Multiple investigators in the Department of Health Policy at Vanderbilt Health are excited to begin or continue research in several areas of public health after receiving more than $15 million in new federal grants.
Ashley Leech, PhD, MS; Andrew Wiese, PhD, MPH; Laura Keohane, PhD, MS; and Margaret Adgent, PhD, MSPH, all received new grants funded by the National Institutes of Health.
“I’m incredibly proud of these awards and am excited for the important insights they will produce,” said David Stevenson, PhD, SM, the Mike Curb Professor of Health Policy. “More than anything, these recent successes represent the commitment of everyone in the department to keep moving forward and to stay focused on doing impactful, high-quality research.”
Leech and collaborators at Boston University and Boston Medical Center received a five-year, $3.7 million grant to study maternal health outcomes associated with medications used to treat opioid use disorder. Accidental drug overdose remains the leading cause of pregnancy-associated death in the U.S., making OUD medications a critical component of stemming the opioid crisis.
Buprenorphine, one of three drugs approved by the Food and Drug Administration for long-term treatment of OUD, is one of the most effective and accessible medications to treat this disorder. However, pregnancy accelerates the metabolism of buprenorphine, meaning that higher doses are often needed for pregnant patients to avoid withdrawal.
Despite research supporting increased dosages as needed for this medication, buprenorphine treatment during pregnancy is inconsistent, and patients often receive inadequate dosages.
“Current buprenorphine dosing recommendations for pregnant and postpartum patients provide little guidance on dose adjustment, and therapeutic inertia — a known phenomenon in pregnancy often driven by fetal safety concerns and clinical uncertainty — can lead to dangerous underdosing,” said Leech, Assistant Professor of Health Policy. “Medicaid pregnancy guidance around buprenorphine dosing in some states includes language that implies dose minimization is the goal, which contradicts decades of evidence demonstrating the clinical needs during pregnancy.”
Leech will collaborate with researchers from Boston University and Boston Medical Center to first assess national and state-level differences in buprenorphine dosing between pregnant and nonpregnant women with OUD and to examine how dosing has evolved over time and in response to fentanyl use. The team will also examine the effectiveness of different buprenorphine thresholds and how those dosages advance or inhibit sustained treatment.
The research is supported by the National Institute on Drug Abuse under award number R01DA065591.
Jake Morgan, PhD, and Jillian McKoy at Boston University contributed to this report.
Wiese and collaborators at Georgia State University, the University of Michigan and the University of Memphis received a $4.3 million, five-year grant from the National Heart, Lung, and Blood Institute to identify the most effective strategies for preventing infections and infection-related complications among children with sickle cell disease.
Despite major advances in vaccination and treatment, children with sickle cell disease remain at higher risk for life-threatening bacterial infections and related complications. Current clinical recommendations support the use of antibiotic prophylaxis and disease-modifying therapies, such as hydroxyurea, but many of these recommendations were developed decades ago, before the emergence of newer therapies and changes in the epidemiology of bacterial infections.
“The landscape of sickle cell disease care has changed considerably over the past several decades,” said Wiese, Assistant Professor of Health Policy. “By leveraging data from thousands of children across multiple states, we have a unique opportunity to evaluate how contemporary treatment strategies impact the risk of infections and other sickle cell-related complications in today’s care environment.”
The research team will use data from the Centers for Disease Control and Prevention-funded Sickle Cell Data Collection Program to study more than 5,000 children with sickle cell disease across Tennessee, Georgia and Michigan. Using linked population-based health data, investigators will compare the effectiveness of antibiotic prophylaxis, hydroxyurea, L-glutamine and crizanlizumab, both individually and in combination, in reducing the risk of infections and infection-related complications.
“Ultimately, we hope this work will help clinicians tailor preventive therapies, improve health outcomes and enhance the quality of life for children living with sickle cell disease,” said Wiese.
The research is supported under award number R01HL183867.
Keohane received a $3 million, five-year grant to study potential gaps and barriers in Medicare’s coverage of wheelchairs for older adults. Many older Americans rely on powered wheelchairs for mobility and access to health care services, but declining numbers of wheelchair vendors in recent years may have contributed to delays or administrative burdens in getting a wheelchair.
Medicare has tried to weed out dishonest vendors and lower payment rates for wheelchairs over the past 15 years. For beneficiaries who need wheelchairs, reduced vendor availability may delay wheelchair access, which may be contributing to adverse health outcomes and less frequent routine care.
“Even though a wheelchair is a critical piece of equipment for many Medicare beneficiaries, there is very little data on how changes in the wheelchair vendor market have affected access to wheelchairs, timely repairs and related health outcomes like pressure ulcers and falls,” said Keohane, Associate Professor of Health Policy. “I’m excited that this project can provide novel evidence on this understudied topic.”
The research is supported by the National Institute on Aging (NIA) under award number R01AG100010.
Separately, Keohane also became a co-investigator on a $1.5 million, two-year NIA grant with collaborators at Cornell Weill Medical College to study health care usage and access for older adults impacted by elder mistreatment and self-neglect.
Despite obvious serious consequences from mistreatment and neglect, little is known about how older adults affected by these events use and interact with the health care system.
The grant will enable the team to create a secure data infrastructure by linking Medicare and Medicaid insurance claims with Adult Protective Services data to examine patterns and outcomes within this population.
Adgent was awarded a $4 million, five-year grant from Eunice Kennedy Shriver National Institute of Child Health and Human Development to study the impacts of newly popular glucagon-like peptide-1 (GLP-1) receptor agonist medications and their benefits to pregnant women who are considered obese.
Obesity during pregnancy can increase risks of serious health outcomes for both mothers and their infants after birth. Achieving a healthy weight before pregnancy is often recommended to reduce obesity-related risks. Recently, GLP-1s like semaglutide, liraglutide and tirzepatide, have emerged as highly effective and increasingly popular weight loss treatments. However, little is known about the potential risks and benefits of their use prior to or during pregnancy. The study will investigate the impacts of GLP-1s on maternal health, including gestational weight gain and pregnancy outcomes, as well as neonatal outcomes associated with maternal use of the medications.
“While these medications have demonstrated substantial benefits for weight management and diabetes control in nonpregnant adults, the effects of GLP-1s on maternal and infant health, particularly if used shortly before or during early pregnancy, are unknown,” said Adgent, Research Associate Professor of Health Policy. “Further, little is known about the potential consequences of stopping treatment during this time. As use of these medications continues to grow, closing these knowledge gaps is increasingly important. We are excited about our opportunity to generate findings that will help patients and clinicians make more informed decisions.”
The research is supported under award number R01HD120349.
