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As a public health researcher, Karl Minges, Ph.D., MPH , is concerned about what he says is among the more perplexing phenomena in healthcare: older patients cycling in and out of the hospital setting. He is endeavoring to help public health professionals better understand – and prevent – this “revolving door,” as it is sometimes known, which is extremely costly to patients, their families, and healthcare facilities.

While completing his doctorate, Dr. Minges worked with many of the leading clinicians and academics at who focus on health services research which seeks to identify ways of improving the overall quality of care that patients receive in health systems, improve health outcomes, and address variation in healthcare results. His own research has aligned with this, and he hopes that by exploring concrete ways to break the cycle of unnecessary rehospitalizations, healthcare can be improved.

“To be the first awarded at the University is a special honor,” said Dr. Minges, an assistant professor and chair of the University’s Health Administration and Policy Department. “Knowing the incredible faculty at the University, I expect to be the first of many future NIH grant recipients."

"My project will help to strengthen the research environment at the University, while also exposing undergraduate and graduate students to research that will spur their interest in research careers in biomedical or behavioral sciences.”Karl Minges, Ph.D., MPH

‘This work holds great promise for patients and health systems’

The proposal, titled “Exploring Outstanding Performance in Low Readmission from Skilled Nursing Facilities for Older Adults,” scored better than 98 percent of the competing proposals in Minges’s study section. His work received an , which is intended to support research projects at institutions that have not previously been major recipients of NIH support.

“NIH grants are the most competitive governmental funding mechanism in the world,” said Glenn McGee, Ph.D., deputy provost and a professor of health administration and policy. “I tell junior faculty that they should only start applying for NIH grants if they are okay with the word ‘no’ because, on average, an investigator will apply more than a dozen times before seeing a dollar. R15 awards are also incredibly desirable.”

Dr. Minges’s research, will focus on skilled nursing facilities (SNF) – facilities that offer more skilled medical expertise and services than nursing homes – for which the rehospitalization statistics are typically high. Of the one in four patients age 65 and older who is transferred to an SNF following an acute hospital stay, a quarter of them are readmitted to the hospital within 30 days at a great financial expense and impact on quality of life.

Although SNFs face financial penalties for higher than expected hospital readmissions, Dr. Minges says there is a dearth of information about the diverse factors that are related to readmission and why some SNFs perform better than others in preventing readmissions.

“Dr. Minges is well-poised to lead this work, which will improve care at skilled nursing facilities,” said , an associate professor of medicine at the and Dr. Minges’s co-investigator on the study. “Leveraging his prior experience in positive deviance research, Dr. Minges will partner with skilled nursing facilities to develop interventions to reduce 30-day hospital readmission. This work holds great promise for patients and health systems.”

‘Support student research opportunities’

Dr. Minges will use the nearly $450,000 award, which will be paid over three years, to explore the many factors related to readmission, and he hopes this information will lead to creative and practical interventions to reduce the risk of readmissions.

“I am very excited to be the first researcher to apply ‘positive deviance’ methodology (an inductive analytical technique using in-depth qualitative methods) to skilled nursing facilities,” said Dr. Minges. “Any NIH award has the potential to improve the research environment of a given institution. At the University of New Haven, this award will institute significant structural change as the University has never previously received an NIH award.”

Passionate about student involvement in research, Dr. Minges is looking forward to the opportunities the award will create for students across the University. It will support two dozen undergraduate and graduate students, enabling them to participate in research, travel to site visits, conduct analysis, and attend and present at leading conferences.

“Dr. Minges’s NIH award is a recognition of the caliber and impact that his research promises to have for the healthcare industry,” said Summer Johnson McGee, Ph.D., dean of the School of Health Sciences. “Learning how healthcare organizations can prevent unnecessary and costly hospital readmissions in the elderly could be one of the magic bullets for bending the curve of healthcare costs in the United States.

“I know his work will make a major contribution to this critical area of research,” Dean McGee continued. “Dr. Minges’ work is also important because his NIH grant will support student research opportunities and give our students valuable learning experiences in conducting vital health services research.”

Dr. Minges also expects the award to foster interdepartmental research collaborations in departments such as Health Administration and Policy, Allied Health, and Entrepreneurship and Innovation, and will include other junior faculty members. He hopes it will also encourage the development of research tools and continued program growth.

"NIH is the nation’s medical research agency facilitating discoveries that improve health and save lives,” said Ronald Harichandran, Ph.D., dean of the University’s Tagliatela College of Engineering and vice provost for research. “With the University’s first NIH grant, Dr. Minges has opened the door, and we will have other faculty in health sciences, biomedical engineering, and biology who will follow in his footsteps."

‘This study is well-timed’

During the first two years of the study, Dr. Minges and his fellow researchers will conduct qualitative interviews with high-and-low-performing SNFs, visiting more than a dozen across the country. They will generate hypotheses regarding the SNF strategies most likely to explain the lowest readmission rates.

During the third year, Dr. Minges and his team will engage with experts and stakeholders to develop interventions that could be piloted to address the most promising strategies to reduce readmissions rates. With the assistance of Brian Marks, J.D., Ph.D., of the University’s Pompea College of Business, the research team will employ a design thinking methodology, which is best described as a human-centered approach to innovation.

“I am honored to participate,” said Dr. Marks, a senior lecturer and executive director of the University’s Entrepreneurship and Innovation Program. “It will be exciting to conduct ‘design sprints’ during the synthesis sessions and other dissemination aspects using a design thinking framework along with notions of behavioral and institutional economics for the purposes of identifying and recommending organizational strategies, tactics, and processes to achieve lower readmission rates in skilled nursing facilities. This grant is also a great opportunity for our students to participate in this interdisciplinary educational opportunity by applying critical thinking to real-world problems.”

Although readmission rates were already a serious problem before the coronavirus global pandemic, Dr. Minges says COVID-19 has impacted SNFs and nursing homes in ways that healthcare professionals are only beginning to understand.

“This study is well-timed, as the vast majority of SNF patients and staff are vaccinated,” he said. “That makes this project more feasible in a post-pandemic world. Although COVID is not the main purpose of the study, it is something I seek to explore in the context of the study.”

Research reported is being supported by the of the National Institutes of Health under Award Number R15AG067456. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.