary care populations", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-09-01", "end_date": "2025-08-31", "award_amount": null, "principal_investigator": { "id": 27447, "first_name": "Lucinda B", "last_name": "Leung", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1708, "ror": "https://ror.org/05xcarb80", "name": "VA Greater Los Angeles Healthcare System", "address": "", "city": "", "state": "CA", "zip": "", "country": "United States", "approved": true }, "abstract": "Background: As part of comprehensive suicide prevention, VA integrated mental and physical health services to better detect and treat depression. Primary care nurses conduct screening annually. Clinicians, including Primary Care Mental Health Integration (PC-MHI) specialists, follow up as-needed for treatment. Depression detection and management processes are complex, involve multilevel stakeholders, and subject to significant disruption from COVID-19 and from resulting expansion of telehealth aiming to preserve care access. Fewer VA visits during the pandemic may signify lowered depression care quality and worsened patient outcomes. Significance: Depression affects 1 in 5 Veterans and is a leading cause of suicidality and disability. It contributes substantially to the current pandemic-related mental health crisis. Depression symptoms, including suicidal thoughts/behaviors, and related functional impairment have increased since COVID onset. Partnering with Primary Care, Mental Health, and Connected Care leaders, we propose to study pandemic-related service disruptions for depression, which may help to mitigate acute care use and mortality in the Veteran population. We apply established depression quality indicators from our prior research to a broad national scale at a critical time. We will also obtain feedback to improve current hybrid (virtual/in-person) care models from VA providers and Veterans who screened positive, including those who were not detected to have depression. Specific Aims: To improve virtual and in-person services for the VA primary care population during recovery, this proposal will examine how the pandemic disrupted depression care delivery mechanisms, including expanded telehealth, and patient outcomes. Our Specific Aims are: 1) To examine engagement in guideline- concordant care for depression (virtual or in-person) following screening, before and during the pandemic; 2) To compare psychiatric emergency/hospital visits and mortality from suicide between Veterans who screened positive and were detected versus not detected to have depression by clinicians; 3) To understand VA patients’ and providers’ current perspectives on addressing new depressive episodes using virtual and in-person modalities during the pandemic and eventual recovery. Methodology: Given hypothesized care disruption (lowered care quality) during COVID-19, Aim 1 proposes to extend our preliminary VISN methods nationally to assess the VA population’s trajectory from a new positive depression (and suicide-risk) screen to appropriate treatment (i.e., medication, therapy) in FY19-22/23. We will also examine the changing mix of virtual and in-person depression care delivered. Aim 2 will use interrupted time series analyses to explore the extent to which acute care use may be mitigated by clinician detection of depression nationally. We will also compare mortality rates between patients detected and not detected to have depression. Sub-analyses will reveal where (e.g., clinics with low PC-MHI access) and for whom (e.g., minorities) detection does not systematically occur, and downstream negative sequelae, to guide future intervention. Finally, Aim 3 will interview (1) 40 Veterans who were detected and not detected to have depression per Aims 1 & 2 about care-seeking behavior change, digital divide, etc. and (2) 40 VA primary care and PC-MHI providers about staffing shortage, telehealth adoption, etc. across three VAs (GLA, Syracuse, and Durham). In addition to contextualizing disrupted care findings, qualitative data will help isolate best practices on patient-to-provider and provider-to-provider (e.g., handoffs) interactions in hybrid depression care models. Next Steps/Implementation: The COVID-19 pandemic provides the VA with an opportunity to improve upon a system-wide proactive response to depression and suicide, one that is conceptualized to care for the entire Veteran population. This proposed research will provide the basis for testable hypotheses (e.g., acceptable virtual depression treatments in primary care), and clinical recommendations (e.g., satisfactory virtual provider- to-provider handoffs for new patient referrals), to improve virtual and in-person VA depression services.", "keywords": [ "Address", "Adoption", "Affect", "Behavior", "COVID-19", "COVID-19 pandemic", "Caring", "Clinic", "Clinical", "Complex", "Consultations", "Data", "Detection", "Drops", "Feedback", "Feeling suicidal", "Future", "Guidelines", "Health", "Health Services Accessibility", "Hospitalization", "Hospitals", "Hybrids", "Interruption", "Intervention", "Interview", "Los Angeles", "Mental Depression", "Mental Health", "Mental Health Services", "Methodology", "Methods", "Minority", "Modality", "Modeling", "Modernization", "Morbidity - disease rate", "Outcome", "Patient-Focused Outcomes", "Patients", "Persons", "Pharmaceutical Preparations", "Population", "Primary Care", "Primary Nursing Care", "Process", "Provider", "Quality Indicator", "Quality of Care", "Recommendation", "Recovery", "Research", "Services", "Solid", "Specialist", "Suicide", "Suicide prevention", "System", "Testing", "Time", "Time Series Analysis", "Veterans", "Visit", "Work", "acute care", "adverse outcome", "behavior change", "care delivery", "care seeking", "collaborative care", "connected care", "coronavirus disease", "cost", "current pandemic", "depression prevention", "depressive symptoms", "digital", "disability", "effective therapy", "experience", "follow-up", "functional disability", "improved", "innovation", "military veteran", "mortality", "multidisciplinary", "pandemic disease", "physical conditioning", "physical health service", "population based", "population health", "preservation", "provider to provider", "psychiatric emergency", "response", "routine screening", "screening", "suicidal", "suicidal behavior", "suicidal risk", "suicide mortality", "telehealth", "tool", "virtual", "virtual healthcare" ], "approved": true } }, { "type": "Grant", "id": "12163", "attributes": { "award_id": "1I21HX003593-01A1", "title": "Virtual Care Coordination in VA Primary Care-Mental Health Integration", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-08-01", "end_date": "2025-01-31", "award_amount": null, "principal_investigator": { "id": 28029, "first_name": "Taona", "last_name": "Haderlein", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1708, "ror": "https://ror.org/05xcarb80", "name": "VA Greater Los Angeles Healthcare System", "address": "", "city": "", "state": "CA", "zip": "", "country": "United States", "approved": true }, "abstract": "Background: Among newly initiated Primary Care-Mental Health Integration (PC-MHI) patients, same day access to PC-MHI from primary care or other select medical clinics (e.g., emergency department/urgent care) is a Veterans Health Administration (VA) Strategic Analytics for Improvement and Learning (SAIL) performance measure (mnemonic: pcmhi7). Prompt initiation of mental health care after a medical visit increases the likelihood of subsequent mental health follow-up visits, enhancing quality of care. Yet, despite the rapid VA virtual care expansion during COVID-19, factors that influence virtual same day access to PC-MHI are unknown. Significance: Preliminary studies from this research group found that in a large VA medical center, PC-MHI same day access rates were nearly twice as high for in-person visits compared to virtual visits. Accordingly, PC-MHI patients who initiate care virtually may experience poorer medical and mental health outcomes from loss to follow-up. This finding reflects a knowledge gap that exists across disciplines in both VA and non-VA settings regarding effective strategies for virtual care coordination. The proposed study addresses multiple HSR&D Priority Areas: Access to Care, Mental Health, Primary Care Practice, Virtual Care/Telehealth. Innovation & Impact: The proposed research would be the first to characterize factors that influence same day access to PC-MHI among patients who use virtual care to initiate mental health services, including mutable clinic characteristics that may be amenable to intervention. By identifying specific predictors of same day access to PC-MHI from primary care, the proposed study will advance understanding of factors that affect virtual same day access while also identifying specific targets for future interventions, improving quality of care, and relatedly, medical and mental health outcomes, for Veterans who seek PC-MHI care virtually. Moreover, the study will advance scientific knowledge by providing data to inform strategies for effective interdisciplinary virtual care coordination. Specific Aims: 1) Identify multi-level characteristics associated with virtual and in-person PC-MHI same day access in a national VA sample. 2) Assess barriers, facilitators, and strategies for successful virtual care coordination in PC-MHI. Methodology: The study will use a mixed methods design. For Aim 1 (Quantitative), a national cohort of Veterans who initiated PC-MHI mental health services during FY2019 − FY2021 will be identified. PC-MHI same day access will be determined based on the presence or absence of a primary care or other select medical clinic visit on the same day as the initial PC-MHI appointment, per the Mental Health SAIL definition. A multi-level generalized linear model will be used to evaluate predictors of virtual and in-person same day access. For Aim 2 (Qualitative), semi-structured qualitative interviews with PC-MHI mental health providers and primary care providers from two VA healthcare systems (one urban, one rural) will be conducted to identify barriers, facilitators, and strategies for virtual care coordination in PC-MHI. Next Steps/Implementation: In partnership with the Office of Mental Health and Suicide Prevention, the Office of Connected Care, and the Office of Primary Care, the findings will be applied toward an HSR&D Merit Review Award grant proposal to develop an intervention to improve virtual care coordination in PC-MHI.", "keywords": [ "Accident and Emergency department", "Address", "Adoption", "Affect", "Ambulatory Care Facilities", "Applications Grants", "Appointment", "Area", "Award", "COVID-19", "COVID-19 pandemic", "Caring", "Characteristics", "Clinic", "Clinic Visits", "Clinical", "Communities", "Data", "Day Care", "Discipline", "Electronic Health Record", "Ethnic Origin", "Funding", "Future", "Goals", "Health Personnel", "Health Services Accessibility", "Healthcare Systems", "Intervention", "Interview", "Knowledge", "Learning", "Linear Models", "Measures", "Medical", "Medical Care Team", "Medical center", "Mental Health", "Mental Health Services", "Methodology", "Methods", "Modality", "Modeling", "Outcome", "Patient Care", "Patient-Focused Outcomes", "Patients", "Performance", "Persons", "Pilot Projects", "Primary Care", "Provider", "Quality of Care", "Race", "Reporting", "Research", "Risk", "Role", "Rural", "Sampling", "Scientific Advances and Accomplishments", "Services", "Specific qualifier value", "Structure", "Suicide prevention", "Telephone", "Time", "Urban Health", "Veterans", "Veterans Health Administration", "Visit", "care coordination", "cohort", "connected care", "design", "experience", "follow-up", "handbook", "health care settings", "improved", "innovation", "medical specialties", "primary care clinic", "primary care practice", "primary care provider", "primary care team", "research study", "rural healthcare", "telehealth", "therapy development", "urgent care", "video chat", "virtual", "virtual healthcare", "virtual patient", "virtual visit" ], "approved": true } }, { "type": "Grant", "id": "12195", "attributes": { "award_id": "1I01HX003584-01A2", "title": "Resilience to Covid-19 Disrupted Chronic Condition Care for Older Veterans At Risk of Hospitalization: Role of VA Ambulatory Care and VA Extended Care Home and Community-Based Care Supports", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-08-01", "end_date": "2025-07-31", "award_amount": null, "principal_investigator": { "id": 28065, "first_name": "Lillian Chiang", "last_name": "Min", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1477, "ror": "https://ror.org/05eq41471", "name": "Veterans Health Administration", "address": "", "city": "", "state": "MI", "zip": "", "country": "United States", "approved": true }, "abstract": "Background: The Covid-19 pandemic disrupted the ambulatory health care of Veterans with chronic conditions, including those with the highest need for VA care. Significance/Impact: This research will study the critical role of the VA healthcare system for delivering chronic disease management during the pandemic, including office, video, and telephone care, and assess clinical outcomes of older Veterans at the highest risk for hospitalizations for chronic disease exacerbations and acute fall injuries. In addition, we will explore how VA Geriatric Extended Care Home and Community- Based Services (HCBS) mitigated Covid-19 related healthcare disruptions. Innovation: This research will implement the newest analytic tools for studying health outcomes of older Veterans, approaches to measure access to VA HCBS programs, and identify those at highest risk of disrupted and delayed chronic disease care. Specific Aims: Using state-of-the-art methods, we will address the following Aims: Aim 1A: Examine the effect of disrupted ambulatory care visits on chronic condition management (CCM) for older Veterans. We will identify changes over time (“disruption”) in ambulatory care, including the volume of face-to-face and virtual visits, video and telephone calls, that are provided by outpatient primary and specialty care outpatient clinics. We will study ~ 1 million older (age ≥65) Veterans with at least 1 of 3 chronic medical and geriatric conditions: hypertension, congestive heart failure (CHF), or falls/mobility impairment during the Covid-19 crisis (2020-21). Management of chronic conditions will be measured by medication adherence, intensity, lab monitoring, and physical therapy services. Vulnerability to service disruption will be defined using the established method in VA patients and two other methods developed specifically for geriatric patient populations, the Predicted Long-term Institutionalization (PLI) measure. Next, in Aim 1B, we will test whether facilities who were able to maintain better access to HBCS mitigated the effect of disrupted ambulatory care on performance of chronic condition care management. This critical Aim will focus on 5 HBCS programs: Home-Based Primary Care, Personal Care Services (homemaker and home health aides, respite care), Veteran Directed Care, Adult Day Care, and Skilled Home Care (e.g., physical and occupational therapy, nursing, social work) Aim 2: Examine the effect of chronic condition management disruption on hospitalizations for ACSCs and acute fall injuries. We will determine whether older Veterans with less disrupted care during the initial and second Covid-19 surges also had a lower risk of hospitalization for chronic ACSC-related hospitalizations related to CHF and hypertension or for a fall-related injury. This Aim will result in a better understanding of how to predict hospitalization for ACSCs among older Veterans according to vulnerability. Methodology: This is a longitudinal study of older Veterans in the national VA healthcare system, using VA healthcare data merged with Medicare and Medicaid long-term care data, and pharmacy files from the VA and Medicare. We will use risk scores and data sources in partnership with the GEC Data Analysis Center. Next Steps: We will identify the chronic condition management services that should be prioritized for older Veterans and a potential roadmap for how the future VA ambulatory care and GEC healthcare systems can partner to provide better chronic condition management and attain better health outcomes for older Veterans.", "keywords": [ "Acute", "Admission activity", "Adult", "Affect", "Age", "Ambulatory Care", "Ambulatory Care Facilities", "COVID-19", "COVID-19 impact", "COVID-19 pandemic", "Cardiovascular system", "Caring", "Chronic", "Chronic Disease", "Clinic Visits", "Clinical", "Communities", "Congestive Heart Failure", "Coupled", "Data", "Data Analyses", "Data Sources", "Day Care", "Diet", "Discipline of Nursing", "Disease Management", "Elderly", "Fall prevention", "Future", "Geographic Locations", "Health", "Health Care Research", "Healthcare", "Healthcare Systems", "Heart failure", "Home", "Home Health Aides", "Hospital Mortality", "Hospitalization", "Hospitals", "Hypertension", "Impairment", "Improve Access", "Institutionalization", "Long-Term Care", "Longitudinal Studies", "Managed Care", "Measures", "Medical", "Medical center", "Medicare", "Medicare claim", "Medicare/Medicaid", "Methodology", "Methods", "Monitor", "Natural experiment", "Occupational Therapy", "Office Visits", "Outcome", "Outpatients", "Patients", "Performance", "Persons", "Pharmaceutical Preparations", "Pharmacy facility", "Physical Rehabilitation", "Physical therapy", "Press Releases", "Primary Care", "Productivity", "Provider", "Recovery", "Research", "Risk", "Role", "Self Care", "Services", "Social Work", "Social support", "Sodium Chloride", "Subgroup", "Telephone", "Testing", "Time", "Transportation", "Vaccines", "Variant", "Veterans", "Visit", "Workload", "aged", "analytical tool", "care systems", "clinical outcome assessment", "community based care", "community based service", "experience", "fall injury", "falls", "health care delivery", "health care service", "high risk", "human old age (65+)", "innovation", "insight", "medical specialties", "medication compliance", "novel", "pandemic disease", "patient home care", "patient population", "poor health outcome", "pre-pandemic", "preservation", "prevent", "programs", "rehabilitation service", "resilience", "respite care", "service delivery", "service programs", "skills", "team-based care", "tool", "video visit", "virtual", "virtual visit" ], "approved": true } }, { "type": "Grant", "id": "12212", "attributes": { "award_id": "1I01BX006273-01", "title": "Role of macrophages and miRNA in regulating lung macrophage polarization and lung pathogenesis during respiratory virus-induced acute lung injury in normal and diabetic Syrian hamsters.", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-08-01", "end_date": "2027-07-31", "award_amount": null, "principal_investigator": { "id": 27400, "first_name": "Jay R", "last_name": "Radke", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 2075, "ror": "https://ror.org/00mz0c648", "name": "Boise VA Medical Center", "address": "", "city": "", "state": "ID", "zip": "", "country": "United States", "approved": true }, "abstract": "Over 25% of US Veterans have diabetes, and those Veterans are at an increased risk of hospitalization and increased morbidity/mortality following severe respiratory viral infections, such as, influenza (H1N1), SARS- CoV-2 (COVID) and adenovirus (Ad). Infection with these respiratory viruses causes acute lung injury (ALI) that can result in acute respiratory distress syndrome (ARDS), with a mortality rate of ~40%. There are few therapeutic options for ALI/ARDS. Virus induced ALI/ARDS is driven primarily by uncontrolled inflammatory responses. Alveolar macrophages both induce and resolve ALI/ARDS, based on their polarization/inflammatory state. The plasticity of macrophages to vary between pro-inflammatory (M1, pro-ALI/ARDS) and anti- inflammatory (M2, anti-ALI/ARDS) phenotypes is driven by their metabolic states. Diabetes is a metabolic disorder in which levels of blood glucose are high and glycolysis is the preferred cellular metabolic pathway. Macrophages from diabetic patients have a high rate of glycolysis and an increased M1 phenotype. In addition, macrophages from diabetic patients have a lower rate of plasticity to change from M1 to M2 because of this shift to glycolysis. One possibility is that this glycolytic shift contributes to severe outcomes from respiratory viral infections in diabetic patients. The Syrian hamster is naturally permissive for influenza, SARS-CoV-2 and Ad (in contrast to other rodents that require viral adaptation). In addition, the Syrian hamster can naturally become diabetic with a high fat/high sugar diet. Ad14p1 is an emergent strain of Ad14 that has caused outbreaks of severe respiratory illness and ALI/ARDS throughout the world. Hamster infection with Ad14p1 results in a patchy bronchopneumonia, as seen in other severe human viral respiratory infections. In contrast, the prototype strain of Ad14 induces little lung inflammation. Other studies have shown that cells dying from Ad14 infection induce an M2-like human macrophage response, while cells dying from Ad14p1 infection fail to change M1 alveolar macrophages to an M2 phenotype. This dying infected cell activity is regulated by the expression of the Ad gene, E1B 20K. Cells infected by Ad14 produced sufficient E1B 20K to repolarize M1 macrophages to M2, while Ad14p1 infection does not produce sufficient E1B 20K, and the infected cells fail to alter M1 macrophage polarization. Therefore, the hamster model of Ad14p1 ALI/ARDS provides an appropriate system to study how diabetes affects macrophage polarization and pathogenesis during severe viral respiratory infections. The long-term goal of this project is to understand how emergent viruses regulate macrophage polarization to develop novel therapeutic strategies to drive macrophage polarization to an ALI/ARDS resolving phenotype in both diabetic and non-diabetic Veterans. To achieve this goal, a multi-omics approach will be used to identify and phenotype macrophages in normal and diabetic hamsters infected with Ad14p1. Transcriptomics using single-cell RNA sequencing will use gene expression profiles at the resolution of individual cells to identify and phenotype macrophages and their polarization states. Infiltrating immune cells and other lung resident cells will also be identified. Proteomics will be used to identify cytokines and chemokines that drive Ad14p1 pathogenesis. Metabolomics will be used to understand the unique metabolic changes in the lungs during Ad14p1 infection in diabetes and how those changes affect macrophage polarization. Comparative virology studies with infection of normal and diabetic hamsters with a pandemic strain of H1N1 influenza will be used to determine whether similar mechanisms of pathogenesis are involved in ALI/ARDS pathogenesis induced by other severe respiratory viruses. Finally, we will test the role of miRNA expression during prototype Ad14 and Ad14p1 infection in regulating macrophage polarization and pathogenesis, with the goals of defining mechanisms of immunomodulation and identifying candidate miRNAs that might be used as therapeutic agents against viral ALI/ARDS.", "keywords": [ "2019-nCoV", "Acute Lung Injury", "Acute Respiratory Distress Syndrome", "Adenovirus Protein", "Adenoviruses", "Affect", "Alveolar Macrophages", "Animal Model", "Anti-Inflammatory Agents", "Blood Glucose", "Bronchopneumonia", "COVID-19", "COVID-19 severity", "Cells", "Cessation of life", "Clinical", "Communicable Diseases", "Comparative Study", "Data", "Development", "Diabetes Mellitus", "Diet", "Disease", "Disease Outbreaks", "Etiology", "Fatty acid glycerol esters", "Functional disorder", "Future", "Gene Expression", "General Population", "Genes", "Glycolysis", "Goals", "Hamsters", "Hospital Mortality", "Hospitalization", "Human", "Immune response", "Impairment", "In Vitro", "Incidence", "Individual", "Infection", "Infection prevention", "Inflammation", "Inflammatory", "Inflammatory Response", "Influenza", "Influenza A Virus H1N1 Subtype", "Innate Immune Response", "Lung", "Lung infections", "Mediating", "Mesocricetus auratus", "Metabolic", "Metabolic Diseases", "Metabolic Pathway", "MicroRNAs", "Modeling", "Molecular", "Morbidity - disease rate", "Non-Insulin-Dependent Diabetes Mellitus", "Outcome", "Pathogenesis", "Pathogenicity", "Patients", "Pattern", "Phenotype", "Play", "Pneumonia", "Production", "Proteomics", "Pulmonary Inflammation", "Reporting", "Repression", "Resistance", "Resolution", "Risk", "Rodent", "Role", "SARS coronavirus", "SARS-CoV-2 infection", "Seasons", "Signal Repression", "Signal Transduction Pathway", "Structure", "System", "Testing", "Therapeutic", "Therapeutic Agents", "Therapeutic Intervention", "Veterans", "Viral", "Viral Pathogenesis", "Viral Respiratory Tract Infection", "Virus", "Virus Diseases", "candidate identification", "cell growth regulation", "chemokine", "comparative", "coronavirus disease", "cytokine", "design", "diabetic", "diabetic patient", "effective therapy", "experimental study", "high risk", "immune cell infiltrate", "immunoregulation", "in vivo", "influenza virus strain", "innovation", "lung injury", "macrophage", "metabolomics", "mortality", "multiple omics", "new therapeutic target", "non-diabetic", "novel", "novel therapeutic intervention", "pandemic disease", "permissiveness", "prevent", "prototype", "pulmonary function", "respiratory", "respiratory virus", "response", "single-cell RNA sequencing", "sugar", "transcriptomics", "virology", "western diet" ], "approved": true } } ], "meta": { "pagination": { "page": 1424, "pages": 1424, "count": 14236 } } }