About CHRT

Evaluating Michigan’s COVID-19 nursing home response and recommending data-driven, evidence-based strategies

July 2020 – August 2020
Funder: Michigan Health Endowment Fund
Need:

In response to the COVID-19 pandemic, the Michigan Department of Health and Human Services (MDHHS) created regional nursing home hubs with the goal of more safely handling COVID-19 patient discharges from hospitals. MDHHS asked CHRT to evaluate the regional nursing home hub approach and to recommend additional strategies to prepare for a potential second wave of COVID-19. MDHHS's goal is to protect and support nursing home residents, discharged COVID-19 patients, and nursing home facility staff with consideration for the long term care continuum that includes nursing homes, hospitals, and home and community based services.

CHRT’s role:

CHRT's objectives are threefold: 1) Evaluate the state’s regional nursing home hub COVID-19 strategy by comparing Michigan’s approach and outcomes to those of other states. 2) Review national best practices and develop recommendations for preparedness in the event of another COVID-19 surge and to keep nursing home patients as safe as possible. 3) Consider the continuum of long-term care services to minimize infections, morbidity, and mortality among individuals who require these services.

To accomplish these objectives, CHRT will conduct key informant interviews with national policy experts, state administrators, nursing home leaders, and hospital and other clinical leaders; compare roughly one dozen state approaches to testing, nursing home structures, infection control protocols, PPE acquisition practices, staffing and recruitment strategies, additional Medicaid fund allocation, telehealth and alternate care models, and visitation policies; and use data from MDHHS and other sources to assess the performance of hub versus non-hub strategies and the factors influencing infection rates and death rates for both residents and staff.

CHRT will focus special attention on practice and policy recommendations to guide future COVID-19 nursing home responses. These will include essential process, policy, and structural practices such as robust infection control and staff training measures, use of "strike teams" to assess and support nursing home practices, and transparent communication with families, residents, staff, and stakeholders.

The CHRT staff team includes Marianne Udow-Phillips, founding executive director; Robyn Rontal, policy analytics director; Jaque King, lead analyst; Cristin Cole, healthcare analyst; Erica Matti, healthcare analyst; Meg Normand, CHRT intern; and Meryl Price, Health Policy Matters.

In addition to the CHRT team, we have retained a number of external consultants to assist with the evaluation:

Brant E. Fries, University of Michigan professor emeritus of health management and policy at the School of Public Health and research professor emeritus at the Institute of Gerontology.

David Hutton, University of Michigan associate professor of health management and policy and associate professor of global public health at the School of Public Health and associate professor of industrial and operations engineering at the College of Engineering.

Lona Mody, University of Michigan Amanda Sanford Hickey Collegiate Professor of Internal Medicine and professor of internal medicine at Michigan Medicine and research professor at the Institute of Gerontology, professor of epidemiology at the School of Public Health.

Edward C. Norton, University of Michigan associate professor of health management and policy and associate professor of global public health at the School of Public Health and associate professor of industrial and operations engineering at the College of Engineering.

Kathy Stiffler, Michigan State University senior health policy advisor at the Institute for Health Policy.

This study is supported by the Michigan Health Endowment Fund, which works to improve the health and wellness of Michigan residents and to reduce the cost of healthcare, with a special focus on children and seniors. Learn more at mihealthfund.org.