Abraham A. Brody

Faculty

Ab Brody headshot

Abraham A. Brody

FAAN PhD RN

Mathy Mezey Professor of Geriatric Nursing
Associate Director, Hartford Institute for Geriatric Nursing

1 212 992 7341

433 First Ave
New York, NY 10010
United States

Accepting PhD students

Abraham A. Brody's additional information

Abraham (Ab) Brody, PhD, RN, FAAN is associate director of the HIGN, Mathy Mezey Professor of Geriatric Nursing and Professor of Medicine. He is also the founder of Aliviado Health, an implementation arm of HIGN focused on implementing high-quality, evidence-based care to support persons living with dementia and their care partners. His work centers on the intersection of geriatrics, palliative care, quality, and equity. This includes the development of interventions tailored for diverse and underserved older adults with serious illness and their care partners that can be implemented in real-world conditions are tested for effectiveness in large multi-site clinical trials. His work leverages emerging technologies, including precision health and machine learning, to support the interdisciplinary healthcare workforce.

Dr. Brody serves in many leadership roles, working across disciplines to help advance geriatrics and palliative care nationally and internationally. As Pilot Core Lead of the NIA IMPACT Collaboratory, he is responsible for heading the pilot program, which reviews and awards funds to help investigators prepare for large-scale pragmatic clinical trials for persons living with dementia and their care partners. He also is an experienced mentor and enjoys training early career faculty, PhD students, and post-doctoral scholars at NYU and nationally in geriatric and palliative focused intervention development and testing.

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 care
Palliative care
Non-communicable disease
Health Policy
Gerontology
Interprofessionalism
Chronic disease
Community/population health
Neurology
Research methods
Underserved populations

American Geriatrics Society
Eastern Nursing Research Society
Gerontological Society of America
Hospice and Palliative Nurses Association
International Home Care Nurses Organization
Palliative Care Research Cooperative
Sigma Theta Tau, Upsilon Chapter

Faculty Honors Awards

Fellow, 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)

Publications

Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial

Lin, 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/gnaa220
Abstract
Abstract
Background 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 review

Lassell, 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.17802
Abstract
Abstract
Background: 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 Delivery

Yamarik, 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.0000000000000850
Abstract
Abstract
Americans 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.

Nurses’ Role in Reducing Inequities for the Seriously Ill

Moss, K. O., Happ, M. B., & Brody, A. (2022). Journal of Gerontological Nursing, 48(8), 3-5. 10.3928/00989134-20220629-01

A Pilot Observational Exploratory Study of Well-Being in Hospice Interdisciplinary Team Members

Schneider, C., Bristol, A., Ford, A., Lin, S. Y., Brody, A. A., & Stimpfel, A. W. (2022). American Journal of Hospice and Palliative Medicine, 39(3), 264-269. 10.1177/10499091211023480
Abstract
Abstract
Introduction: Well-being and turnover intent represent key aspects to the promotion of a healthy workforce. Alarming levels of burnout and low levels of well-being have been documented in health professionals across care settings. Not only do high levels of burnout, low well-being and high turnover affect health professionals, but they are associated with poor patient care. However, limited research has investigated this topic specifically in hospice interdisciplinary team (IDT) members, nurses, chaplains, social workers. Thus, the purpose of this study was to explore hospice IDT members’ well-being, and turnover intent. Methods: This observational, pilot study used quantitative surveys to examine the well-being, and turnover intention at baseline and at 3 months. Twenty-five hospice IDT members at one site participated. Results: Paired t-tests and percent change demonstrated significant decreases in compassion satisfaction (44.5 vs. 42.1, p = 0.04) and secondary traumatic stress score (18.5 vs. 13.3, p = 0.0001) and a significant increase in burnout score (17.6 vs. 20.5, p = 0.03) from baseline to follow up. Employee turnover slightly decreased from baseline to follow-up. Conclusions: In this pilot study, hospice IDT members had low levels of well-being at baseline that worsened over 3-months indicating a higher potential risk for burnout. Moreover, given the COVID-19 pandemic, this may be an ominous sign of what lies ahead for hospice providers regarding turnover, leading to significant long-term staffing problems in the field. If these results hold true in a larger sample, it could necessitate developing and testing further strategies to ensure a healthy and stable workforce.

A Pilot Randomized Controlled Trial of Integrated Palliative Care and Nephrology Care

Scherer, J. S., Rau, M. E., Krieger, A., Xia, Y., Zhong, H., Brody, A., & Charytan, D. M. (2022). Kidney360, 3(10), 1720-1729. 10.34067/KID.0000352022
Abstract
Abstract
Key Points A pilot randomized controlled trial of integrated palliative and nephrology care in patients with CKD stage 5 not on dialysis is feasible. A pilot randomized controlled trial of integrated palliative and nephrology care in patients with nondialysis CKD 5 is acceptable. Participants in the integrated care arm had lower symptom burden scores at the end of the trial, whereas the control group had higher scores. Background There has been a call by both patients and health professionals for the integration of palliative care with nephrology care, yet there is little evidence describing the effect of this approach. The objective of this paper is to report the feasibility and acceptability of a pilot randomized controlled trial testing the efficacy of integrated palliative and nephrology care. Methods English speaking patients with CKD stage 5 were randomized to monthly palliative care visits for 3 months in addition to their usual care, as compared with usual nephrology care. Feasibility of recruitment, retention, completion of intervention processes, and feedback on participation was measured. Other outcomes included differences in symptom burden change, measured by the Integrated Palliative Outcome Scale-Renal, and change in quality of life, measured by the Kidney Disease Quality of Life questionnaire and completion of advance care planning documents. Results Of the 67 patients approached, 45 (67%) provided informed consent. Of these, 27 patients completed the study (60%), and 14 (74%) of those in the intervention group completed all visits. We found small improvements in overall symptom burden (-2.92 versus 1.57) and physical symptom burden scores (-1.92 versus 1.79) in the intervention group. We did not see improvements in the quality-of-life scores, with the exception of the physical component score. The intervention group completed more advance care planning documents than controls (five health care proxy forms completed versus one, nine Medical Orders for Life Sustaining Treatment forms versus none). Conclusions We found that pilot testing through a randomized controlled trial of an ambulatory integrated palliative and nephrology care clinical program was feasible and acceptable to participants. This intervention has the potential to improve the disease experience for those with nondialysis CKD and should be tested in other CKD populations with longer follow-up.

A qualitative analysis of communication workflows between adult day service centers and primary care providers

Zhong, J., Boafo, J., Brody, A. A., Wu, B., & Sadarangani, A. T. (2022). Journal of the American Medical Informatics Association, 29(5), 882-890. 10.1093/jamia/ocab284
Abstract
Abstract
Objectives: Our study documented communication workflows across adult day care centers (ADCs) and primary care providers (PCPs) around complex needs of persons living with dementia (PLWD). We also identified barriers and facilitators to productive communication in clinical decision support and clinical information systems. Materials and Methods: We conducted 6 focus groups with ADC staff (N=33) and individual semistructured interviews with PCPs (N=22) in California. The eHealth Enhanced Chronic Care Model was used to frame the directed qualitative content analysis. Results: Our results captured cumbersome and ineffective workflows currently used to exchange information across PCPs and ADCs. Stakeholders characterized current communication as (1) infrequent, (2) delayed, (3) incomplete, (4) unreliable, (5) irrelevant, and (6) generic. Conversely, communication that was bidirectional, relevant, succinct, and interdisciplinary was needed to elevate the standard of care for PLWD. Discussion and Conclusion: ADCs possess a wealth of information that can support clinical decision-making across community-based providers involved in the care of PLWD, especially PCPs. However, effective information exchange is mired by complicated workflows that rely on antiquated technologies (eg, facsimile) and standard templates. Current information exchange largely focuses on satisfying regulatory guidelines rather than supporting clinical decision-making. Integrating community-based services into the health care continuum is a necessary step in elevating the standard of care for PLWD. In the absence of interoperable electronic health records, which may not be financially viable for ADCs, other options, such as mobile health, should be explored to facilitate productive information exchange of personalized relevant information.

Supporting dementia family care partners during COVID-19: Perspectives from hospice staff

Lin, S. Y., Jones, T., David, D., Lassell, R. K., Durga, A., Convery, K., Ford, A., & Brody, A. A. (2022). Geriatric Nursing, 47, 265-272. 10.1016/j.gerinurse.2022.08.003

Transitioning to Remote Recruitment and Intervention: A Tale of Two Palliative Care Research Studies Enrolling Underserved Populations During COVID-19

Brody, A. A., Convery, K. A., Kline, D. M., Fink, R. M., & Fischer, S. M. (2022). Journal of Pain and Symptom Management, 63(1), 151-159. 10.1016/j.jpainsymman.2021.06.017
Abstract
Abstract
Context: During the COVID-19 pandemic, community-based research studies experienced prolonged shutdowns unless able to pivot to remote study procedures. Objectives: To describe the revision of two National Institutes of Health funded community-based palliative-focused clinical trials serving underserved populations to accommodate remote subject enrollment and examine its impact. Methods: Transitioning to remote processes required multiple protocol and procedural changes including: altering informed consent processes; reducing the number of surveys administered; adding internet access as an inclusion criterion. To understand technological challenges, a screening tool was developed for one study to identify potentially eligible subjects’ technology abilities and accessibility. Results: Subjects’ limited access to the internet and internet-enabled devices and discomfort with technology led to changes in recruitment patterns. Lack of familiarity with technology increased the amount of time it took research team members and subjects to connect remotely. Patients with significant cognitive and/or sensory deficits were at higher risk of experiencing fatigue during remote study visits leading to streamlining of data collection. A researcher-developed technology screening tool found that potential subjects were not comfortable with videoconferencing through Zoom expressing a preference for phone visits. Reduced travel time made scheduling remote study visits more efficient. Conclusion: Future community- and home-based palliative care trials must consider the best way to utilize remote recruitment, enrollment, and data collection processes to increase efficiency and reduce costs. Researchers should consider technology accessibility and train staff to ensure the greatest possible opportunity to recruit underserved populations who have traditionally been underrepresented in research studies.

Adaptation and Piloting for Hospice Social Workers of Aliviado Dementia Care, a Dementia Symptom Management Program

Jones, T. M., & Brody, A. A. (2021). American Journal of Hospice and Palliative Medicine, 38(5), 452-458. 10.1177/1049909120962459
Abstract
Abstract
Background: Forty-five percent of hospice patients currently have a primary or secondary diagnosis of Alzheimer’s disease or related disorders. However, few programs have focused specifically on assisting hospices in providing evidence-based symptom management to persons living with dementia (PLWD). Objective: To adapt and pilot the training component of Aliviado Dementia Care, a dementia symptom management quality improvement program originally developed for home healthcare, for use by social workers as part of the hospice interdisciplinary team. Design: A prospective pre-post design was utilized, measuring knowledge, confidence, and attitudes at baseline, and immediately and 1-month post-training. Analysis was performed using paired t-tests and repeated measures ANOVA. Subjects: Hospice social workers currently practicing in the United States with at least 1 year of experience. Measurements: The Dementia Symptom Knowledge Assessment and a post-training continuing education evaluation form. Results: Forty-six subjects were enrolled, of whom 26 completed the first post-test and 23 both post-tests. There was a poor baseline level of knowledge and confidence in caring for PLWD. Significant improvements occurred following training, particularly in implementing non-pharmacologic interventions for behavioral and psychological symptoms of dementia (BPSD) (16.64% increase, p <.0001) and confidence in managing behavioral symptoms (16.86%, p =.01) and depression (25.18%, p <.0001). Changes were maintained over time. All respondents were either very satisfied or satisfied with the quality and content of the program. Conclusions: The training modules of Aliviado Dementia Care were successfully tailored for use by hospice social workers, showing significant improvement in knowledge and confidence in caring for behavioral symptoms in PLWD. Future work will examine whether the larger program, including this training, can subsequently improve patient outcomes in hospice.