Research in Brief: Recapping the Latest Findings from the Institute
Shining a Spotlight on Rigorous Research
For over 30 years, the hallmark of the Institute has been producing rigorous research aimed at improving health care delivery and policy. In 2024 alone, Institute researchers led or provided senior-authorship guidance to 150 publications, and overall, lent their expertise to 319 papers.
In our new series, Research in Brief, we'll recap recent findings and spot the researchers who've led this important work. This month: examining Medicaid ACO models and their impact on maternal health; how extreme weather events can effect the pharmaceutical supply chain, costs of food insecurity for young people with diabetes, and more.
Maternal health in the U.S. has reached crisis levels and Medicaid accountable care organizations (ACOs) – groups that work together to improve patient care and lower costs – may offer part of the solution. Yet evidence on their impact is limited. A new study by Megan Cole Brahim and colleagues from Boston Medical Center, and Boston University School of Public Health examined two ACO models: primary care-led and health system-led. They found that primary care-led ACOs helped increase doctor visits during pregnancy and after birth, while health system-led ACOs were linked to fewer emergency room visits and more timely postpartum care. Both models improved screening for postpartum depression. The study highlights the importance of thoughtful design of Medicaid programs and offers timely guidance for policy makers.
About lead author Megan Cole Brahim
Having joined the Institute in July 2025, Dr. Brahim brings with her a deep commitment to advancing health equity and a wealth of expertise in Medicaid policy and health care delivery reform. She also serves as Co-Director of Research and Evaluation for the TEAM UP Scaling and Sustainability Center and is Adjunct Faculty in the Department of Health Law, Policy, and Management at the Boston University School of Public Health. Additionally, she is the Co-Founder of the Medicaid Policy Lab. A health services researcher, Dr. Brahim uses causal inference methods to examine the impact of Medicaid policies, insurance coverage, and delivery system reforms on access, quality, and equity in health care.
Current hospital-acquired infection surveillance guidelines, according to Fizza Manzoor, Chanu Rhee, and Michael Klompas of the Center for Sepsis Epidemiology and Prevention Studies (SEPSIS), likely harken back to a now 50-year-old landmark study revealing the vital link between infection-control programs and reduced rates of infection. While successful, modern infection control practice, which focuses on six set infections detected via manual chart review, is not without its limitations. The authors outline a new approach they say can expand HAI surveillance efforts from a burdensome, manual process limited in scope to comprehensive, hospital-wide, automated processes that account for the complex nature of modern health care. The key, they say, lies in the CDC’s new hospital-onset sepsis metric.
About lead author Fizza Manzoor
Dr. Manzoor is an infectious diseases fellow in the joint program at Massachusetts General Hospital and Brigham and Women's Hospital. She completed medical school and internal medicine residency at the University of Toronto.
Dr. Manzoor's current research focus is on the surveillance and prevention of healthcare-associated infections, infection control interventions, and infectious disease epidemiology.
About the SEPSIS Center
Sepsis is a life-threatening condition caused by a dysregulated immune response to infection, leading to organ dysfunction, shock, and often death. Despite advances in modern medicine, sepsis remains a leading cause of mortality, contributing to over 350,000 deaths annually in the US and one in five deaths worldwide. The economic and emotional toll is staggering, with billions of dollars in healthcare costs each year and long-term disability affecting many survivors.
Although sepsis awareness and treatment have improved over time, progress is hindered by gaps in epidemiologic surveillance, challenges in diagnosis, variability in clinical presentations, and uncertainties about optimal prevention and management strategies. The Center is committed to closing these gaps through cutting-edge research and data-driven solutions.
While survey-based studies have long documented that sexual minority populations experience worse health outcomes than their heterosexual peers, they rely on self-reported health data and often lack a heterosexual reference group to compare potential differences in health outcomes. Landon Hughes and team (including senior author Brittany Charlton) used a novel approach to identify members of sexual minority populations and potentially monitor their health: administrative claims data. In one of the largest studies on sexual minority populations to date, Dr. Hughes and team’s findings support the survey literature that has documented that these populations experience greater mental health and HIV-related morbidity, and also offer an innovative approach to identifying these populations within datasets.
About lead author Landon Hughes
Landon Hughes joined the Institute faculty after completing a joint post-doctoral at the Institute and Harvard T.H. Chan School of Public Health. His research utilizes demographic methods to examine morbidity, mortality, and mental health outcomes among LGBTQ populations and considers the effects of social factors on health and aging.
Recent extreme weather events, such as 2024’s Hurricane Helene, have highlighted vulnerabilities in the U.S. pharmaceutical supply chain. A study led by Mahnum Shahzad assessed the frequency with which climate-related disaster events affected counties with U.S. drug production facilities. Results showed that nearly two-thirds of all drug production facilities were in counties that experienced at least one disaster declaration. Dr. Shahzad and team suggest these findings highlight the following needs: recognition of the threats posed by climate-related vulnerabilities; supply chain transparency; strategic allocation of production; and risk management strategies to avoid disruptions.
About lead author Mahnum Shahzad
Mahnum Shahzad is an Instructor in the Department of Population Medicine at the Harvard Pilgrim Health Care Institute. She received her PhD in Health Policy (Economics) from Harvard University. Her research interests are driven by the question of how regulatory and financial incentives change the type of evidence generated about the safety and efficacy of pharmaceuticals, and how that information is incorporated into real-world use of these products.
Over ¾ of the cancer therapeutics available have been approved via the FDA’s expedited regulatory programs. This fast-track pathway often results in clinical uncertainties based on a variety of factors. While these uncertainties are documented in FDA benefit-risk assessments, a team led by research fellow Avi Cherla, under the mentorship of Anita Wagner, questions whether they are effectively reaching the clinicians who prescribe them. While clinicians tend to rely on journal publications and clinical guidelines when considering cancer treatments, these sources have been found to lack information about clinical uncertainties. They suggest three potential solutions: making benefit-risk assessments more accessible and user-friendly, requiring disclosure of key clinical trial uncertainties, and that guideline developers incorporate FDA assessments into their recommendations.
About lead author Avi Cherla
Dr. Cherla’s research focuses on developing and evaluating methods to communicate the evidence of drugs to patients, physicians, and the public using large, randomized experiments. He earned his PhD and master’s degree from the London School of Economics.
About senior author Anita Wagner
Together with colleagues across the world, Dr. Wagner conducts empirical research to generate evidence for answering challenging health system questions. Their work evaluates impacts of insurance and other policy changes on medicines’ availability, access, affordability, and use, in the United States, Europe, China, and elsewhere. The team also seeks to improve communication about benefits, harms, and evidence uncertainties of new medicines, specifically new cancer medicines.
Hadley Stevens Smith and colleague address a critical challenge facing one of the most successful public health programs in the U.S.: newborn screening (NBS). While NBS science and technology are advancing rapidly—meaning increased potential to improve the health of pediatric populations—the end of the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC) has left gaps that threaten the timely diagnosis and facilitation of life-saving treatment for newborns. The authors suggest that a reputable professional organization fill the gap left by the termination of the ACHDNC and pick up the duties of hosting a future version of the organization to preserve the progress made to date.
About Hadley Stevens Smith
Hadley Stevens Smith is a health economist and a researcher of the ethical, legal, and social implications (ELSI) of genomics. She studies clinical, patient-centered, and economic outcomes of genomic medicine, primarily for newborn and pediatric patient populations. The goal of her research program is to inform efficient and ethical implementation of genomic technologies into clinical care.
Research fellow Lauren Violette, under the mentorship of Julia Marcus, aimed to determine whether populations who would likely benefit from HIV prevention tools would support easier access to these tools and care. Dr. Violette and team analyzed data from the 2023-2024 Transgender Women’s internet Survey and Testing study. They found that, among transgender women and transfeminine nonbinary individuals, nearly 87% supported over-the-counter PrEP availability. Those who had previously taken PrEP, tested for HIV, or experienced healthcare-related stigma showed higher support. The team suggests that making PrEP available without a prescription could benefit transfeminine people by expanding access to HIV prevention beyond clinic-based settings.
About lead author Lauren Violette
Dr. Violette's doctoral research explored preferences for and use of HIV pre-exposure prophylaxis (PrEP) products and delivery models among women who inject drugs and gay, bisexual, and other men who have sex with men living in Seattle, Washington. More broadly, her research has focused on HIV/STI testing and PrEP implementation among priority populations in the US and doxycycline post-exposure prophylaxis for prevention of STIs among cisgender women in Kenya. Her current research involves assessing the acceptability, feasibility, and potential impact of over-the-counter PrEP.
About senior author Julia Marcus
Dr. Marcus focuses on improving the implementation of preexposure prophylaxis (PrEP) to prevent new HIV infections and promote sexual health in the United States as her primary research interest. She has used electronic health record, survey, and qualitative data to identify people likely to benefit from PrEP, evaluate clinical outcomes among PrEP users in real-world healthcare settings, and characterize gaps and inequities in the PrEP continuum of care.
During midlife, many women develop substandard cardiovascular health problems. A Project Viva study of 767 women led by Sheryl Rifas-Shiman took a street-level approach to evaluating the effect that greenspace can have on improving cardiovascular health. Using deep learning models applied to Google Street View images, the team measured the percentage of trees, grass, and other plants within view in images within 500m of study participants’ homes. They found that women who lived near more trees (but not more grass) had better overall cardiovascular health. The benefits didn’t stop there: higher exposure to trees was also linked to improved diet, physical activity, sleep, body weight, blood pressure, blood glucose, and smoking avoidance. The study, funded by the National Institute of Environmental Health Sciences (NIEHS), was chosen as one of the organization’s Papers of the Month for September.
About lead author Sheryl Rifas-Shiman
Sheryl Rifas-Shiman is a Lead Research Analyst in the Department of Population Medicine. Her research focuses on nutrition and other prenatal and early-life exposures, and how these influence the health of both mother and child. Much of her work stems from Project Viva, a longitudinal pre-birth cohort study. She hopes to contribute to the field of life-course epidemiology through her research and by helping to advise research fellows and medical students.
For those with diabetes, managing blood glucose relies on three key pillars: nutrition therapy, physical activity, and monitoring and self-management of glucose levels. Household food insecurity, affecting nearly one in three youth and young adults with diabetes between 2016 and 2019, undermines these pillars and is associated with increased expenditures among this population – especially those with gaps in insurance coverage. A study senior authored by Davene Wright found that food insecurity is linked to higher medical and non-medical costs for those patients, and that having continuous health coverage helps reduce how much food insecurity effects these costs. The findings suggest that interventions aimed at helping families access food and continuous health insurance could lower costs for both patients and health systems.
Dr. Wright is a decision scientist, interested in the study of how stakeholders make decisions and how they can make better decisions in the presence of uncertainty, complexity, and competing values. The overarching goal of her research is to improve the demand for and supply of effective and efficient health care for patients with chronic diseases with a focus on obesity and diabetes. She is committed to using her methodological toolkit to design health care interventions and policies that will have high uptake and high potential to improve population health.