SPARKS GRANTS:

BEYOND BIRTH: OPTIMIZING THE TRANSITION FROM OBSTETRIC TO PRIMARY CARE

Chloe Zera, MD, MPH, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
Ann Celi, MD, MPH, Associate Physician, Brigham and Women’s Hospital

The transition from obstetric to ongoing primary care represents a key opportunity to reduce short- and long-term adverse outcomes following birth and delivery. This project aims to design and test a solution to close integration gaps during this period between obstetric and primary care providers. In year one of the project, the team designed a prototype of a workbook to guide the birthing person and their provider through the postpartum care plan over time and began a qualitative study of patients’ perceptions of their health care needs after delivery. In year two, the team will refine the tool further, test the feasibility, acceptability, and perceived utility of the tool, and complete collection and analysis of qualitative patient input. The team will also develop a provider implementation guide and patient education resources.

SPARKS GRANTS:

CHECKLIST FOR IMPROVING ENDOVASCULAR THROMBECTOMY FOR STROKE

Sandeep Kumar, MD, Associate Professor of Neurology, Harvard Medical School
Ajith Thomas, MD, Chairman and Professor of Neurosurgery at Cooper University Hospital
Magdy H. Selim, MD, PhD, Physician, Neurology, BIDMC Department of Neurology

Stroke is a leading cause of long-term disability and death worldwide; recent advances in stroke management, such as endovascular thrombectomy (EVT) for acute ischemic strokes, has been shown to be very effective when used appropriately. EVT, however, remains underutilized, and gaps in current stroke care practices decrease its effectiveness in real-world settings. This project aims to adapt and test feasibility, acceptance, and utility of a prototype checklist to streamline workflows for rapid assessment and triaging of potential EVT candidates at community hospitals.

SPARK GRANTS:

IMPROVING SURGICAL RECOVERY THROUGH HIGH QUALITY INTEGRATION OF MHEALTH TECHNOLOGY IN PERIOPERATIVE CARE

Christy Cauley, MD, MPH, Faculty, Safe Surgery, Staff Surgeon, Massachusetts General Hospital
Trey Sinyard, MD, MBA, General Surgery Resident, Massachusetts General Hospital, Safe Surgery Fellow, Ariadne Labs

In surgical care, gaps in communication and coordination can lead to poor patient outcomes and decreased system performance. Mobile health (mHealth) offers an opportunity to improve quality of care through timely individualized assessments, improved patient education, and more effective care coordination. The project aims to conduct necessary background research and develop a toolkit for integrating mHealth into perioperative care.

SPARK GRANTS:

MAKING GOAL-CONCORDANT MEDICATION PRESCRIBING TRAINING SCALABLE

Susan DeSanto-Madeya, PhD, APRN-CNS, FAAN, Associate Clinical Professor, Connell School of Nursing, Boston College
Erik Fromme, MD, Serious Illness Care Faculty, Ariadne Labs

Patients in hospice care are often prescribed numerous daily medications, putting them at increased risk for drug-related harm and creating stress and confusion for family caregivers. To support a person-centered approach to medication management, this project will adapt Ariadne Labs’ Serious Illness Conversation Guide to create and test a Goal-Concordant Prescribing Serious Illness Conversation Guide. The guide will help clinicians regularly review and simplify treatment regimens in alignment with patients’ goals of care. The team will also develop a package of educational materials for scalable clinician training.

HMS DEAN’S GRANTS:

DEVELOPING A MODEL FOR A JOINT PROVIDER-PAYER STRATEGY TO INCREASE USE OF HOME-BASED PALLIATIVE CARE

Anita Wagner, PharmD, MPH, DrPH, Associate Professor, Department of Population Medicine, a joint Department of Harvard Medical School and the Harvard Pilgrim Health Care Institute; Director, Harvard Pilgrim Health Care Ethics Program

Research suggests that home-based palliative care offers numerous benefits, but most patients who could benefit from it do not receive it, as it is difficult to identify eligible patients at a population level. This project aims to develop a scalable provider-payer collaboration to support rapid identification of patients for whom home-based palliative care would be appropriate and address the barriers to adoption among payers and providers. Having completed extensive background research in year one of funding, the team will use year two to develop and test a payer-provider engagement model.

HMS DEAN’S GRANTS:

PROTOCOLS FOR SAFE POSTPARTUM CARE AT HOME FOR WOMEN DELIVERING BY C-SECTION IN RURAL AFRICA

Bethany Hedt-Gauthier, PhD, Associate Professor, Department of Global Health and Social Medicine, Harvard Medical School; Associate Professor, Department of Biostatistics, Harvard T.H. Chan School of Public Health

Global protocols for cesarean sections detail standards of care for the procedure and hospitalization, but do not provide guidelines for after discharge. This gap is particularly harmful for women as many complications, such as surgical site infections which are common in sub-Saharan Africa, occur after discharge. This project will build a foundation for developing postpartum care protocols to improve consistency in discharge messages and quality of care. In year one of this work, the team completed a scoping review and began developing post-discharge instructions. In the second year the team will test the acceptability and feasibility of the instructions with mothers, community health workers, and providers and will develop strategies to effectively communicate the instructions.

HMS DEAN’S GRANTS:

IMPROVING EQUITY IN THE QUALITY OF ONCOLOGY CARE WITH PRACTICE FEEDBACK

Nancy Keating, MD, MPH, Professor of Health Care Policy, Harvard Medical School; Professor of Medicine and Practicing General Internist, Brigham and Women’s Hospital 
Mary Beth Landrum, PhD, Professor of Health Care Policy, Harvard Medical School

While research shows persistent racial inequities in cancer treatments, quality assessments have rarely incorporated measures of racial inequities, and few metrics are available for practices to know if they are providing similar care to all patients. This project aims to develop an audit-and-feedback intervention to provide oncology practices with actionable, race-specific data about their performance in delivering equitable and high-quality care to both Black and White oncology patients relative to other oncology practices.

HMS DEAN’S GRANTS:

OPTIMIZING SUPERVISION OF COMMUNITY HEALTH WORKERS IN REMOTE SETTINGS

Matthew Bonds, PhD, Assistant Professor, Department of Global Health and Social Medicine, Harvard Medical School

Community health that expands beyond the formal health care system is key to achieving universal health coverage, particularly in low-income, rural locations such as Madagascar. Since 2014, PIVOT, a nongovernmental health care organization, has partnered with the Madagascar government to strengthen the health system of one district. Community health workers are an integral component of this effort, but global evidence to guide community health worker supervision is lacking. This project aims to develop a new protocol and tools for data-informed supervision of community health workers and to study the impact of this supervision on quality of care and health worker motivation.

HMS DEAN’S GRANTS:

LIBRE POST-TB: PROTOCOL FOR CARE FOR POST-TUBERCULOSIS PULMONARY SEQUELAE IN HIGH-BURDEN TB SETTINGS

Carole Mitnick, ScD, Professor of Global Health and Social Medicine, Harvard Medical School

While tens of millions of people have been successfully treated for tuberculosis (TB), many are left with an increased risk for chronic obstructive pulmonary disease (COPD) or recurrent TB, and guidance on routine screening for these conditions is lacking. This project will develop a package of tools to reach vulnerable individuals when they complete TB treatment. Using the Global Initiative for Chronic Obstructive Lung Disease guidelines as a guide, the package will characterize lung function and quality of life following TB treatment, determine need for follow-up, and monitor for and treat post-TB lung disease. Together, these approaches could decrease morbidity due to recurrent TB and COPD and improve quality of life for millions after TB recovery.