Research Roundup November 2022
Helping Heal Wounds in the South Bronx
Associate Professor Kellie Bryant, DNP, has piloted an innovative project for people who use drugs, to help them prevent injection-site infections and to encourage them to engage with the medical system.
Opioid overdose deaths jumped by 37% across New York City during the first year of the pandemic, notes Bryant, who is assistant dean of clinical affairs and medical director of Columbia Nursing’s Opioid Overdose Prevention program. The New York City Department of Health, which Bryant frequently collaborates with, sought her help when they observed an increase in serious drug-related wounds, some so severe they required surgical treatment.
The Bronx Opioid Collective (BOC), another partner on the project, sends peer outreach workers to the South Bronx three times a week, with the goal of reducing opioid-related deaths by motivating people to seek treatment, providing syringe exchange services, dis-tributing Narcan, and handing out bag lunches. They reach about 300 people in a typical day.
Working with the BOC; the Department of Health; and the Acacia Network, which provides community outreach to residents of the South Bronx, many of whom face housing instability, Bryant received funding to provide additional lunches, offer wound care education, and conduct a study on wound prevalence.
The pilot project’s goals were to identify the prevalence of substance use-related wounds in the South Bronx, provide people who use drugs with education on preventing and treating their wounds, and ultimately motivate those with severe wounds to seek treatment. The study, titled “Empirical Assessment of Drug-Related Wounds Among People Who Use Drugs: Pilot Testing a Standardized Wound Care Assessment and Referral Protocol,” received a $25,000 grant from CHOSEN (Columbia Center for Healing Opioid and Other Substance Use Disorders) in 2021. Bryant was its principal investigator, and she had three co-investigators from Columbia University Irving Medical Center: Michael Chaple, PhD, an assistant professor of clinical medical psychology; Jermaine Jones, PhD, an associate professor of clinical neurobiology (in psychiatry); and Stephanie Rozen, MS, director of addiction information and management strategies at Student Health on Haven.
From Feb. 28 to July 25, 2022, Bryant and three psychiatry DNP students went out every Monday to do outreach alongside the BOC teams. The study participants received $10 for completing a survey, undergoing wound assessment, and receiving a wound care kit plus information on preventing infections. “We also provided wound care education to those that already had wounds,” Bryant explains. “We used motivational interviewing techniques to encourage those with more severe wounds to seek medical treatment.” The team completed 691 encounters.
“The first part was just establishing trust,” Bryant notes. “Some people we would see on a weekly basis, so we would see their wounds actually getting better.”
She is currently working on partnerships with other Columbia University investigators and funders to continue the project beyond the pilot stage; she plans to present the findings so far at an upcoming Harm Reduction Conference. “There is a significant need to continue this work,” Bryant says. “People from this community are often stigmatized and do not receive the care that’s needed.”
DNP student Angela Cameron, MS ’21, was one of Bryant’s research assistants on the project. “My biggest takeaways from this placement were humility, consistency, transparency, reliability, and the importance of culture and language in our work as nurses and researchers,” she says. “It was heartwarming witnessing the improvement over time that a lot of the research participants made. I enjoyed the brief rapport and connections made with the people we served. Also, we had the luxury of witnessing in real time the benefits of harm reduction interventions on vulnerable populations.”
Cameron adds: “This experience highlighted the many cracks in our society that contribute to [such populations’] lived experiences. For me as a nursing student, this opportunity highlighted not only the importance of research and community outreach but the value of collaborative interdisciplinary teamwork and advocacy. Taking part in the research also sparked an interest in addiction services and harm reduction opportunities post-graduation.”
Most Nursing Homes Lack Data-Sharing Capabilities
Most U.S. nursing homes have little or no capacity to communicate with external providers about patient care, according to a new survey by Columbia Nursing researchers.
“We identified important structural disparities in nursing homes (NHs) that are likely impacting the quality of care their residents are receiving,” conclude first author Gregory Alexander, PhD, the Helen Young CUPHSONAA Professor of Nursing, and co-authors Jianfang Liu, PhD, an associate professor, and Patricia Stone, PhD, the Centennial Professor of Health Policy, in an article published August 23 in JMIR Aging.
Health information technology (HIT) can help improve nursing home quality by providing clinicians with timely, secure access to patient information and improving care coordination, the authors note. But while 95% of NHs report using electronic health records, they add, the level of HIT adoption varies widely across facilities.
Alexander and his team looked at HIT maturity—a measurement of the use and integration of health information technology within resident care, clinical support, and administrative activities—in a sample of 719 nursing homes. They rated each facility’s HIT maturity stage from 0 (no HIT) to 6 (residents or their representatives can use the system to generate clinical data and drive self-management).
The study revealed that larger nursing homes and those in metropolitan areas had more mature HIT systems.
But most of the facilities (486, or more than 60%) were at HIT maturity stage 3 or lower, meaning they were not able to communicate electronically with staff from other facilities, such as outside clinics, laboratories, or pharmacies. “This lack of connectivity can result in reduced levels of electronic data sharing, leading to deficiencies in care delivery, substandard care-coordination activities, and poorer resident outcomes,” according to the authors.
“These differences could be due to inadequate infrastructures, availability of a knowledgeable workforce, or financial resources to promote higher levels of adoption,” the authors wrote. “It is crucial that we begin to consistently identify a means to address these disparities, first by increasing transparency and public reporting about the trends in NH HIT maturity in the United States, followed by implementing national policies to level these deficits.”
Global Leaders Shape NP Research Agenda at Center’s Inaugural Conference
Thirty national and international experts in the field of advanced nursing and health services research gathered at Columbia Nursing on June 27 and 28, 2022, for the Advancement of Research on Nurse Practitioners (ARNP) conference, hosted by the Center for Healthcare Delivery Research and Innovations and led by the center’s executive director, Lusine Poghosyan, PhD.
“ARNP brought together a group of interdisciplinary experts both from the U.S. and internationally to set a research agenda to study the growing NP workforce and barriers affecting their optimal practice in primary care,” Poghosyan said.
Along with Poghosyan—the principal investigator of this Agency for Healthcare Research and Quality-funded project and an expert in the NP workforce—the conference was co-chaired by Grant Martsolf, PhD, a professor at the University of Pittsburgh School of Nursing and chair of nursing science at the University of Pittsburgh Medical Center Health System.
A committee of 11 leading experts from the U.S., U.K., Germany, and Canada joined the co-chairs in planning the conference. Policymakers, administrators, clinicians, and researchers from several countries, including Germany, the United Kingdom, and Israel, attended the meeting.
During ARNP’s four plenary sessions, subject matter experts delivered presentations on topics including:
- NP workforce in primary care globally
- Care of the underserved and NP workforce
- Methodologies to study NP workforce and practice, and
- New environments and roles: NP training and continuum of health care.
Following each plenary, participants self-selected into discussion groups and held robust conversations. On day two of the conference, attendees used the Delphi method to identify key questions to guide future research.
The expected product of the conference is a scholarly manuscript outlining a research agenda to enhance the NP workforce and primary care delivery by NPs in the U.S., which will be shared with nationally relevant organizations.
This article originally appeared in the Fall 2022 issue of Columbia Nursing Magazine.