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Principal Investigator: Ishani Ganguli
Organization: BRIGHAM AND WOMEN'S HOSPITAL
Fiscal Year: 2024
Award: $168,480
Funding agency: National Institute on Aging
Project Summary/Abstract
This K23 award will establish Ishani Ganguli MD, MPH as a clinician-investigator focused on
how care delivery and payment innovation can advance high-value outpatient care and better
outcomes for older adults. Dr. Ganguli is an Assistant Professor of Medicine and primary care
physician at Harvard Medical School and Brigham and Women’s Hospital. Building on her
clinical training, methods coursework, and experiences studying care innovation and leading it
at an Accountable Care Organization (ACO), this award will allow her to develop expertise in (1)
how aging needs, especially for those with multimorbidity and Alzheimer’s Disease (AD) and
AD-related dementias (AD/ADRD), can be met through outpatient care innovation, (2) advanced
quantitative methods, and (3) claims-linked electronic health record (EHR) data analysis. To
achieve these goals, Dr. Ganguli has assembled a team with expertise in health services
research on care innovation (Drs. Ateev Mehrotra, Thomas Sequist), geriatrics (Dr. Christine
Ritchie), primary care (Drs. Meredith Rosenthal, Joshua Metlay), quantitative methods (Drs. E.
John Orav, J. Michael McWilliams, Craig Pollack), and EHR data analysis (Dr. Christine Vogeli).
Primary care access and continuity of care improve outcomes for multimorbid older adults, so a
recent decline in primary care office visit rates – likely due in part to barriers attending these
visits – raises concerns. Virtual care may enable access and continuity. But we do not know
which groups faced office visit barriers pre-dating the Covid-19 pandemic nor how post-
pandemic expansion of virtual care will affect primary care access or continuity for these groups.
To address these critical questions, Dr. Ganguli will first use the claims-linked Medicare Current
Beneficiary Survey to describe visit use and visit continuity of care (COC) associated with
reported trouble getting to the doctor’s office and whether adults with AD/ADRD or social risk
factors were at greater risk of this barrier (Aim 1). In Aim 2, using difference-in-differences
analysis of claims-linked EHR data in a large Medicare ACO, she will assess how post-
pandemic expansion of virtual care affects primary care use in these populations. In Aim 3, she
will use these claims-linked EHR data to develop a novel application of the COC measure
(“touch continuity,” which includes virtual care) and determine if it is associated with risk of
preventable hospitalizations. This work and training will provide the basis for a future R01
proposal of a quasi-experimental, multi-health system study of virtual primary care for
multimorbid older adults. This K23 award and future R01 will inform how to pay for and deliver
virtual care to promote high-value outpatient care and better outcomes for older adults.
Terms: <21+ years old><65 and older><65 or older><65 years of age and older><65 years of age or more><65 years of age or older><65+ years><65+ years old><> 65 years><AD dementia><AD related dementia><ADRD><Access to Care><Address><Adult><Adult Human><Affect><Aged 65 and Over><Aging><Alzheimer Type Dementia><Alzheimer disease dementia><Alzheimer sclerosis><Alzheimer syndrome><Alzheimer's><Alzheimer's Disease><Alzheimer's and related dementias><Alzheimer's disease and related dementia><Alzheimer's disease and related disorders><Alzheimer's disease or a related dementia><Alzheimer's disease or a related disorder><Alzheimer's disease or related dementia><Alzheimer's disease related dementia><Alzheimers Dementia><Ambulatory Care><Award><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 pandemic affected><COVID-19 pandemic consequence><COVID-19 pandemic effects><COVID-19 pandemic impact><COVID-19 pandemic impacted><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Caring><Chronic><Claims Analyses><Claims Analysis><Claims Review><Continuity of Care><Continuity of Patient Care><Continuum of Care><Data><Data Analyses><Data Analysis><Drops><Electronic Health Record><Evaluation><Fee-for-Service Plans><Fees for Service><Future><Geriatrics><Goals><Groups at risk><Health><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Health Services><Health Services Accessibility><Health Services Evaluation><Health Services Research><Health system><Hospital Admission><Hospitalization><Hospitals><Improve Access><Incentives><Insurance Claim Review><Internet><Investigators><K23 Award><K23 Mechanism><K23 Program><Knowledge><Link><Low income><Measures><Medical Care Research><Medicare><Medicare claim><Medicine><Memory><Mentored Patient-Oriented Research Career Development Award><Mentored Patient-Oriented Research Career Development Award (K23)><Mentorship><Methods><Modeling><Office Visits><Organizational Models><Outcome><Outpatient Care><Patients><People at risk><Persons at risk><Phone><Policies><Policy Maker><Population><Populations at Risk><Primary Care><Primary Care Physician><Primary Senile Degenerative Dementia><QOC><Quality of Care><Quasi-experiment><Quasi-experimental analysis><Quasi-experimental approach><Quasi-experimental design><Quasi-experimental methods><Quasi-experimental research><Quasi-experimental study><Quasi-experimental technique><Reporting><Research><Research Personnel><Researchers><Risk><Risk Factors><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Secure><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Survey Instrument><Surveys><Telephone><Title 18><Touch><Touch sensation><Training><Visit><WWW><Woman><Work><above age 65><access to health services><access to services><access to treatment><accessibility to health services><accountable care organization><adulthood><after age 65><age 65 and greater><age 65 and older><age 65 or older><age > 65><age of 65 years onward><aged 65 and greater><aged 65+><aged ≥65><availability of services><beneficiary><care access><care delivery><care outcomes><career><clinical training><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 pandemic consequence><coronavirus disease 2019 pandemic impact><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><cost><data interpretation><delivered virtually><effects following the COVID-19 pandemic><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><experience><geriatric medicine><health care outcomes><health insurance for disabled><health service access><health services availability><healthcare outcomes><human old age (65+)><impact of the SARS-CoV-2 pandemic><improved><improved outcome><indexing><innovate><innovation><innovative><medical college><medical schools><multimorbidity><multiple chronic conditions><novel><old age><older adult><older adulthood><outpatient treatment><over 65 years><pandemic><pandemic disease><payment><physician office visit><post-pandemic><pre-pandemic><primary care provider><primary care setting><primary care visit><primary degenerative dementia><professor><providers from primary care><providers of primary care><racial minority><school of medicine><senile dementia of the Alzheimer type><service availability><services research><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><social role><tactile sensation><treatment access><video visit><virtual><virtual assessment><virtual care><virtual delivery><virtual evaluation><virtual health care><virtual healthcare><web><world wide web><≥65 years>