February 2020
CHAS eNews
Assessment of Nursing Home Reporting of Major Injury Falls for Quality Measurement on Nursing Home Compare
Since the 1990s, a centerpiece of federal efforts to improve nursing home quality has been a public reporting initiative by the Centers for Medicare and Medicaid Services (CMS) called Nursing Home Compare (NHC). However, as the underlying quality of resident care data, called the Minimum Data Set (MDS), is self‐reported by nursing homes, it is important to ask: are NHC patient safety measures accurate? To address concerns about the accuracy of the MDS, CHAS Fellow and Assistant Professor at UChicago’s Department of Public Health Sciences, Prachi Sanghavi, PhD and colleagues Shengyuan Pan, BA and Daryl Caudry, MS assessed the quality of nursing home reporting of major injury falls by linking MDS assessments with Medicare hospital admission claims at the patient level. They found substantial underreporting on the specific MDS item (J1900C) used by NHC and that reporting rates on the MDS of claims‐identified falls by Asian, black, and Hispanic residents were substantially lower than those for white people both within and across nursing homes. This finding is consistent with long‐standing concerns about racial disparities in nursing home care. Their study indicates an urgent need to assess the value and limits of patient safety measurement that is based on the MDS. Given the amount of research that has been based on the MDS, researchers highlight that it may be important to revisit some of the field’s understanding of nursing home quality of care. Additionally, researcher’s alternative and additional approaches to monitoring and measuring patient safety in nursing homes should be developed.
Social Networks Moderate the Syndemic Effect of Psychosocial and Structural Factors on HIV Risk Among Young Black Transgender Women and Men who have Sex with Men

Young Black transgender women and men who have sex with men (YBTM) bear an increasingly disproportionate burden of new HIV infections in the United States. However, compared to other men who have sex with men (MSM), Black MSM (BMSM) are more likely to use condoms during anal sex and less likely to use drugs during sex. Thus, the excessive burden of HIV infection among YBTM is not likely explained solely by individual behavior and may be better explained by psychosocial (i.e., indicators of psychological and social functioning, such as depression, anxiety, substance abuse) and structural factors (i.e., poverty, justice system involvement, unemployment). A study by CHAS Fellows Alida Bouris, PhD and John Schneider, PhD and colleagues Daniel Teixeira da Silva, MD, Dexter Voisin, PhD, Anna Hotton, PhD and Russell Brewer, DrPH   examines the syndemic effect of both psychosocial and structural factors on HIV transmission-related behaviors and HIV infection, and the potential moderating effect of social network factors in a representative sample of YBTM. Their findings indicate that psychosocial and structural factors have a syndemic effect on HIV risk, and this effect is moderated by several social network characteristics. More specifically, this study highlights the importance of including incarceration, poverty and community violence as syndemic factors that contribute to increased HIV risk among YBTM. Future syndemic research should include those psychosocial and structural factors most relevant to the population of interest, as this information can be used to develop effective HIV prevention programs. Given the disproportionately high burden of HIV among YBTM, the researchers recommend that future research should further clarify which social network characteristics contribute to resilience versus vulnerability among YBTM. 
Differences in the Receipt of Low-Value
Services Between Publicly and
Privately Insured Children

Little is known about which factors predict the receipt of low-value services in children, a gap that impedes the optimal targeting of limited quality improvement resources. One potentially important factor is patient payer type. Compared with privately insured children, publicly insured children covered by Medicaid or the Children’s Health Insurance Program (CHIP) may have different rates of receipt of low-value services for several reasons. To find whether the receipt of services differs between publicly and privately insured children, CHAS Fellows Anna Volerman, MD and Elbert S. Huang, MD, MPH , Medicaid Working Group member  Kao-Ping Chua, MD, PhD  and colleagues Aaron L. Schwartz, MD, PhD and Rena M. Conti, PhD used data from 8.6 million children from 12 states and 20 claims-based measures of low- value services to determine the degree to which the receipt of low-value services differs between publicly and privately insured children. They found that both privately and publicly insured children frequently receive low-value services. Publicly insured children were more likely to receive low-value services, but the overall modest magnitude of this difference, coupled with the inconsistent direction of differences by payer type among services, suggests that wasteful care in children is not highly associated with payer type. Future research to identify factors that do drive wasteful care could facilitate the optimal targeting of quality improvement resources. 
Michael Davis Lectures return
April 7, 2020
Associate Professor
Program in Public Health
University of California, Irvine
Assistant Professor
Brown School
Washington University in St. Louis
4/21/20: Jonathan Ozik, PhD
Computational Scientist
Repast and EMEWS Project Lead
Argonne National Laboratory
4/28/20: Gina Fedock, PhD
Assistant Professor
School of Social Service Administration
The University of Chicago
Professor of Pediatrics
Indiana University School of Medicine
5/12/20: Ruth Bloch Rubin, PhD
Assistant Professor
Department of Political Science
The University of Chicago
Louis Block Professor of Public Health Sciences and the College,
Department Chair, Department of Public Health Sciences
The University of Chicago
Author of The Deepest Well, CEO/Founder of the  Center for Youth Wellness   and the 1st and current Surgeon General of California.

Professor, Department of Medicine and CIO/Founder of  NowPow
CHAS Seed Grants

The CHAS Seed Grants program is now open for all UChicago faculty members with an academic appointment. The Seed Grants program aims to support promising health services and policy research projects at the University of Chicago by providing modest research funding for a limited time (usually two years) to enable eligible investigators to explore the feasibility of a concept related to the mission of the Center and to generate sufficient data to pursue it through other funding mechanisms.

Proposals are currently being accepted online through  April 30, 2020 . New awards will be funded for the performance cycle of July 2020-June 2022. See PI criteria at our website .
To learn more about the CHAS Seed Grant program or to submit a proposal, please  click here .