AHCA/NCAL helps shape and execute federally-funded research across the country that will deliver solutions to our members. We are action-oriented—we want to find out what works to achieve better outcomes in post-acute and long term care (LTC). Our involvement spans different levels of effort, and includes advising, recruiting research participants, and implementing new strategies to evaluate. We and our research partners, who are often universities, are funded by the National Institutes of Health (NIH), National Institute on Aging (NIA), the Patient-Centered Outcomes Research Institute (PCORI), and others. 

Why do we prioritize research on effectiveness?

1.    Most studies on the effectiveness of treatments do not include older adults.¹  Most clinical trials enroll a younger population. The under-representation of older, medically-complex adults in clinical trials has real-world effects. For example, the use of semaglutide (e.g., Ozempic) is on the rise, and not just among younger patients. Yet, we don’t fully know the effects on an older population. Additionally, individuals receiving care in long term care settings—particularly people living with dementia—are frequently excluded from clinical trials. Building the capacity to help test treatments in older adults with a wider range of conditions will yield better information to improve care delivered in long term settings. That is one of the reasons AHCA established the Center for Long-Term Care Quality & Innovation at the Brown University School of Public Health 10 years ago.
2.    We want to deliver solutions. The bulk of published literature about the LTC setting focuses on analysis of trends in outcomes over time or for specific populations. These types of studies are just the first step. We often already know where the opportunities for improvement are, so we want to encourage more attention on evaluating what strategies and interventions can achieve different—and better—resident outcomes. 
3.    We want to increase learning and development opportunities for professionals working in LTC settings. Research that yields information on what works for improving outcomes for older adults, and how new clinical practices and treatments can be implemented in nursing homes and assisted living communities, will generate an evidence base that LTC setting professionals can use. This evidence base is just one piece of what is needed to create a learning health system² within LTC settings. A learning health system creates development and career opportunities for professionals, attracts and retains leadership and staff who are committed to continuous improvement, and identifies additional topics for future research.

How is AHCA/NCAL supporting effectiveness research in LTC? Some examples:

• LTC Data Cooperative. The LTC Data Cooperative is a provider-led initiative that is funded by NIA and involves a partnership with Brown. It assembles electronic health record (EHR) data from the major LTC EHR vendors on behalf of provider organizations that choose to participate. This resource is developed with minimal burden to providers. The Research Review Committee, with a majority of providers as members, reviews proposals from researchers to use these data for two approved uses: observational, comparative effectiveness research or clinical trials. Data may be linked with Medicare and Medicaid claims for research purposes.
• Led by Brown, the University of Pittsburgh, and Boston University with funding by NIH, Learning Health Systems Research Rehabilitation Network (LeaRRN) funded two types of projects: 12-month partnerships between rehabilitation researchers and health systems to research topics of interest to the health system, and pilot grants to research priority topics to test and improve rehabilitation science in LTC settings.
• Prevention of Injury in Skilled Nursing Facilities through Medication Optimization (PRISM). Funded by PCORI, this trial compares three evidence-based approaches to determine which is better at reducing falls with injury after a fracture, and which has fewest adverse side effects and other symptoms. A fracture nurse consultant identifies eligible patients at participating skilled nursing facilities and works with them (or their representatives) remotely to recommend potential ways to either (1) reduce medications that increase risk of falls, (2) increase osteoporosis medications, or (3) both. The study will compare the outcomes of people who received each of these approaches.
• Project Firstline and Building Trust Leadership Academy. Funded by the Centers for Disease Control and Prevention (CDC), AHCA has developed a library of infection prevention and control resources housed at the National Infection Prevention Forum (NIPF). The NIPF invites Infection Preventionists in LTC to share questions and answers with each other in an online format. Similarly, AHCA has developed and evaluated the Building Trust Leadership Academy, which brings together LTC leaders in live online sessions to follow evidence-based practices in assessing and improving levels of trust within buildings.

Why is federal funding for research important to nursing home and assisted living owners and operators? 

• Increasing the evidence for what works to improve outcomes—whether it’s care practices, staff education, or treatments—can help guide policy, regulations, and operations, which could yield benefits both clinically and financially.
• For example, we learned during the COVID-19 pandemic that getting faster, more accurate understanding of outcomes from real-world data like the EHR data in the LTC Data Cooperative can guide action and policy to save lives in LTC.
• Federal funding for research helps to attract new scientists to study important questions that are relevant to our sector—and get answers to the challenges we will face as the older population expands and the demand for post-acute and LTC increases. 

1. Schwartz, JB. Current status of inclusion of older groups in evaluations of new medications: Gaps and implementation needs to fill them. J Am Geriatr Soc. 2024;72:2894–2902. DOI: 10.1111/jgs.18912.
2. Agency for Healthcare Research and Quality, Rockville, MD. About Learning Health Systems. Accessed at: https://www.ahrq.gov/learning-health-systems/about.html.