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Article ; Online: Analysis of the First Round of Public Comments for the National Coverage Determination for Monoclonal Antibodies in the Treatment of Alzheimer's Disease.

Wahl, Jenna / Gadbois, Emily A

2023 , Page(s) 1–20

Abstract: ... period was available for 30 days between July 12, 2021 and August 11, 2021. This study analyzed the 132 ...

Abstract	Following the Food and Drug Administration's (FDA) controversial approval of aducanumab for the treatment of Alzheimer's disease, the Centers of Medicare & Medicaid Services (CMS) used its National Coverage Determination process to determine its coverage for Medicare beneficiaries. A public comment period was available for 30 days between July 12, 2021 and August 11, 2021. This study analyzed the 132 comments submitted in the first public comment period. The comments were downloaded from CMS' publicly-available website and analyzed to identify key themes across stakeholders. Three major themes were identified. Those supporting CMS approving aducanumab argued FDA's approval was appropriate and the final decision for treatment should be left to patients and their doctors. Those against or uncertain of CMS approving aducanumab stated concerns about its clinical benefits, risks, burdens, and costs; many of these stakeholders instead argued CMS institute Coverage with Evidence Development. Lastly, regardless of perspective, stakeholders encouraged CMS to cover diagnostic tools to support Alzheimer's disease research and treatments. Our analysis identifies key themes and policy implications of CMS' decision, including acknowledgment of comments and subsequent changes to CMS' determination, highlighting the value of public comments as a resource to understand stakeholder perspectives on policy decisions.
Language	English
Publishing date	2023-07-24
Publishing country	England
Document type	Journal Article
ZDB-ID	1046396-3
ISSN	1545-0821 ; 0895-9420
ISSN (online)	1545-0821
ISSN	0895-9420
DOI	10.1080/08959420.2023.2238534
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Article ; Online: Administrator Perspectives on the Impact of COVID-19 on the Administration of the Patient Driven Payment Model in U.S. Skilled Nursing Facilities.

Meehan, Amy / Brazier, Joan F / Grabowski, David C / Rahman, Momotazur / Shield, Renee R / Gadbois, Emily A

Medical care research and review : MCRR

2024 , Page(s) 10775587241233018

Abstract: ... Through 156 semi-structured interviews with 40 SNF administrators from July 2020 to December 2021 ...

Abstract	The Patient Driven Payment Model (PDPM) was implemented in U.S. skilled nursing facilities (SNFs) in October 2019, shortly before COVID-19. This new payment model aimed to reimburse SNFs for patients' nursing needs rather than the previous model which reimbursed based on the volume of therapy received. Through 156 semi-structured interviews with 40 SNF administrators from July 2020 to December 2021, this qualitative study clarifies the impact of COVID-19 on the administration of PDPM at SNFs. Interview data were analyzed using modified grounded theory and thematic analysis. Our findings show that SNF administrators shifted focus from management of the PDPM to COVID-19-related delivery of care adaptations, staff shortfalls, and decreased admissions. As the pandemic abated, administrators re-focused their attention to PDPM. Policy makers should consider the continued impacts of the pandemic at SNFs, particularly on delivery of care, admissions, and staffing, on the ability of SNF administrators to administer a new payment model.
Language	English
Publishing date	2024-02-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	1232314-7
ISSN	1552-6801 ; 1077-5587
ISSN (online)	1552-6801
ISSN	1077-5587
DOI	10.1177/10775587241233018
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Article ; Online: The introduction of a novel formulation of buprenorphine into organized health systems.

Mullen, William / Hedberg, Michaela / Gadbois, Brian / Heidbreder, Christian

Drug and alcohol dependence reports

2022 Volume 4, Page(s) 100090

Abstract: ... evaluated from July 2019 through July 2020. BUP-XR distribution data by OHS subtype (VHA, IHS, CJS, IDN) and ...

Abstract	Background: Effective medications for opioid use disorder (MOUD) are underutilized. This exploratory study used real-world data to analyze US distribution patterns of buprenorphine extended-release (BUP-XR) within organized health systems (OHS), including the Veterans Health Administration (VHA), Indian Health Service (IHS), criminal justice system (CJS), and integrated delivery networks (IDNs). Methods: National BUP-XR distribution data within each OHS were available from WNS Global Services and were evaluated from July 2019 through July 2020. BUP-XR distribution data by OHS subtype (VHA, IHS, CJS, IDN) and state were aggregated and reported. Results: The total distribution of BUP-XR increased from 6,721 units in the second half of 2019 (H2'19) to 12,925 in the first half of 2020 (H1'20). OHS distribution increased from H2'19 to H1'20 in every subtype but was primarily driven by IDN distribution growth. IDNs accounted for 73% of total units in H2'19 and continued to grow in H1'20. In H1'20, IDNs accounted for 78%, VHA for 12%, CJS for 6%, and IHS for 4%. IDN distribution for BUP-XR increased from 4,911 to 10,100 units, showing the highest growth rate of 106% within all OHS subtypes. The states with the highest total BUP-XR distribution over the 12-month period were Massachusetts (4,534), Pennsylvania (3,773), and California (1,866). Conclusions: Overall distribution of BUP-XR, as a treatment option for OUD, is increasing; however, access to MOUD varies greatly across OHS subtypes and geography. Identifying and overcoming barriers to appropriate MOUD use is critical in addressing the opioid crisis.
Language	English
Publishing date	2022-08-12
Publishing country	Netherlands
Document type	Journal Article
ISSN	2772-7246
ISSN (online)	2772-7246
DOI	10.1016/j.dadr.2022.100090
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Article ; Online: "It's Not a Sprint, It's a Marathon": Stages of Managing a Nursing Home Throughout the Pandemic.

Meehan, Amy / Gadbois, Emily A / Brazier, Joan F / Madrigal, Caroline / Grabowski, David C / Shield, Renee R

Journal of the American Medical Directors Association

2023 Volume 24, Issue 10, Page(s) 1579–1585.e2

Abstract: ... interviews with nursing home administrators, repeated 3 months apart for a total of 4 each from July 2020 ...

Abstract	Objectives: To qualitatively examine the impact of COVID-19 on nursing homes over the course of the pandemic from the perspective of nursing home administrators. Design: In-depth, semi-structured interviews with nursing home administrators, repeated 3 months apart for a total of 4 each from July 2020 through December 2021. Settings and participants: Administrators from a total of 40 nursing homes from 8 health care markets across the United States. Methods: Interviews were conducted virtually or via phone. The research team identified overarching themes using applied thematic analysis, and iteratively coded transcribed interviews. Results: Nursing home administrators across the United States reported challenges of managing nursing homes during a pandemic. We found their experiences could generally be categorized into 4 stages, not necessarily coinciding with surge levels of the virus. The initial stage was characterized by fear and confusion. The second stage, by a "new normal," a term administrators used to report feeling better prepared for an outbreak and how residents, staff, and families began to adjust to life with COVID. Administrators started using the phrase "a light at the end of the tunnel" to describe the third stage, characterized by the hope associated with the availability of vaccinations. The fourth stage was marked by "caregiver fatigue" as nursing homes experienced numerous breakthrough cases. Some challenges, like staffing issues and uncertainty about the future, were reported throughout the pandemic, as was a continued mission to keep residents safe. Conclusions and implications: As the ability of nursing homes to provide safe, effective care faces unprecedented and continued challenges, the insights reported here from longitudinal perspectives of nursing home administrators may help policy makers develop solutions to encourage high-quality care. Knowing how the needs for resources and support vary across the progression of these stages has the potential to be helpful in addressing these challenges.
MeSH term(s)	Humans ; COVID-19 ; Nursing Homes ; Pandemics ; Skilled Nursing Facilities ; United States
Language	English
Publishing date	2023-05-30
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2023.04.024
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Article ; Online: The introduction of a novel formulation of buprenorphine into organized health systems

William Mullen / Michaela Hedberg / Brian Gadbois / Christian Heidbreder

Drug and Alcohol Dependence Reports, Vol 4, Iss , Pp 100090- (2022)

2022

Abstract: ... from July 2019 through July 2020. BUP-XR distribution data by OHS subtype (VHA, IHS, CJS, IDN) and state ...

Abstract	Background: Effective medications for opioid use disorder (MOUD) are underutilized. This exploratory study used real-world data to analyze US distribution patterns of buprenorphine extended-release (BUP-XR) within organized health systems (OHS), including the Veterans Health Administration (VHA), Indian Health Service (IHS), criminal justice system (CJS), and integrated delivery networks (IDNs). Methods: National BUP-XR distribution data within each OHS were available from WNS Global Services and were evaluated from July 2019 through July 2020. BUP-XR distribution data by OHS subtype (VHA, IHS, CJS, IDN) and state were aggregated and reported. Results: The total distribution of BUP-XR increased from 6,721 units in the second half of 2019 (H2’19) to 12,925 in the first half of 2020 (H1’20). OHS distribution increased from H2’19 to H1’20 in every subtype but was primarily driven by IDN distribution growth. IDNs accounted for 73% of total units in H2’19 and continued to grow in H1’20. In H1’20, IDNs accounted for 78%, VHA for 12%, CJS for 6%, and IHS for 4%. IDN distribution for BUP-XR increased from 4,911 to 10,100 units, showing the highest growth rate of 106% within all OHS subtypes. The states with the highest total BUP-XR distribution over the 12-month period were Massachusetts (4,534), Pennsylvania (3,773), and California (1,866). Conclusions: Overall distribution of BUP-XR, as a treatment option for OUD, is increasing; however, access to MOUD varies greatly across OHS subtypes and geography. Identifying and overcoming barriers to appropriate MOUD use is critical in addressing the opioid crisis.
Keywords	Opioid use disorder ; Medication-assisted treatment ; Medication for opioid use disorder ; Buprenorphine ; BUP-XR ; Medicine ; R
Subject code	360
Language	English
Publishing date	2022-09-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
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Article ; Online: COVID-19 Vaccination Among Skilled Nursing Facility Staff: Challenges and Strategies Identified by Administrators.

Gadbois, Emily A / Brazier, Joan F / Meehan, Amy / Madrigal, Caroline / White, Elizabeth M / Rafat, Aseel / Grabowski, David / Shield, Renee R

Medical care research and review : MCRR

2023 Volume 80, Issue 6, Page(s) 608–618

Abstract: ... We conducted repeated interviews with SNF administrators at 3-month intervals between July 2020 and December ...

Abstract	COVID-19 vaccinations are critical for mitigating outbreaks and reducing mortality for skilled nursing facility (SNF) residents and staff, yet uptake among SNF staff varies widely and remains suboptimal. Understanding which strategies are successful for promoting staff vaccination, and examining the relationship between vaccination policies and staff retention/turnover is key for identifying best practices. We conducted repeated interviews with SNF administrators at 3-month intervals between July 2020 and December 2021 (
MeSH term(s)	Humans ; COVID-19 Vaccines ; COVID-19/prevention & control ; Skilled Nursing Facilities ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2023-05-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1232314-7
ISSN	1552-6801 ; 1077-5587
ISSN (online)	1552-6801
ISSN	1077-5587
DOI	10.1177/10775587231168435
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Article ; Online: Perspectives of nursing home administrators across the United States during the COVID-19 pandemic.

Gadbois, Emily A / Brazier, Joan F / Meehan, Amy / Rafat, Aseel / Rahman, Momotazur / Grabowski, David C / Shield, Renee

Health services research

2022 Volume 58, Issue 3, Page(s) 686–696

Abstract: ... in eight health care markets across the country from July 2020 through December 2021.: Study design ...

Abstract	Objective: To characterize the experiences of nursing home administrators as they manage facilities across the United States during the COVID-19 pandemic. Data sources and study setting: We conducted 156 interviews, consisting of four repeated interviews with administrators from 40 nursing homes in eight health care markets across the country from July 2020 through December 2021. Study design: We subjected the interview transcripts to a rigorous qualitative analysis to identify overarching themes using a modified grounded theory approach to applied thematic analysis. Data collection methods: In-depth, semi-structured qualitative interviews were conducted virtually or by phone, and audio-recorded, with participants' consent. Audio recordings were transcribed. Principal findings: Interviews with nursing home administrators revealed a number of important cross-cutting themes. In interviewing each facility's administrator four times over the course of the pandemic, we heard perspectives regarding the stages of the pandemic, and how they varied by the facility and changed over time. We also heard how policies implemented by federal, state, and local governments to respond to COVID-19 were frequently changing, confusing, and conflicting. Administrators described the effect of COVID-19 and efforts to mitigate it on residents, including how restrictions on activities, communal dining, and visitation resulted in cognitive decline, depression, and weight loss. Administrators also discussed the impact of COVID-19 on staff and staffing levels, reporting widespread challenges in keeping facilities staffed as well as strategies used to hire and retain staff. Administrators described concerns for the sustainability of the nursing home industry resulting from the substantial costs and pressures associated with responding to COVID-19, the reductions in revenue, and the negative impact of how nursing homes appeared in the media. Conclusions: Findings from our research reflect nursing home administrator perspectives regarding challenges operating during COVID-19 and have substantial implications for policy and practice.
MeSH term(s)	United States ; Humans ; COVID-19/epidemiology ; Pandemics ; Nursing Homes ; Skilled Nursing Facilities ; Administrative Personnel
Language	English
Publishing date	2022-12-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	410435-3
ISSN	1475-6773 ; 0017-9124
ISSN (online)	1475-6773
ISSN	0017-9124
DOI	10.1111/1475-6773.14104
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Article: Computed tomographic evaluation of a bronchogenic cyst in a German shepherd dog.

Gadbois, Julie / Blond, Laurent / Lapointe, Catherine / Collard, Fabien

The Canadian veterinary journal = La revue veterinaire canadienne

2012 Volume 53, Issue 1, Page(s) 86–88

Abstract: A German shepherd dog was referred for further evaluation of a cavitary pulmonary lesion. Computed tomography identified a well-defined rounded radiolucent area in the left cranial lung lobe in continuity with the bronchial lumen. These findings were ... ...

Abstract	A German shepherd dog was referred for further evaluation of a cavitary pulmonary lesion. Computed tomography identified a well-defined rounded radiolucent area in the left cranial lung lobe in continuity with the bronchial lumen. These findings were consistent with a bronchogenic cyst.
MeSH term(s)	Animals ; Bronchogenic Cyst/diagnosis ; Bronchogenic Cyst/veterinary ; Dog Diseases/diagnosis ; Dogs ; Female ; Tomography, X-Ray Computed/methods ; Tomography, X-Ray Computed/veterinary
Language	English
Publishing date	2012-06-29
Publishing country	Canada
Document type	Case Reports ; Journal Article
ZDB-ID	41603-4
ISSN	0008-5286
ISSN	0008-5286
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Article ; Online: Examination of Staffing Shortages at US Nursing Homes During the COVID-19 Pandemic.

Brazier, Joan F / Geng, Fangli / Meehan, Amy / White, Elizabeth M / McGarry, Brian E / Shield, Renee R / Grabowski, David C / Rahman, Momotazur / Santostefano, Christopher / Gadbois, Emily A

JAMA network open

2023 Volume 6, Issue 7, Page(s) e2325993

Abstract: ... quantitative data sets was used. Semistructured qualitative interviews were conducted between July 14, 2020 ...

Abstract	Importance: Staffing shortages have been widely reported in US nursing homes during the COVID-19 pandemic, but traditional quantitative research analyses have found mixed evidence of staffing shortfalls. Objective: To examine whether nursing home administrator perspectives can provide context for conflicting aggregate staffing reports in US nursing homes during the COVID-19 pandemic. Design, setting, and participants: In a qualitative study, convergent mixed-methods analysis integrating qualitative and quantitative data sets was used. Semistructured qualitative interviews were conducted between July 14, 2020, and December 16, 2021. Publicly available national Payroll Based Journal data were retrieved from January 1, 2020, to September 30, 2022, on 40 US nursing homes in 8 health care markets that varied by region and nursing home use patterns. Staffing and resident measures were derived from Payroll Based Journal data and compared with national trends for 15 436 US nursing homes. Nursing home administrators were recruited for interviews. Of the 40 administrators who consented to participate, 4 were lost to follow-up. Exposure: Four repeated, semistructured qualitative interviews with participants were conducted. Interview questions focused on the changes noted during the COVID-19 pandemic in nursing homes. Main outcomes and measures: Thematic description of nursing home administrator compensatory strategies to provide context for quantitative analyses on nursing home staffing levels during the COVID-19 pandemic. Results: A total of 156 interviews were completed with 40 nursing home administrators. Administrators reported experiencing staff shortages during the COVID-19 pandemic and using compensatory strategies, such as overtime, cross-training, staff-to-resident ratio adjustments, use of agency staff, and curtailing admissions, to maintain operations and comply with minimum staffing regulations. Payroll Based Journal data measures graphed from January 1, 2020, to September 30, 2022, supported administrator reports showing that study facilities had reductions in staff hours, increased use of agency staff, and decreased resident census. Findings were similar to national trends. Conclusions and relevance: In this qualitative, convergent mixed-methods study, nursing home administrators reported the major staffing strain they experienced at their facilities and the strategies they used to offset staffing shortages. Their experiences provide context to quantitative analyses on aggregate nursing home census data. The short-term compensatory measures administrators used to comply with regulations and maintain operations may be detrimental to the long-term stability of this workforce.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Pandemics ; Nursing Homes ; Skilled Nursing Facilities ; Workforce
Language	English
Publishing date	2023-07-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.25993
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Article ; Online: “All Hands on Deck”

Joan F. Brazier / Amy Meehan / Renee R. Shield / Elizabeth M. White / David C. Grabowski / Fangli Geng / Emily A. Gadbois

Journal of Long-Term Care (2023)

Administrator Perspectives on Managing COVID-19 Outbreaks in U.S. Nursing Homes

2023

Abstract: ... U.S. nursing homes from July 2020–December 2021. Interview questions focused on the impact of COVID ...

Abstract	Context: Managing COVID-19 outbreaks at U.S. nursing homes highlight the structural weaknesses of pre-pandemic long-term care emergency preparedness protocols. Objective: To understand how nursing home administrators managed staffing and facility operations during an active COVID-19 outbreak. Methods: This descriptive qualitative study conducted semi-structured interviews with administrators at 40 U.S. nursing homes from July 2020–December 2021. Interview questions focused on the impact of COVID-19 on nursing home operations and staffing, among other topics. Interview transcripts were qualitatively analysed to identify overarching themes using modified grounded theory and thematic analysis. Findings: Four major themes emerged from analysis. (1) Administrators described the rapidity of viral infection of staff and residents as overwhelming and long-lasting; (2) a COVID-19 outbreak had an immediate impact on staffing levels; (3) administrators implemented short-term compensatory strategies to manage staffing shortages during COVID-19 outbreaks; and (4) administrator and staff roles and responsibilities expanded in order to maintain facility operations during, and post-COVID-19 outbreak. Limitations: Findings may not be generalizable to all U.S. nursing homes and may not reflect current COVID-19 mitigation protocols and perspectives as interviews concluded in December 2021. Implications: U.S. nursing home administrators used crisis-management strategies to sustain facility operations during active COVID-19 outbreaks. This approach highlights on-going weaknesses in the long-term care infrastructure at U.S. nursing homes. Learning from administrator experiences during the COVID-19 pandemic is critical for the development of robust emergency preparedness plans and the improvement of state and federal resource coordination efforts to support U.S. nursing homes during future public health emergencies.
Keywords	COVID-19 outbreaks ; staffing ; U.S. nursing homes ; emergency preparedness ; Medicine ; R ; Social Sciences ; H
Subject code	360
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	LSE Press
Document type	Article ; Online
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