CANA Global CONNECT Vol. 2, Issue 2 – Research Highlights

Infection in Home Health Care

Dr. Jing Jing Shang, PhD, RN, OCN

Columbia University School of Nursing

The ultimate goal of Dr. Shang’s research is to improve patient outcomes and quality of care through nursing care. Her current research seeks to understand how best to promote quality patient outcomes and improve nursing services in the home health care (HHC) setting.

Infection is prevalent in HHC, the most rapidly growing health care sector. Infection prevention and control is challenging in HHC because of the uncontrolled environment, limited sources for infection control, and intermittent nature of the care. Despite this significance, the research in this area is limited and many of the HHC infection prevention and control guidelines are based on evidence from the hospital setting and/or expert opinion. Dr. Shang’s research inquiry tackles this healthcare issue from a variety of perspectives and makes important clinical and policy relevant contribution.

Through Columbia University internal pilot grants and a NINR funded R03 project, Dr. Shang published the first systematic review of infection prevalence and risk factors in HHC and was the first to study infection related hospitalization rates among HHC patients using the national Outcome and Assessment Information Set (OASIS). She found that 18% of hospitalizations among home care patients were caused by infections, and HHC agency-level infection rates varied dramatically with an average of 3.3%.

By linking the national OASIS with American Community Survey data. Dr. Shang also examined the socioeconomic disparities among patients in HHC. She found that HHC patients who lived in areas with low income and low educational level were significantly more likely to develop infections that result in hospitalization or emergency care.

These findings led to Dr. Shang’s 2 large R01 grants that further her research inquiry in this field. In the AHRQ funded R01, Dr. Shang & her research team use mixed methods (i.e., survey, qualitative interview, direct observation) to study the knowledge of, attitude towards, as well as compliance with infection prevention and control among HHC nurses in the Visiting Nursing Services of New York (VNSNY), the largest non-for-profit HHC agency in the country. They found a high level of infection control compliance, correct knowledge, favorable attitudes, and positive associations between attitudes and compliance, demonstrating that efforts to improve infection control practices compliance in HHC should focus on strategies to improve nurses’ perceptions about infection risk and attitudes toward infection prevention and control to improve compliance with agency policies. Dr. Shang’s research team also proposes an innovative predictive risk modeling approach using OASIS, claims data, and other clinical data sources. The predictive risk modeling can provide rigorous, needed evidence to complement a clinician’s experience, expertise and intuition; help streamline nursing care planning; identify the best clinical protocols; and allocate costly resources to patients who need and benefit from them the most.

In the NINR funded R01, Dr. Shang & her research team study HHC infection prevention and control related policy and practice on a national level. They conduct qualitative interviews with HHC personnel of different roles from 12 agencies to understand the agency’s infrastructure, policies, and processes on infection prevention and control policies. They will also conduct a national survey, which is informed by the qualitative interview results. Finally, they will develop economic models by linking the survey data with multiple national datasets, including OASIS, CMS claims data, provider of service data, county data to compare the effectiveness of various infection prevention and control infrastructures and policies in preventing infections and other patient outcomes in HHC.

Through another grant funded by the Alliance for Home Health Quality and Innovation, Dr. Shang & her team will explore how HHC agencies are responding to various quality and value-based purchasing initiatives through mixed methods approach. This project has received support from the National Association for Home Care & Hospice, Elevating HOME and Visiting Nurse Associations of America.

Dr. Shang’s other research interests focus on organizational factors and their relation to patient outcomes and quality of care. She published a method paper to analyze the commonly used approaches in the research of nurse staffing and healthcare associated infection (HAI), identify methodological challenges and proposed potential solutions. This paper provides much needed guidance for future researchers on studying relationship between nursing organizational factors and HAIs.

Dr. Shang also studied burnout and job dissatisfactions among oncology nurses using a 4-state survey. She also examined contract-based nursing employment in China and published the first paper to focus on Chinese nurse employment transition on a national scale. The paper made a significant contribution to the knowledge development surrounding the Chinese nurse employment system by strengthening the ‘equal pay for equal work’ policy emphasized by the China Ministry of Health’s regulations, which calls for efforts in Chinese hospitals to eliminate the employment disparities.

About Dr. Jing Jing Shang:

Dr. Jingjing Shang (PhD, RN, OCN) is an experienced nurse health services researcher with in-depth knowledge in research methodology, statistical modeling, and specific expertise in handling large datasets and a nursing educator.

She obtained her BSN from Peking Union Medical College in Beijing, China, her MSN in Oncology/Hematology Nursing from University of Delaware, and her PhD from Johns Hopkins University. She completed a 2-year post-doctoral fellowship training from the Center for Health Outcomes and Policy Research in University of Pennsylvania, under the advice of Dr. Linda Aiken.

Dr. Shang is currently an Assistant Professor of Nursing at Columbia University School of Nursing, where she teaches doctoral level research methods classes. She serves as faculty research advisor and mentors pre and post-doctoral advisees.

Dr. Shang received multiple grants from different organizations including the National Institute of Nursing Research (NINR), Agency for Healthcare Research and Quality (AHRQ), and the Alliance of Home Health and Quality. She is the Principal Investigator (PI) for two large R01s and a co-PI of a NINR funded P20 center grant to improve palliative care among vulnerable patients with multiple chronic condition. She is also involved in multiple federal grants as a co-investigator.

Dr. Shang has published in multiple high quality multidisciplinary journals and presented in international and national conferences in nursing, health services research, and infection prevention. She serves as reviewer for multiple high impact journals and difference research conferences.

Dr. Shang serves in peer review committee for different study sections, including AHRQ study sections, CDC Special Emphasis Panel for Infection Control, and the Netherlands Organization of Health, Research and Development (ZonMw). She is a standing member of American Cancer Society Peer Review Committee on Scholarships and has been a reviewer in since 2015.

Dr. Shang is an Oncology Certified Nurse and had worked as an oncology nurse for 7 years before obtaining her PhD degree, including 3 years in China and 4 years in the U.S.A. She cherishes her oncology nursing experience, which has always been the inspiration of her research.  

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