Projects

Here are the projects we are currently working on.

Traumatic Brain Injury
The major goals of this project are to open the black box of acute rehabilitation for individuals with TBI and create sophisticated, outcomes-based tools for clinical decision-making.  This 5-year study will use Practice-Based Evidence for Clinical Practice Improvement methodology to characterize rehabilitation therapy services for 1,815 individuals with moderate to severe TBI and evaluate effects of these therapies on TBI rehabilitation outcomes, controlling for differences in patient characteristics and severity of injury and illness.  Three primary outcomes addressed are: (1) extent of functional improvement; (2) discharge to a private residence (versus nursing home, hospital, other institutional setting); and (3) resources reflected in length of stay.

Spinal Cord Injury
This 5-year project will use Practice-Based Evidence for Clinical Practice Improvement (PBE-CPI) research methodology to isolate specific components of rehabilitation interventions, and to determine how, and to what degree, each component is associated with outcomes for patients with spinal cord injury.  PBE-CPI is an outcomes-directed, model-building process that has identified and established effective and efficient evidence-based treatment guidelines in stroke rehabilitation and other diagnostic groups and clinical settings. This project will open the black box of acute rehabilitation for individuals with SCI and contribute to outcomes-based guidelines for clinical decision-making.

SCI SKIN
The purpose of this study is to examine treatment processes in hospital and rehabilitation settings for patients with spinal cord injury (SCI) and determine those treatments that are associated with development of pressure ulcers in various levels of SCI patients.  This will allow determination of how treatment can be optimized taking into account the different needs of SCI patients, and to launch a quality improvement initiative in keeping with the study’s principal findings.

Cornell Chronic Pain:

The major goals of this project are to establish a chronic pain data registry (prospective and retrospective) composed of patients attending the pain clinics of 4 New York City academic hospitals. Comparative effectiveness research methods will be used to determine which patients derive maximum benefit from the currently available interventions for the management of chronic pain.

DHHS AHRQ
The purpose of this task order is four-fold: 1) to evaluate the effect of the On-Time PrU program, 2) to design the tools and establish the foundation for a Falls Prevention implementation effort using an approach similar to On-Time pressure ulcer prevention, (3) to write a Train-the-Trainer manual for the On-Time PrU program, and (4) to design the tools and establish the foundation for a Avoidable Hospitalization implementation effort using an approach similar to On-Time pressure ulcer prevention .  The On-Time PrU program uses health information technology solutions for certified nursing assistant (CNA) documentation and reports for clinical decision-making, engaging CNAs in workflow redesign and process improvement efforts, and supporting participating NHs through facilitation of process improvements designed to be part of caregiver daily work.  For the On-time Falls Prevention and Avoidable Hospitalization modules, we will develop and standardize documentation data elements, actionable reports of resident falls and hospitalization risk factors, and tracking tools, using lessons learned from the On-Time pressure ulcer prevention and healing development phases. These elements should be integrated into everyday practice.

Preventing Pressure Ulcers:
A Multi-site RCT in Nursing Facilities

The purpose of this multi-site, randomized, controlled trial is to determine the optimal frequency of repositioning nursing facility residents with mobility limitations who are at moderate and high risk for pressure ulcer development and who are cared for on high density foam mattresses for the purpose of preventing pressure ulcers. Pressure ulcers result primarily from pressure over a bony prominence that occludes blood flow to tissues.  Traditionally, soft surfaces over mattress and repositioning individuals every 2 hours to relieve pressure have been the gold standard of care to prevent ulcers. Recent improvements in support surfaces may reduce the need for 2-hour repositioning.