More COVID-19 Cases and Deaths in Nursing Homes with More Black Residents
Nursing homes (NHs) with Black residents had higher rates of COVID-19 infection and death during the first wave of the pandemic compared to those with no Black residents, according to new research from Columbia University School of Nursing.
“It is likely that attributes of place, such as resources, services, and providers, important to equitable care and health outcomes are not readily available to counties where NHs have greater proportions of Black residents,” wrote Patricia Stone, PhD, the Centennial Professor of Health Policy and the director of Columbia Nursing’s Center for Health Policy, and her colleagues in their report. “Structural bias may underlie these inequities,” the authors concluded.
The pandemic has disproportionately affected nursing homes with a high proportion of Black residents, Stone and her team noted. To further investigate the relationship between a nursing home’s share of Black residents and its burden of COVID-19 illness and death, they looked at nearly 11,600 nursing homes that reported data to the Centers for Disease Control and Prevention and that were also included in publicly available long-term-care databases covering the period from mid-January to mid-June 2020.
Nursing homes with any Black residents had higher rates of infection and death due to COVID-19 compared to those with no Black residents, the researchers found. Rates were highest in nursing homes with at least 50% Black residents. The differences were more pronounced in rural areas than in urban areas. Facilities with higher percentages of Black residents were more likely to be for-profit institutions, to have staffing shortages, and/or to have at least 75% of residents on Medicaid. In addition, the amount of registered nurse and aide time per patient decreased as the proportion of Black residents increased.
When the researchers took county-level factors into account—such as COVID-19 mortality rates within a given county, along with whether it was in a rural or urban setting—these differences nearly disappeared, suggesting that some local factor or factors explain the worse outcomes for nursing homes with more Black residents.
To address these disparities, Stone and her colleagues say, it will be necessary to invest in “infrastructure, social services, healthcare, education, housing, and neighborhoods” in Black communities where nursing homes are located. They also recommend increasing Medicaid reimbursement levels, making sure these funds go toward resident care, as well as making more qualified medical and nonmedical staff available, particularly in rural areas.
Columbia Nursing Receives $1.9 million from HRSA to Expand Mental Health Care for Young People
Laura Kelly, PhD, an associate professor at Columbia Nursing, has received a $1.9 million, four-year grant from the Health Resources and Services Administration (HRSA) to improve mental health care for young people in underserved areas.
The grant will train Columbia students in how to provide evidence-based care. It will support 10 psychiatric nurse practitioner students in Columbia Nursing’s doctor of nursing practice (DNP) program and six students in the occupational therapy (OT) master’s degree program at Columbia’s Vagelos College of Physicians and Surgeons. It is part of HRSA’s Behavioral Health Workforce Education and Training (BHWET) Program for Professionals, which awarded a total of $22 million in grants to 56 organizations this year. To date, BHWET has granted $66 million to 168 organizations to expand the behavioral health care work force.
Young people who experience trauma often have little or no access to evidence-based mental health care, which can help them heal and begin to thrive, Kelly notes.
“The purpose of the grant is twofold. The first is to increase the mental health workforce in underserved areas,” she explains. “The second is to integrate interprofessional competencies into OT and nursing education, which will be accomplished with an interprofessional seminar where students learn and practice trauma-informed care interventions.”
Students will receive training in interprofessional collaborative practice, trauma-informed care, and violence assessment and prevention—all with a focus on children, adolescents, and young adults.
“Childhood trauma increases the risk of serious mental health concerns as children grow,” Kelly says. “Early identification and treatment will allow clients to have the tools to help them cope with their difficult experiences. The grant will also allow preceptors, faculty, and other interested students to attend the trainings.”
NIH Awards Columbia Nursing Over $6 Million for Asthma Trials
Two Columbia Nursing professors have received grants from the National Institutes of Health to test innovative treatments aimed at reducing disparities in care for racial or ethnic minority adults and adolescents with asthma.
Maureen George, PhD, was awarded $2.45 million by the National Institute of Nursing Research (NINR) to study a primary-care intervention for Black adults with poorly controlled asthma. And Jean-Marie Bruzzese, PhD, received $4 million from the National Heart, Lung, and Blood Institute to evaluate an interactive, web-based program for urban adolescents with uncontrolled asthma. Both projects are five-year studies.
George, a professor of nursing, is studying an approach called BREATHE (BRief intervention to Evaluate Asthma THErapy) in 200 men and women enrolled through four Federally Qualified Health Centers in the New York metropolitan area. The study’s title is “BREATHE: An Efficacy Implementation Trial of a Brief Shared Decision-Making Intervention among Black Adults with Uncontrolled Asthma in Federally Qualified Health Centers (FQHC).”
NINR has provided an additional grant to George and Bruzzese, her co-principal investigator on the trial, to study BREATHE in adolescents. “It’s a feasibility grant,” George says. “It will support us doing focus groups to adapt the intervention to adolescents and to do a small pilot trial, which we are partnering with an FQHC in the Bronx to do.”
Bruzzese’s study, “The Efficacy of CAMP Air, a Web-Based Asthma Intervention Among Urban Adolescents with Uncontrolled Asthma,” will test the efficacy and cost-effectiveness of CAMP Air, an interactive learning and health management program, with 370 adolescents. It will also examine barriers to and ways of facilitating the intervention’s adoption and implementation in high schools. Bruzzese is a professor of applied developmental psychology.
Asthma is poorly controlled in 60% of adult patients overall, George notes, while the percentage is even higher among people of color and those living below the poverty level.
“If you think about the school’s mission in terms of social justice, this work really speaks to developing an intervention that can overcome the lack of resources in primary-care settings,” George adds. BREATHE “has great opportunity for scalability and sustainability, because if you can do it in resource-limited settings, then it should be able to be translated, adopted, and implemented in settings without those limitations—and [that] raises the bar for everyone.”
This article originally appeared in the Fall 2021 issue of Columbia Nursing magazine.
The findings were published in the April 2021 issue of the Journal of the American Medical Directors Association.