PGPF Pandemic Response Policy Research Grant Proposal Summaries October 2021
PGPF Pandemic Response Policy Research Grant Proposal Summaries, Oct. 2021
“Telehealth as a Substitute for Non-urgent Emergency Department Care During the Pandemic: How Much Can We Really Save?” Principal Investigator, Lindsay Allen, Assistant Professor, Department of Emergency Medicine & Buehler Center for Health Economics, Feinberg School of Medicine.
The COVID-19 pandemic caused a rapid and widespread acceleration in the use of telemedicine for acute, unscheduled health care visits. The shift could result in substantial cost-savings if telemedicine provides a way to reduce costly non-emergent visits to the emergency department. However, prior work has indicated that telehealth cost-savings are offset by an increase in downstream health care use, and by generating new health care visits that add to spending. We will compare downstream utilization and costs among Northwestern Medicine patients who initiated urgent care visits via telehealth to those initiated in-person in the emergency department, during the pandemic. We will also assess the extent to which the rise in telehealth represents new health care use (potentially increasing spending), or substitution away from the ED (potentially reducing spending). Results from our study will help decision makers design more cost-effective telemedicine approaches, thereby maximizing the technology’s value during the pandemic and into the future.
“Strengthening resilience in the healthcare system and maintaining an effective trained workforce to deliver safe, quality care by reducing burnout of healthcare workers due to the COVID-19 pandemic.” Principal investigator: Charlesnika T. Evans, PhD, MPH, Professor, Preventive Medicine (Epidemiology), Feinberg School of Medicine.
Healthcare systems around the world have faced tremendous stress because of the COVID-19 pandemic. Healthcare workers (HCWs) (ie. physicians, nurses, and support staff), who serve as the foundation of the healthcare system, report high levels of psychological stress and burnout, which will likely worsen as the pandemic continues. The consequences of stress and burnout can reduce quality of life for providers and lead to adverse health behaviors (poor dietary choices, reduced physical activity, increased alcohol intake, increases in weight etc.) among HCWs. In addition, burnout can have dire consequences on healthcare delivery effectiveness including poor quality of care and significant cost implications due to medical errors1 and HCW absenteeism and turnover.2 In fact, annual estimates of burn-out related turnover range from $7,600 per physician3 to >$16,000 per nurse.4 However, programs focused on reducing burnout in HCWs have the potential to reduce costs to the healthcare system by $5,000 per HCW per year.4 Maintaining and recovering psychological and behavioral well-being is essential to ensuring we have a workforce that is resilient to acute and ongoing stressors such as the COVID-19 pandemic, ensuring that they are capable of providing the highest level of quality and compassionate care to patients. In this project, we will strengthen the resiliency of the Northwestern Medicine (NM) healthcare system by implementing an online psychological well-being intervention (PARK). We will assess HCW willingness to engage in PARK, which has been shown in other populations experiencing stress (e.g,. dementia caregivers, general public coping with COVID-19) to be effective. We will also assess if the PARK is effective in reducing stress and associated-burnout, absenteeism, and intentions to leave the workforce in a subset of 750 persons who have been participating in a study of HCWs at NM since Spring 2020. In the entire cohort, we will measure the psychological well-being, levels of burnout, health behaviors, absenteeism, and plans to leave the workforce at three time periods: the start, middle, and end of the study period and assess whether they differ by HCW characteristics including gender, race, and role in health care. Results from this study will provide much-needed information: 1) about the current state of psychological well-being and burnout among NM HCWs, now over 1 ½ years into the pandemic; 2) on the role of an online wellness intervention to improve well-being during a protracted pandemic; and 3) about the contribution of PARK to reduce burnout, HCW absenteeism and turnover, and potential impacts on costs. PARK has the potential to have a significant impact on not only NM HCWs but also to be generalizable to other healthcare organizations for addressing burnout and to contribute to lessons learned on how to support HCWs responding to future pandemics, ensuring resiliency in the healthcare delivery system. In addition, we will work with our already engaged stakeholder committee to ensure results can provide actionable policy and fiscal insights. Future opportunities will include collaboration with other healthcare systems to expand roll-out of the successful PARK intervention.
"COVID-19 surveillance in Illinois: Trends, disparities, and design” PI: Jaline Gerardin, Assistant Professor, Preventive Medicine (Epidemiology), Feinberg School of Medicine.
Understanding trends in COVID-19, and where it is circulating, is critically important for public health officials but technically quite challenging. Good surveillance lets health officials and policymakers responsibly relax mitigation measures because reliable early warning systems are in place to detect rebounds in transmission as soon as possible.
Unfortunately, common indicators such as case counts and test positivity rate are biased because they are sensitive to changes in testing policies and demand for testing, and hospitalizations, while less biased, lag infection by nearly two weeks. Uptake of vaccination has also made trends harder to interpret because vaccinated people experience hospitalization, and perhaps seek testing, at different rates.
Our proposal aims to improve COVID-19 surveillance in Illinois in three different ways:
- We will provide weekly estimates of transmission rate in Chicago by adjusting hospitalization data to account for vaccine uptake. We will also evaluate how well a small sentinel surveillance system is reflecting trends in the general population.
- We will quantify racial and ethnic disparities in testing, cases, deaths, and vaccination, and track how these disparities are changing in time.
- We will use a simulation model to explore what the requirements would be for an effective sentinel surveillance system, then use data on implementation costs of Illinois’s sentinel surveillance system to estimate the cost-effectiveness of improved surveillance. We hypothesize that better surveillance will lead to better decision-making and improved health outcomes, and this model will help us estimate by how much health outcomes would improve and whether it would be worth the cost.
“Student Loan Forbearance in the Pandemic Recession.” Principal Investigator, Robert Korajczyk, Professor, Finance Department, Kellogg School of Management
From March 2020 until January 2022, the U.S. Department of Education froze student loan payments, set interest rates to 0 per cent and stopped all collection on defaulted loans. We propose to examine the effect that this student loan moratorium had on the U.S. labor market and wider economy. Borrowers with paused student loan payment found themselves unexpectedly (but temporarily) unburdened from a long-term
debt obligation. This relief may have helped to alleviate financial distress, but it may also have motivated borrowers to make labor market decisions differently than if their payment obligations had remained in place. We will examine these labor market decisions: did student loan borrowers make different choices regarding what jobs to accept, how long to remain unemployed or whether to enter graduate school than
they would have if the moratorium had not been in place? Using novel data that merges LinkedIn employment histories with detailed credit information, we will track the labor market and financial decisions of student loan borrowers from 2020-2022. By comparing student loan borrowers to a comparison group of college graduates who have less loan debt for quasi-random reasons, we will separate out the effect of the student
loan moratorium from the other Covid-era shocks. Our research will identify how student loan relief can affect the labor market, and how this effect should be taken into account in future policymaking.
“Mitigating the Negative Health Effects of Belief in COVID-19 Conspiracy Theories for U.S. Adults and their Children.” Cynthia Wang, Clinical Professor, Management and Organizations, Executive Director, Dispute Resolution Research Center, Kellogg School of Management
COVID-19 related conspiracy theories have had a significant negative impact on public health in the U.S. over the course of the pandemic. In this proposal, we seek to develop social interventions that ameliorate some of these adverse effects. In particular, we focus on increasing the masking and vaccination rates of adults with COVID-19 related conspiratorial beliefs. Moreover, children’s vulnerability to COVID-19 is a timely topic, as vaccination rates for teenagers aged twelve to seventeen have fallen behind adults’ rates, and there is now authorization to vaccinate children between the ages of five and eleven. Our interventions differ from previous efforts in that they do not rely on rational persuasion to dissuade people of conspiratorial notions. Instead, we focus on reducing the impact of conspiratorial beliefs. We do this using social and relational interventions intended to either increase social connection to certain people and groups or alter the way people think about their existing identities and groups. If effective in increasing vaccination rates, our interventions can be introduced in new communication efforts (targeted at unvaccinated individuals) and educational programs (targeted at healthcare professionals, community leaders, and family members). Importantly, even slight increases in vaccination rates could have a significant fiscal impact on the healthcare system. One Peterson-KFF brief estimated that between June and August of 2021 alone, there was $5.7 billion in additional healthcare costs due to preventable COVID-19 hospitalizations among unvaccinated individuals. Unvaccinated individuals have placed an enormous financial strain on not only on hospitals and their staff, but also those who support public health insurance programs (e.g., taxpayers, and individuals and organizations paying health insurance premiums; Amin & Cox, 2021). Our proposed research attempts to alleviate some of the financial burdens faced by the healthcare industry by reducing the number of unvaccinated individuals in the United States.