Welcome back to the Institute Research Recap, a biweekly overview of work published by Institute investigators and their collaborators.

This Research Recap, topics include: COVID-19 and the genome, embedded pragmatic clinical trials, and the effects of high deductible health plans on ED visits for chest pain.

For all investigator publications, see our Publications page. For up-to-date media coverage and research findings, visit In the Media, and follow us on Twitter. To search for a subject matter expert, visit our Investigator Directory or contact the Institute Communications Team.

Examining the SARS-CoV-2 genome

New work co-authored by Sharon Lutz in Genetic Epidemiology used genome-wide association studies (GWAS) methodology to examine whole-genome sequencing (WGS) data of the SARS-COV-2 virus and COVID-19 mortality. The team analyzed 7548 single-stranded SARS-CoV-2 genomes of COVID-19 patients in the GISAID database and associated variants with mortality. Their analysis suggests that GWAS can help identify, early in the virus’s sequence variations, highly pathogenic strains to target for containment.

Institute Investigator(s): Sharon Lutz

Embedded pragmatic trials as a tool to engage health care system participation in research

The pace of traditional medical research is not on track to keep up with real-world demands for evidence, according to a new New England Journal of Medicine Perspective led by Richard Platt. The COVID-19 pandemic highlighted this need for nimble and efficient trials. Instead, embedded pragmatic clinical trials (ePCTs) can produce this evidence without the limitations of observational studies, having the added benefit of being integrated into standard care, involving existing clinicians, and using data already being routinely collected. The team demonstrates the feasibility of using ePCTs by citing experience gained from working in the coordinating center of the NIH Health Care Systems Research Collaboratory.

Institute Investigator(s): Richard Platt

How do high-deductible health plans affect emergency department visits for nonspecific chest pain?

Although most evaluations of acute chest pain do not result in significant coronary disease, their potential severity encourages a timely evaluation. A new study in Circulation led by former research fellow Andrew Chou and senior-authored by Frank Wharam examines how the switch to a high-deductible health plan might alter patients’ use of the emergency department when encountered by chest pain. The team used data from a commercial and Medicare Advantage claims database to examine outcomes between HDHP and control groups. Overall, they found that patients with HDHPs used the emergency department less, but saw no significant change in post-ED cardiac testing. However, HDHP members from higher-poverty neighborhoods saw increases in 30-day acute myocardial infarction admission after ED diagnosis of nonspecific chest pain. Results suggest that when working with patients with high out-of-pocket costs, clinicians should account for likely delays in care preceding the patients’ ED visit and also consider out-of-pocket costs when discussing cardiac testing options.

 

Institute Investigator: Frank Wharam