Research Recap: January 17 - 28
A biweekly overview of recent studies published by Institute investigators and their collaborators spans a wide variety of topics, including:
Health care costs and medication adherence; COVID-19 and hospital-acquired respiratory viruses; COVID-19 and ventilator-associated events; newborn screening for TP53 variants; sepsis patients with comorbidities; racial and ethnic disparities in COVID-19 treatment; precision medicine in diabetes; children’s hospital readmission rates; newborn genomic screening; COVID-19 transmission in hospitals; polygenic risk scores and integrated risk models; preventability of hospital-onset bacteremia and fungemia.
For all faculty publications, see our Publications page. For up-to-date media coverage and research findings, visit In the Media, and follow us on Twitter. To search for a subject matter expert, visit our Investigator Directory.
How families manage the cost of asthma care
Families affected by asthma report difficulty adhering to care regimens because of high medication costs, coupled with increased cost sharing required by some insurance plans. To inform efforts to support adherence, a team led by former faculty member Melissa Gilkey, with senior author Alison Galbraith, conducted a qualitative study to explore how families manage asthma care costs. Via phone interviews with commercially-insured, U.S. adults with asthma or who had a child with asthma, they obtained a purposive sample with high- and low-/no-deductible plans from which to analyze strategies for managing asthma care costs. Findings, published in Journal of Asthma, show that commercially-insured families use a wide range of strategies to manage asthma care costs, with both positive and negative implications for adherence. The team’s typology of asthma cost management strategies can inform insurance redesign and other interventions to help families safely reduce costs and maximize adherence to recommended care.
Institute Investigator(s): Alison Galbraith
What COVID-19 has taught us about hospital-acquired respiratory viruses
The COVID-19 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses, and with a fifth or more of hospital-acquired pneumonias attributable to respiratory viruses, the pandemic has also clarified the primary mechanisms and risk factors for transmission. Respiratory viruses are primarily transmitted by aerosols emitted when people exhale, talk, and cough. In a review article published in Seminars in Respiratory and Critical Care Medicine, Michael Klompas reports that labored breathing and coughing increase aerosol generation to a much greater extent than so-called aerosol-generating procedures, such as intubation, extubation, and positive pressure ventilation. Strategies to prevent hospital-acquired respiratory viral infections include testing all patients upon admission, preventing health care providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and health care workers.
Institute Investigator(s): Michael Klompas
The impact of COVID-19 on ventilator-associated events
In this retrospective cohort study, researchers including Michael Klompas and Chanu Rhee compared incidences, causes, and outcomes of ventilator-associated events (VAE) among mechanically ventilated adults at four Massachusetts hospitals during the COVID-19 pandemic versus in prepandemic years. Results, published in Annals of the American Thoracic Society, show that VAE rates per 100 episodes of mechanical ventilation and per 1,000 ventilator-days were higher among COVID-19–positive patients than among COVID-19–negative patients, providing insight into the natural history of COVID-19 in ventilated patients and informing targeted strategies to mitigate complications in this population.
Institute Investigator(s): Michael Klompas, Chanu Rhee
Pros and cons of population-wide TP53 screening in newborns
Under usual care, 608 individuals out of 4 million newborns would develop TP53-associated cancers before the age of 20. A team of researchers led by Natalia Kunst with Natasha Stout, Ann Chen Wu, Pamela McMahon, and Kurt Christensen, simulated the impact of population-wide newborn screening for TP53 variants, which is currently conducted only for infants with Li-Fraumeni syndrome. The study aimed to assess the clinical benefits and cost-effectiveness of population-wide newborn screening for TP53 variants. Results, published in Journal of the National Cancer Institute, found that population-wide TP53 screening could be cost-effective, but investigators determined further research is needed to reduce the uncertainty in the potential health outcomes and costs associated with this practice.
Institute Investigator(s): Kurt Christensen, Natalia Kunst, Pamela McMahon, Natasha Stout, Ann Chen Wu
Community-Onset Sepsis: Prevalence and Patient Outcomes
Devastating cases of sepsis in previously healthy patients have received widespread attention, but it is unclear what proportion of sepsis patients previously were healthy and how their outcomes compare with those of patients with comorbidities. A team of researchers, including Michael Klompas and Chanu Rhee, conducted a study published in CHEST, which found that the majority of patients hospitalized with community-onset sepsis harbor pre-existing comorbidities, but previously healthy patients may be more likely to die when they seek sepsis treatment at a hospital compared with patients with comorbidities, underscoring the importance of early sepsis recognition and treatment.
Institute Investigator(s): Michael Klompas, Chanu Rhee
Racial and Ethnic Disparities in COVID-19 Treatment
The COVID-19 pandemic has magnified longstanding health care and social inequities, resulting in disproportionately high COVID-19-associated illness and death among members of racial and ethnic minority groups. Using electronic health record data from 41 U.S. health care systems, a team of researchers including Jason Block assessed receipt of medications for COVID-19 treatment by race and ethnicity. Results, published in the Morbidity and Mortality Weekly Report (MMWR), found relative disparities in treatment of all patients with a positive COVID-19 test result, with disparities of a lesser magnitude among inpatients. Equitable receipt of outpatient treatments and implementation of prevention practices are essential to reducing existing racial and ethnic inequities in severe COVID-19-associated illness and death.
Institute Investigator(s): Jason Block
An International Perspective and Future Vision for Precision Medicine in Diabetes
The Precision Medicine in Diabetes Initiative (PMDI), launched in 2018 by the American Diabetes Association (ADA), aims to establish consensus on the implementation of precision medicine for the diagnosis, prevention, treatment, prognosis, and monitoring of diabetes. A recent Diabetes Care article co-authored by Marie-France Hivert describes PMDI progress toward its mandate through regional and international collaborations among leading clinicians and researchers in precision diabetes medicine, encouraging continued dialogue between individuals of diverse personal and professional backgrounds and cross-sector partners.
Institute Investigator(s): Marie-France Hivert
Condition-Specific Variation in Children’s Hospital Readmission Rates
Despite extensive efforts, overall readmission rates at U.S. children's hospitals have not materially declined over the past decade, raising questions about how to direct future efforts. A team of researchers including Alon Peltz conducted a retrospective cohort study of 49 U.S. children's hospitals to measure prevalence and performance variation in readmission by condition. Findings, published in American Pediatrics, found that common childhood conditions have little variation in readmission rates, and conditions with high rate variation account for a relatively small share of total discharges, suggesting modest potential impacts on national rates through quality improvement.
Institute Investigator(s): Alon Peltz
Medical, ethical, and societal impacts of newborn genomic screening
Genomic sequencing is a powerful diagnostic tool for children with a suspected genetic or undiagnosed disease. Christine Lu, Pamela McMahon, and Ann Chen Wu explore the technical, clinical, ethical, and societal challenges of widely implementing genomic screening in concert with existing state-based universal newborn screening programs. In a Viewpoint published in JAMA Pediatrics, investigators discuss the benefits and challenges of using a microsimulation model to synthesize clinical and epidemiological data in order to asses emerging variant-disease associations, project long-term outcomes, and estimate the potential value of newborn genomic screening focusing on specific sets of genes.
Institute Investigator(s): Christine Lu, Pamela McMahon, Ann Chen Wu
Three measures to reduce COVID-19 transmission in hospitals
The increase in hospital-onset Omicron infections demonstrates the discounted frequency of hospital-based COVID transmissions throughout the pandemic. In this JAMA Viewpoint, Michael Klompas and colleague point to hospitals’ limited testing procedures to explain the unappreciated frequency of hospital-acquired infections. The article outlines three additional measures hospitals can implement to reduce the risk of transmission and better protect patients and staff, recommending mandatory vaccine boosters, more frequent testing, and universal use of N95 respirators.
Institute Investigator(s): Michael Klompas
A Smoothed Version of the Lassosum Penalty for Fitting Integrated Risk Models
Polygenic risk scores are a popular means to predict the disease risk or susceptibility of an individual based on its genotype information. An integrated risk model, which includes epidemiological covariates such as age or sex, can improve the precision of risk prediction by identifying high risk patients at an earlier stage. In a recent Genes publication, investigators including Sharon Lutz propose a smoothed version of the "Lassosum" penalty used to fit polygenic risk scores and integrated risk models, which demonstrated increased accuracy for experimental datasets on Alzheimer's disease and COPD (chronic obstructive pulmonary disease), compared to the original Lassosum algorithm. However, the odds ratio achieved by current polygenic risk scores is too small to warrant their usage as a screening method, and in the case of Alzheimer’s disease and COPD, this means that the usage of an integrated risk model is only sensible for costly treatments.
Institute Investigator(s): Sharon Lutz
Assessing the preventability of hospital-onset bacteremia and fungemia
To assess the preventability of hospital-onset bacteremia and fungemia (HOB), a team of researchers including Chanu Rhee developed and evaluated a structured rating guide to account for intrinsic patient and extrinsic healthcare-related risks. The proposed HOB preventability rating guide was compared against a reference standard expert panel. Results, published in Infection Control & Hospital Epidemiology, demonstrated that preventability ratings of HOB scenarios by reviewers using the proposed rating guide matched expert consensus in most cases, with moderately high interreviewer reliability. Investigators suggest that this is a step toward standardized assessment of HOB preventability, but diversity of expert opinions and uncertainty of preventability merit further exploration.
Institute Investigator(s): Chanu Rhee