Pilot Project Grants

Pilot Grant Recipients

Year 4

Customized optimal use of telehealth for chronic care management and disparity reduction: A machine learning and clustering approach
PI: Jessica Cao, University of Wisconsin-Madison

During the COVID-19 pandemic, many waivers and programs were implemented to allow telehealth to be delivered with few restrictions, leading to a rapid increase in use. Since then, public authorities, payers and providers are deciding to either end, extend, or make permanent these waivers or programs. To inform these major policy changes, this project aims to understand the role of telehealth and patterns of telehealth use for chronic care management and disparity reduction in care outcomes, as well as the effects of policies and policy rollbacks. Aim 1 will identify clusters of telehealth delivery patterns, balance and alternating sequence with in-person care by patient rural/urban advantage/disadvantage subgroup and care system groups. Aim 2 will estimate the causal effects of changes in telehealth policy (waivers, subsidies, etc.) and care system contextual factors on telehealth delivery patterns, chronic care outcome and variations over time. This project will provide critical evidence to inform national decisions on telehealth delivery and policies for chronic care management and disparity reduction.

Childhood material hardship, adolescent neuroinflammation, and brain connectivity as predictors of young adult mental health during COVID-19: A longitudinal birth cohort study
PI: Christopher Monk, University of Michigan

We are investigating how early-life adversity influences neuroinflammation, brain connectivity, and mental health vulnerability during the COVID-19 pandemic. Using data from the Future Families and Childhood Wellbeing Study ? a well characterized longitudinal cohort followed since birth ? we aim to understand how material hardship in childhood contributes to neuroinflammation and brain network connectivity in adolescence, and how these factors predict mental health outcomes in young adulthood during COVID.

Trust in the health system and COVID-19 vaccine hesitancy in the United States
Co-PIs: Sharifa Nasreen and Victor Puac-Polanco, SUNY Downstate Health Sciences University

This study aims to examine trust in the health system and vaccine hesitancy related to COVID-19 vaccines in the US adult population using data from the Health Reform Monitoring Survey 2021. Aim 1: Examine the association between trust in other entities and sex and racial concordance and trust in healthcare providers. Aim 2: Measure constructs of COVID-19 vaccine hesitancy in US adults, and determine the association between trust in the health system and vaccine hesitancy constructs. Findings from this study will provide actionable evidence to develop targeted interventions to improve vaccine uptake and reduce COVID-19 morbidity and mortality.

Spatial and social disparities in subjective and objective transportation accessibility to healthcare services and their relationship to long COVID
Co-PIs: Sicheng Wang and Xueying Yang, University of South Carolina

As a medical condition characterized by lingering symptoms following recovery from COVID-19, long COVID presents a significant public health challenge. This study seeks to examine the associations between transportation accessibility and the prevalence and severity of long COVID across space, aiming to inform more effective and efficient healthcare strategies. This project addresses the urgent need to understand and mitigate the impacts of long COVID, which disrupts lives and strains healthcare systems. By clarifying the role of transportation in healthcare access, the study aims to guide the development of interventions that enhance healthcare accessibility and reduce health risks associated with long COVID across different regions and population groups.

Project Aims:

• Measure and Map Accessibility: To assess both subjective (perception-based) and objective (calculated metrics) transportation accessibility to healthcare services for individuals with long COVID, utilizing Geographic Information System (GIS) technologies.
• Identify Disparities: To identify spatial and social disparities in transportation accessibility across different states, metropolitan areas, urban-rural settings, and among various sociodemographic groups.
• Conduct Spatial Regression Modeling: To analyze the correlation between transportation accessibility and long COVID outcomes, examining how these relationships vary by location and individual characteristics.

Year 3

Examining the effects of the expiration of the 2021 expanded CTC and SNAP benefit on perinatal health: Quasi-experimental evidence from a national survey
PI: Guangyi Wang, University of California, San Francisco

This project will evaluate the impacts of policy rollbacks during the COVID-19 pandemic on perinatal health, a pivotal life stage that profoundly influences an individual’s lifelong well-being. Specific aims include assessing the consequences of the expiration of the 2021 Child Tax Credit (CTC) and Supplemental Nutrition Assistance Program (SNAP) benefit expansions. This project will also assess variations in the effects of policy rollbacks across different populations based on their vulnerability.

The impact of tele-critical care on rural-urban disparities among hospitalized critically ill patients during the COVID-19 pandemic
PI: Uchenna R. Ofoma, Washington University in St. Louis

This project seeks to investigate the patterns and effects of patient-level utilization of telemedicine among hospitalized patients during the COVID-19 pandemic period. Aim 1: Evaluate the hospital and provider patterns of patient-level utilization of telemedicine among critically ill Medicare fee-for-service beneficiaries during the COVID-19 pandemic period; Aim 2: Determine the effectiveness of patient-level utilization of TCC using quasi-experimental methods. The study’s findings will enhance our understanding of the effectiveness of telemedicine as a care delivery model and create knowledge for clinical leaders and policymakers working to improve outcomes and reduce disparities for critically ill patients.

Improving survey measures of time and money help given and received due to hardships of the COVID-19 pandemic
Co-PIs: I-Fen Lin, Bowling Green State University; Judith A. Seltzer, UCLA

This project will develop a coding scheme and code open-ended responses to questions about help given and received in the 2020 Health and Retirement Study (HRS). The questions obtain complete information about who helped older adults during the crisis of the pandemic, and to whom older adults gave pandemic-related help. These new data will provide a better understanding of older adults’ support networks, as well as disparities in how much social support older adults can draw on to mitigate the health and economic challenges they faced during the pandemic. We also will work with HRS to make the new data available to the broader research community.

Quantifying how the COVID-19 pandemic exacerbated maternal health disparities during continuous postpartum enrollment in Medicaid
PI: Elaine Hill, University of Rochester

Maternal health was a crisis long before the COVID-19 Pandemic. The Pandemic only intensified the problem and exacerbated racial-ethnic disparities in maternal mortality (MM). This project seeks to understand how the COVID-19 Public Health Emergency (PHE) policy, specifically the Families First Coronavirus Response Act (FFCA) that led to continuous coverage for Medicaid-covered births up to 1 year postpartum, effected maternal health disparities and late postpartum maternal mortality. Aim 1 is to develop a maternal cohort in the Medicaid T-MSIS Analytic File (TAF) data. Aim 2 is to quantify how the COVID-19 Pandemic exacerbated severe maternal morbidity (SMM), maternal mortality (MM), and postpartum mental health disparities in the Medicaid population. Aim 3 is to evaluate the effectiveness of continuous postpartum Medicaid coverage in preventing late postpartum MM (42 days to 1 year postpartum) in the Medicaid population. Findings will be applicable to the American Rescue Plan Act of 2021 which gave states a new option to extend Medicaid to 12 months postpartum (46 states have expanded as of March 2024).

Year 2

Using place visitation big data to improve health measure estimation at the census tract level
PI: Zhenlong Li, Penn State University.

Health measures for small areas (i.e., census tract level health outcomes, prevention, health risk behaviors, and health status) can support effective public health planning for policymakers. Social determinants of health (SDOH) factors are usually applied to generate health measure estimation. However, SDOH lacks consideration of resident routine activities that may affect health measures. For example, more fitness center visitation might relieve depression, and bar trips might increase binge drinking. This study investigated whether the additional resident routine activity information improves health measure estimation in areas with small populations (i.e., census tract) in the United States (US), and whether such improvement is different between urban and rural areas.

What is long COVID? Quantifying the enduring and disparate effects of COVID-19
Co-PIs: Kurt Lavetti, Adibah Abdulhadi; Ohio State University

This project will quantify the multidimensional patterns of long-term diagnoses and healthcare utilization associated with long COVID by examining the recovery trajectories of individuals with COVID-19. The patterns of diagnoses and healthcare use will then be mapped to various proposed medical definitions of long COVID to compute the incidence of this condition under different definitions. This project will also examine how long COVID outcomes vary across different demographic and socioeconomic groups.

Changes in trust in health systems, interactions with the healthcare system, and health-related behaviors and household finances since the COVID-19 pandemic: Preliminary analysis
PI: Caroline Rudisill, University of South Carolina

Trust in health systems is integral to the utilization of healthcare and interactions with providers. The COVID-19 pandemic changed individuals’ trust in health systems and caused temporary and permanent changes in healthcare utilization, household finances, and other sectors which ultimately impacted health systems.

This study aims to examine how trust and household finances impacted healthcare utilization and health behavior during the pandemic and the present period, specifically looking at effects across gender, age, and rurality.

Investigating vaccine hesitancy and factors that build vaccine confidence among refugees in Rhode Island, U.S.
Co-PIs: Julie C. Keller, Steven Cohen, Mary Greaney, and Erica Liebermann; University of Rhode Island

Vaccine hesitancy was a major concern through the COVID-19 pandemic. Organizations working with immigrants and refugees indicated that vaccine hesitancy was especially concerning within these populations. However, there is little research that investigates immigrant or refugee vaccination rates and vaccine hesitancy. In this study, Keller and colleagues aimed to:

• investigate COVID-19-related knowledge, attitudes, and belief among refugees,

• identify perceived barriers to COVID-19 vaccination,

• examine COVID-19 health literacy, and

• identify factors associated with increased vaccine confidence and decreased vaccine hesitancy.

How and how much has New York state’s Excluded Workers Fund affected the food and housing security and health of immigrants?
PI: Robert Smith, CUNY

We will study how New York State’s (NYS) $2.1 billion Excluded Workers Fund (EWF) affected the food and housing security and health of immigrants and their children. NYS’s EWF was the largest of a new type of state program inclusively targeting immigrants (and their US citizen children) excluded from federal pandemic relief programs in America’s worst pandemic, reflecting American ethical and policy divisions.

Year 1

Examination of health disparity and its social determinants for vulnerable populations of COVID transmission
Co-PIs: Yajuan Si, University of Michigan; Cameron Kaplan, University of Southern California

Researchers have previously developed a measure of asymptomatic Covid-19 transmission using electronic health records from an urban/suburban setting in Indiana. The pilot project will validate and expand this measure for Black adults using records from Los Angeles County emergency room visits.

Vaccination, healthcare and grief in the National Couples’ Health and Time Study
PI: Claire Kamp Dush, University of Minnesota

The project will conduct a pilot follow-up data collection for the National Couples’ Health and Time Study (NCHAT), the only population-representative study with fully-powered subsamples of racial and ethnic, and sexual and gender diverse adults fielded during the pandemic. The second wave will repeat measures of health outcomes, stressors, and coping from the original study. It will also add measures of vaccination status and intention, self and partner management of physical and mental health care, and grief and ambiguous loss.

Enhancing the utility of the National Wellbeing Survey to understand rural-urban differences in the impacts of COVID-19 on adult psychological wellbeing and substance use
PI: Shannon Monnat, Syracuse University

Researchers are already using the National Wellbeing Survey to measure the mental health effects of states’ Covid-19 policies by age group, sex, race/ethnicity, and education. The pilot project will expand the next wave of data collection to oversample rural populations in order to measure effects by rural-urban variation.