Abraham A Brody
Mathy Mezey Professor of Geriatric Nursing
Associate Director, Hartford Institute for Geriatric Nursing
1 212 992 7341
433 First Ave
New York, NY 10010
Abraham A Brody's additional information
Abraham Brody, PhD, RN, FAAN is associate director of the Hartford Institute for Geriatric Nursing and Professor of Nursing and Medicine at NYU Meyers College of Nursing. He is also the founder of Aliviado Health and the Pilot Core Lead of the NIA IMPACT Collaboratory. His work focuses on the intersection of geriatrics, palliative care, quality, and equity. The primary goal of his research, clinical, and policy pursuits is to improve the quality of care for older adults with serious illnesses wherever they reside. His primary mode for doing so is through the development, testing, and dissemination of real-world, technology, and informatics-supported quality improvement interventions. He is currently the principal investigator of two NIH-funded large-scale pragmatic clinical trials to improve the quality of care and quality of life for persons living with dementia and their caregivers in the community and a co-investigator on several other pragmatic trials and health services research projects in geriatrics and palliative care.
From a leadership perspective, Brody works across disciplines to help advance geriatrics and palliative care nationally. As pilot core lead of the $53.4 million nationwide Collaboratory, he is responsible for heading the pilot program, which, in collaboration with the National Institute on Aging, reviews and awards funds to help investigators prepare for large-scale pragmatic clinical trials for persons living with dementia and their caregivers. He also serves on the Steering Committee of the NINR Funded Palliative Care Research Cooperative, the policy-setting body for the organization.
In addition to his research and national leadership responsibilities, Brody is passionate about mentoring and developing a diverse nursing and scientific workforce. To this end, he developed the Hospice and Palliative Nurses Association Leadership Development Program and is the technology core director of NYU Meyer’s P20 Exploratory Center for Precision Health in Diverse Populations, and serves on the Executive Committee of the Training, Research, and Education Core of the NYU-HHC Clinical Translational Sciences Institute. He mentors faculty, post-doctoral scholars, and PhD students across multiple disciplines and institutions. Brody also maintains an active practice in the Geriatric and Palliative Consult Services at NYU Langone Health.
Home Health Study
PhD - University of California, San Francisco (2008)MSN - University of California, San Francisco (2006)BA - New York University, College of Arts and Sciences (2002)
Home carePalliative careNon-communicable diseaseHealth PolicyGerontologyInterprofessionalismChronic diseaseCommunity/population healthNeurologyResearch methodsUnderserved populations
American Geriatrics SocietyEastern Nursing Research SocietyGerontological Society of AmericaHospice and Palliative Nurses AssociationInternational Home Care Nurses OrganizationPalliative Care Research CooperativeSigma Theta Tau, Upsilon Chapter
Faculty Honors AwardsFellow, American Academy of Nursing (2017)Fellow, Palliative Care Nursing, Hospice and Palliative Nurses Association (2017)Fellow, New York Academy of Medicine (2016)Fellow, Gerontological Society of America (2016)Nurse Faculty Scholar, Robert Wood Johnson Foundation (2014)Sojourns Scholar, Cambia Health Foundation (2014)Medical Reserve Corps, NYC, Hurricane Sandy Award (2013)Goddard Fellowship, NYU (2013)Research Scholar, Hospice and Palliative Nurses Association (2010)Finalist, SRPP Section Young Investigator, Gerontological Society of America (2008)Edith M. Pritchard Award, Nurses' Education Funds (2006)Scholar, Building Academic Geriatric Nursing Capacity, John A Hartford (2006)Finalist, Student Regent, University of California, San Francisco (2005)Inducted into Sigma Theta Tau, Nursing Honor Society (2004)
Defining a taxonomy of Medicare-funded home-based clinical care using claims dataAbstractAnkuda, C. K., Ornstein, K. A., Leff, B., Rajagopalan, S., Kinosian, B., Brody, A. A., & Ritchie, C. S. (2023). BMC Health Services Research, 23(1). 10.1186/s12913-023-09081-8AbstractBackground: As more Americans age in place, it is critical to understand care delivery in the home. However, data on the range of home-based services provided by Medicare is limited. We define a taxonomy of clinical care in the home funded through fee-for-service Medicare and methods to identify receipt of those services. Methods: We analyzed Fee-for-service (FFS) Medicare claims data from a nationally-representative cohort of older adults, the National Health and Aging Trends Study (NHATS), to identify home-based clinical care. We included 6,664 NHATS enrollees age ≥ 70 and living in the community, observed an average of 3 times each on claims-linked NHATS surveys. We examined provider and service type of home-based clinical care to identify a taxonomy of 5 types: home-based medical care (physician, physician assistant, or nurse practitioner visits), home-based podiatry, skilled home health care (SHHC), hospice, and other fee-for-service (FFS) home-based care. We further characterized home-based clinical care by detailed care setting and visit types. Results: From 2011–2016, 17.8%-20.8% of FFS Medicare beneficiaries age ≥ 70 received Medicare-funded home-based clinical care. SHHC was the most common service (12.8%-16.1%), followed by other FFS home-based care (5.5%-6.5%), home-based medical care (3.2%-3.9%), and hospice (2.6%-3.0%). Examination of the other-FFS home-based care revealed imaging/diagnostics and laboratory testing to be the most common service. Conclusions: We define a taxonomy of clinical care provided in the home, serving 1 in 5 FFS Medicare beneficiaries. This approach can be used to identify and address research and clinical care gaps in home-based clinical care delivery.
Multiple Chronic Conditions among Seriously Ill Adults Receiving Palliative CareAbstractMurali, K. P., Yu, G., Merriman, J. D., Vorderstrasse, A., Kelley, A. S., & Brody, A. A. (2023). Western Journal of Nursing Research, 45(1), 14-24. 10.1177/01939459211041174AbstractThe objective of this study was to characterize multiple chronic conditions (MCCs) among seriously ill adults receiving palliative care at the end of life. A latent class analysis was conducted to identify latent subgroups of seriously ill older adults based on a baseline Charlson comorbidity index (CCI) measurement, a measure of comorbidity burden, and mortality risk. The three latent subgroups were: (1) low to moderate CCI with MCC, (2) high CCI with MCC, and (3) high CCI and metastatic cancer. The “low to moderate CCI and MCC” subgroup included older adults with chronic obstructive pulmonary disease (COPD), cardiovascular disease, congestive heart failure, myocardial infarction, dementia, diabetes, and lymphoma. A “high CCI and MCC” subgroup included individuals with severe illness including liver or renal disease among other MCCs. A “high CCI and metastatic cancer” included all participants with metastatic cancer. This study sheds light on the MCC profile of seriously ill adults receiving palliative care.
One accurate measurement is worth 1000 expert opinions—Assessing quality care in assisted living
Outcomes of home-based primary care for homebound older adults: A randomized clinical trialAbstractFederman, A. D., Brody, A., Ritchie, C. S., Egorova, N., Arora, A., Lubetsky, S., Goswami, R., Peralta, M., Reckrey, J. M., Boockvar, K., Shah, S., Ornstein, K. A., Leff, B., DeCherrie, L., & Siu, A. L. (2023). Journal of the American Geriatrics Society, 71(2), 443-454. 10.1111/jgs.17999AbstractBackground: Homebound older adults are medically complex and often have difficulty accessing outpatient medical care. Home-based primary care (HBPC) may improve care and outcomes for this population but data from randomized trials of HBPC in the United States are limited. Methods: We conducted a randomized controlled trial of HBPC versus office-based primary care for adults ages ≥65 years who reported ≥1 hospitalization in the prior 12 months and met the Medicare definition of homebound. HBPC was provided by teams consisting of a physician, nurse practitioner, nurse, and social worker. Data were collected at baseline, 6- and 12-months. Outcomes were quality of life, symptoms, satisfaction with care, hospitalizations, and emergency department (ED) visits. Recruitment was terminated early because more deaths were observed for intervention patients. Results: The study enrolled 229 patients, 65.4% of planned recruitment. The mean age was 82 (9.0) years and 72.3% had dementia. Of those assigned to HBPC, 34.2% never received it. Intervention patients had greater satisfaction with care than controls (2.26, 95% CI 1.46–3.06, p < 0.0001; effect size 0.74) and lower hospitalization rates (−17.9%, 95% CI −31.0% to −1.0%; p = 0.001; number needed to treat 6, 95% CI 3–100). There were no significant differences in quality of life (1.25, 95% CI −0.39–2.89, p = 0.13), symptom burden (−1.92, 95% CI −5.22–1.37, p = 0.25) or ED visits (1.2%, 95% CI −10.5%–12.4%; p = 0.87). There were 24 (21.1%) deaths among intervention patients and 12 (10.7%) among controls (p < 0.0001). Conclusion: HBPC was associated with greater satisfaction with care and lower hospitalization rates but also more deaths compared to office-based primary care. Additional research is needed to understand the nature of the higher death rate for HBPC patients, as well as to determine the effects of HBPC on quality of life and symptom burden given the trial's early termination.
What's next for Hospital at Home Programs in the United States: A clarion call for permanent, person-centered solutionsBrody, A. A., Dorfman, E., Caspers, C. G., & Sadarangani, T. R. (2023). Journal of the American Geriatrics Society, 71(1), 11-14. 10.1111/jgs.18089
“The Sun Came Up Because You Got Here…”: A Qualitative Exploration of Person-Centered Care Strategies Used by Adult Day Care Centers to Manage Behavioral and Psychological Symptoms of DementiaAbstractBoafo, J., David, D., Wu, B., Brody, A. A., & Sadarangani, T. (2023). Journal of Applied Gerontology, 42(2), 147-159. 10.1177/07334648221128283AbstractIn order to reduce care partner strain and support aging in place for people living with Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD), adult day centers (ADCs) must manage behavioral and psychological symptoms of dementia (BPSD). The purpose of this paper is to identify person-centered care strategies used by center staff to manage BPSD. Six focus groups with center staff (n = 31) were conducted. Data were analyzed using directed content analysis guided by Kitwood’s conceptual approach to cultivating personhood in dementia care. Themes were identified and organized within Kitwood’s framework. The results demonstrate that staff incorporate evidence-based person-centered approaches to AD/ADRD care that align with Kitwood’s principles of comfort, attachment, inclusion, and identity. Staff individualize their approach to people with AD/ADRD within a group setting. They monitor, engage, socially stimulate, and, when needed, de-stimulate them. Centers are flexible social environments with underrecognized expertise managing BPSD using person-centered approaches.
Aliviado Mobile App for Hospice Providers: A Usability StudyAbstractDavid, D., Lin, S. Y., Groom, L. L., Ford, A., & Brody, A. A. (2022). Journal of Pain and Symptom Management, 63(1), e37-e45. 10.1016/j.jpainsymman.2021.07.019AbstractContext: Evaluation of usability and mobile health content is critical for ensuring effective implementation of technology utilizing interventions tailored to the needs of hospice care providers for people living with dementia in community-based settings. Objectives: To evaluate the usability, content, and “readiness to launch” of the Aliviado mobile health app for interdisciplinary team members participating in the Hospice Advanced Dementia Symptom Management and Quality of Life. Methods: Usability of the Aliviado app was assessed in 86 respondents with an adapted IBM Computer Usability Satisfaction Questionnaire following Hospice Advanced Dementia Symptom Management and Quality of Life training and implementation of the mobile app. Results: More than half of users receiving training employed the mobile app in practice. Users reported use as: Daily-6.3%, Weekly-39.6%, monthly-54.2%. The highest measured attributes were usefulness, value, and effectiveness. Over 90% deemed the app “ready to launch” with no or minimal problems. Conclusion: This study shows that a newly-developed mobile app is usable and can be successfully adopted for care of people living with dementia.
Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical TrialAbstractLin, S. Y., Schneider, C. E., Bristol, A. A., Clancy, M., Sprague, S. A., Aldridge, M., Cortes, T., Goldfeld, K. S., Kutner, J. S., Mitchell, S. L., Shega, J. W., Wu, B., Zhu, C. W., & Brody, A. A. (2022). Gerontologist, 62(2). 10.1093/geront/gnaa220AbstractBackground and Objectives: Many investigators of Alzheimer's disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses implementation barriers and additional infrastructure and implementation strategies developed in preparation for a nationwide AD/ADRD ePCT. Research Design and Methods: Two pilot trials were conducted in 2 hospices sequentially to refine and test Aliviado Dementia Care - Hospice Edition, a complex quality improvement intervention for advanced dementia symptom management. Readiness for the subsequent full-scale ePCT was assessed by three milestones: ≥80% training completion rate ("feasibility"), ≥80% posttraining survey respondents indicating intention for practice changes ("applicability"), and at least 1 Aliviado care plan/assessment instrument administered in ≥75% of dementia patients admitted to home hospice within 1-month posttraining ("fidelity"). Results: Participants included 72 interdisciplinary team members and 11 patients with AD/ADRD across the pilots. Feasibility, applicability, and fidelity outcomes (92%, 93%, and 100%, respectively) all surpassed the preestablished milestones (80%, 80%, and 75%). Main implementation challenges were related to hospice staff turnover, integration of the Aliviado toolbox materials within the electronic health records, and hospices' limited research experience and infrastructure. Discussion and Implications: This pilot phase demonstrated feasibility, applicability, and fidelity required to proceed to the full-scale ePCT. Our study findings and discussions of additional infrastructure and implementation strategies developed following the pilot phase can inform researchers and clinicians interested in conducting AD/ADRD-related pilot studies for ePTCs or quality improvement initiatives. Clinical Trials Registration Number: NCT03681119.
Hospice interventions for persons living with dementia, family members and clinicians: A systematic reviewAbstractLassell, R. K., Moreines, L. T., Luebke, M. R., Bhatti, K. S., Pain, K. J., Brody, A. A., & Luth, E. A. (2022). Journal of the American Geriatrics Society, 70(7), 2134-2145. 10.1111/jgs.17802AbstractBackground: Hospice care was initially designed for seriously ill individuals with cancer. Thus, the model and clinicians were geared toward caring for this population. Despite the proportion of persons living with dementia (PLWD) receiving hospice care substantially increased over the past 10 years, and their longer lengths of stay, established hospice interventions for this population are scarce. No systematic review has previously evaluated those interventions that do exist. We synthesized hospice intervention studies for PLWD, their families, and hospice professionals by describing the types of interventions, participants, outcomes, and results; assessing study quality; and identifying promising intervention strategies. Methods: A systematic review was conducted using a comprehensive search of five databases through March 2021 and follow-up hand searches. Included studies were peer-reviewed, available in English, and focused on hospice interventions for persons with dementia, and/or care partners, and clinicians. Using pre-determined inclusion and exclusion criteria, data was extracted guided by the Cochrane Checklist, and quality was assessed using a 26-item Consolidated Standards of Reporting Trials (CONSORT) Checklist. Results: The search identified 3235 unique studies in total, of which 10 studies met inclusion criteria. The search revealed three types of interventions: clinical education and training, usual care plus care add-on services, and “other” delivered to 707 participants (mostly clinicians). Five studies included underrepresented racial and ethnic groups. Outcomes measured knowledge and skills, psychosocial and health outcomes, feasibility, and acceptability, with significant improvements in six studies. Study quality was reflective of early-stage research with clinical education and training strategies showing deliberate progression towards real-world efficacy testing. Implications: Hospice interventions for PLWD are sparse and in early-phase research. More research is needed with rigorous designs, diverse samples, and outcomes considering the concordance of care.
Nurse-Led Telephonic Palliative Care: A Case-Based Series of a Novel Model of Palliative Care DeliveryAbstractYamarik, R. L., Tan, A., Brody, A. A., Curtis, J., Chiu, L., Bouillon-Minois, J. B., & Grudzen, C. R. (2022). Journal of Hospice and Palliative Nursing, 24(2), E3-E9. 10.1097/NJH.0000000000000850AbstractAmericans near the end of life experience high rates of nonbeneficial, burdensome, and preventable hospital-based care. If patients' goals of care are unknown or unclear, they have higher rates of hospitalization at the end of life. The demand for palliative care has grown exponentially because of its impact on quality of life, symptom burden, and resource use, requiring the development of new palliative care models. Nurses' holistic outlook and patient-centered focus make them ideal to deliver telephonic palliative care. This article discusses 4 cases delivered by a nurse-led telephonic palliative care program, a part of the Emergency Medicine Palliative Care Access project, which is a randomized controlled trial comparing outpatient palliative care with nurse-led telephonic case management after an emergency department visit. Telephonic nurses discuss patients' goals, fears, hopes, and concerns regarding their illness and its trajectory that inform decisions for future interventions and treatments. In addition, they share this information with the patients' surrogate decision-makers and clinicians to facilitate care coordination and symptom management. For seriously ill patients, nurses' abilities and expertise, as well as the difficulties of providing care through in-person models of palliative care delivery, make a nurse-led telephonic model an optimal option.