Observations

Solving Problems with the Cedars-Sinai Nursing Research Team

Helping frail older adults retain their independence

The Nursing Research Department at Cedars-Sinai has a foot in both worlds: We support quality improvement efforts within our health system while also conducting research projects aimed at improving the health and wellbeing of the populations we serve, including our own nursing workforce.

Meet the Team

The research team consists of two Ph.D.-prepared nurse scientists, two Ph.D.-prepared social scientists, a research clinical nurse specialist and two data analysts, supported by a research coordinator and a management assistant. We were all drawn to this team by the intense desire to make a difference in real-world healthcare delivery. Our research agenda is heavily weighted toward health equity and clinician wellbeing.

For example, our director, Bernice Coleman, RN, Ph.D., a nurse practitioner in cardiac transplant, is studying why African-Americans have poorer transplant surgery outcomes, even controlling for other risk factors.

Our other Ph.D. nurse scientist, whose research has focused on nursing work environments, is currently seeking an objective measure for burnout during the COVID-19 pandemic, which will help in developing effective interventions to reduce provider burnout.

Into the Community

We’re currently in the midst of a large funded research project studying ways to prevent functional decline and injury/illness in older adults who live in low-income independent housing in the Los Angeles area. This project has an interesting history that took us from hospital admissions data to discharge transitions and eventually into community-based interventions.

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About 10 years ago, we mounted an effort to rapidly identify inpatients at risk of frailty, who tend to have poorer health outcomes and are at higher risk of injury and hospital-acquired conditions.

We conducted a randomized trial that demonstrated that older adult patients who went through a frailty intervention program had shorter average lengths of stay and were half as likely to have complications or ICU admissions. The program was expanded to all nursing units, and we just completed an implementation study in three partnering Magnet hospitals.

As often happens in research, this project suggested other areas to investigate. Our successful inpatient effort led us to look at what happened to frail older adults after discharge.  We ran a demonstration project, an adaptation of the Transitional Care Model developed by Mary Naylor, RN, Ph.D., FAAN, in which we sent advance practice nurses to patients’ homes to manage care and health interventions.

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This program was subsequently adopted by our Medical Delivery Network and has been successful in reducing hospital readmissions.

An “Epic” Study

During the demonstration project, we noticed that several patients shared the same address, a building in an apartment complex for independent, low-income older adults.

The tenants in this complex told us their greatest health concern was the risk of losing their independence and ending up in permanent long-term care. We set to work collaborating with tenants and housing management to create a program to help prevent illness and injury and thus reduce tenants’ need for high-cost acute and long-term care. This was the genesis of the study we are preparing to launch, which is entitled EPIC, for Elders Preserving Independence in the Community.

We have funding from the Patient Centered Outcome Research Institute (PCORI) to study the comparative effectiveness of two evidence-based interventions: onsite health promotion/illness prevention classes and in-home preventive health care visits by an advanced practice nurse.Our whole research team is involved in this project, which could ultimately benefit many older adults.

Currently, we are working with the housing providers on how best to conduct our study with appropriate COVID-19 precautions. The study kicks off this month. We’re looking forward to seeing where it leads us next.

Photo above: The team’s director, Bernice Coleman, RN, Ph.D. (foreground), a nurse practitioner in cardiac transplant, with team leader Harriet Aranow, Ph.D. (background).

Other members of the team include: Selena Davis, Lucia Florindez, Margo Minissian, Linda Kim, Xu-Wenrui, Mana Manoukian, Nia Mabrie, LaKeisha Hall.

Harriet Aronow, Ph.D., is a research scientist at the Cedars-Sinai Nursing Research Department.


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