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“AHRQ as a funding agency has provided an important opportunity for us to positively influence nursing home care, which is critical given the negative impact of COVID-19.”

The COVID-19 pandemic called nationwide attention to the vulnerability of nursing home residents to viral respiratory healthcare-associated infections (HAIs). Myriad factors, including patient-to-staff ratio and shared living spaces, increase residents’ exposure to infection outbreaks.

Amy Vogelsmeier, Ph.D., .R.N., FAAN, an associate professor at Sinclair School of Nursing, University of Missouri—Columbia, has more than 30 years of experience as a registered nurse in acute and long-term care settings. When COVID-19 hit, Dr. Vogelsmeier was working on a demonstration project that employed advanced practice registered nurses in 16 Missouri nursing homes to reduce avoidable resident hospitalizations. She realized the way nursing homes responded to COVID-19 could influence the health outcomes of residents.

In 2021, Dr. Vogelsmeier received an to understand nursing homes’ response to COVID-19 and how that response influenced resident outcomes. “An opportunity to minimize respiratory infections and the negative outcomes, not just from the illness itself but all of the constraints put on nursing homes, specific to COVID, is what drove this study,” she noted. Under this 4-year grant, Dr. Vogelsmeier and her co-principal investigator, Lori Popejoy, Ph.D., R.N., FAAN, are conducting research in 24 Missouri nursing homes to develop knowledge and recommendations to improve U.S. nursing homes’ ability to respond to high-risk respiratory and HAI outbreaks. Their goal is to identify best practices and combine them with existing guidelines to reduce risk of patient harm.  “We’re learning how nursing homes used the guidelines imposed on them to understand what worked and what didn’t for COVID-related care.”

Dr. Vogelsmeier says the next step will be to implement the updated and combined best practices and existing evidence-based guidelines in nursing homes. “One example might be to assure nursing homes are part of emergency planning at the community or county level. The few nursing homes in our study that were part of community-level planning noted that it helped them prepare and access resources; unfortunately, community engagement did not commonly occur.”

“Many times, when you look at large-scale outcomes, you miss the nuances of the story and that’s where these 24 nursing homes provide an in-depth understanding of what really happened. This funding mechanism allows us to do that.” This project will end August 31, 2025.

Principal Investigator: Amy Vogelsmeier, Ph.D., R.N., FAAN
Institution: Sinclair School of Nursing, University of Missouri–Colombia
Grantee Since: 2021
Type of Grant: Health Services Research Project

Related AHRQ Resources

• AHRQ Nursing Home COVID-19 Action Network.
• AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits.
• AHRQ’s Safety Program for Nursing Homes: On-Time Prevention.
• Center to Advance Palliative Care (CAPC) COVID-19 Response Resources Hub.
• Nursing Home Antimicrobial Stewardship Modules.
• Protecting the Most Vulnerable Through Partnership: Helping Nursing Homes Respond to the COVID-19 Crisis.
• Staffing During the COVID-19 Pandemic: A Guide for Nursing Home Leaders.

Return to AHRQ Grantee Profiles