About

David Gifford, MD, MPH, is a Clinical Associate Professor of Health Services, Policy and Practice, and Medicine at Brown University. He is a geriatrician and currently serves as the Chief Medical Officer at the American Health Care Association (AHCA). In this role, he helped create the AHCA Quality Department, which supports providers in quality improvement efforts and collaborates with administrators on regulations and policies affecting the profession. He also established the Center for Health Policy and Evaluation in Long-Term Care at AHCA and oversees the Long Term Care Data Cooperative, a National Institute of Aging funded initiative linking electronic medical record data from nursing homes to improve care. Dr. Gifford has served on the Board of the Baldrige Foundation and chairs the U.S. Department of Veteran’s Affairs Geriatric and Gerontology Advisory Committee, a congressional chartered body advising the U.S. Secretary of Veteran’s Affairs on geriatric services for veterans. His previous roles include Director of the Rhode Island State Department of Health, where he managed the H1N1 influenza outbreak and received the National Governor’s Distinguished Service Award, and Chief Medical Officer for Quality Partners of Rhode Island, where he directed a national CMS nursing home quality improvement effort. He holds a medical degree from Case Western Reserve University, completed his geriatric fellowship at UCLA, and earned a Master’s in Public Health as a Robert Wood Johnson Clinical Scholar. His academic appointments at Brown University include the Medical School and School of Public Health.

Research topics

• Virology
• Nursing
• Medicine
• Internal medicine
• Family medicine
• Medical emergency

Selected publications

• ASSOCIATION BETWEEN LONG-TERM CARE FACILITY STAFF TRUST IN LEADERSHIP AND RECEIVING THE COVID-19 VACCINE

  Innovation in Aging · 2023-12-01

  articleOpen access

  Abstract Trust in the sources recommending COVID-19 vaccine is thought to be associated with COVID-19 vaccine uptake. We compared long-term care (LTC) staff’s trust with leadership and public health organizations and their vaccination status. We administered a questionnaire to all staff in 48 long term facilities (39 Skilled Nursing Facilities (SNFs) and 9 Assisted Living (AL) facilities) to assess their overall trust level on a 5-point Likert scale with leadership and public health agencies along with their reported used COVID-19 vaccination status. We received 759 responses, with 34 were excluded due to incomplete data. Overall, 12% were not vaccinated, 25.2% completed initial series, 25.0% received one booster, and 37.8% received bivalent booster. Average trust was lowest with CDC (3.62) & CMS (3.60) and highest with leadership (Supervisor (4.07), Administrator (3.98) and DON (3.89)), which were higher than trust with the LTC organization (3.74). Trust levels increased as the staff’s vaccination status increased (p< 0.01) for each category in ANOVA tests. Building overall trust may help increase staff compliance with vaccination recommendations.

  PublisherOA PDFDOI

• Design of a Nursing Home Infection Control Peer Coaching Program

  Journal of the American Medical Directors Association · 2023-01-25 · 5 citations

  article
  PublisherDOI

• Providers’ Perspectives on High-Quality Dementia Care in Long-Term Care

  Journal of the American Medical Directors Association · 2022-09-02 · 5 citations

  articleOpen access
  PublisherOA PDFDOI

• Advancing Clinical Trials in Nursing Homes: A Proposed Roadmap to Success

  Journal of the American Geriatrics Society · 2022-02-23 · 7 citations

  articleOpen access

  An effective clinical research effort in nursing homes to address prevention and treatment of COVID-19 faced overwhelming challenges. Under the Health Care Systems Research Network-Older Americans Independence Centers AGING Initiative, a multidisciplinary Stakeholder Advisory Panel was convened to develop recommendations to improve the capability of the clinical research enterprise in US nursing homes. The Panel considered the nursing home as a setting for clinical trials, reviewed the current state of clinical trials in nursing homes, and ultimately developed recommendations for the establishment of a nursing home clinical trials research network that would be centrally supported and administered. This report summarizes the Panel's recommendations, which were developed in alignment with the following core principles: build on available research infrastructure where appropriate; leverage existing productive partnerships of researchers with groups of nursing homes and nursing home corporations; encompass both efficacy and effectiveness clinical trials; be responsive to a broad range of stakeholders including nursing home residents and their care partners; be relevant to an expansive range of clinical and health care delivery research questions; be able to pivot as necessary to changing research priorities and circumstances; create a pathway for industry-sponsored research as appropriate; invest in strategies to increase diversity in study populations and the research workforce; and foster the development of the next generation of nursing home researchers.

  PublisherOA PDFDOI

• Facility characteristics and costs associated with meeting proposed minimum staffing levels in skilled nursing facilities

  Journal of the American Geriatrics Society · 2022-02-03 · 25 citations

  articleSenior author

  BACKGROUND: Federal minimum nurse staffing levels for skilled nursing facilities (SNFs) were proposed in 2019 U.S. Congressional bills. We estimated costs and personnel needed to meet the proposed staffing levels, and examined characteristics of SNFs not meeting these thresholds. METHODS: This was a cross-sectional analysis of 2019Q4 payroll data, the Hospital Wage Index, and other administrative data for 14,964 Medicare and Medicaid-certified SNFs. We examined characteristics of SNFs not meeting proposed minimum thresholds: 4.1 total nursing hours per resident day (HPRD); 0.75 registered nurse (RN) HPRD; 0.54 licensed practical nurse (LPN) HPRD; and 2.81 certified nursing assistant (CNA) HPRD. For SNFs falling below the thresholds, we calculated the additional HPRD needed, along with the associated full-time equivalent (FTE) personnel and salary costs. RESULTS: In 2019, 25.0% of SNFs met the minimum 4.1 total nursing HPRD, while 31.0%, 84.5%, and 10.7% met the RN, LPN, and CNA thresholds, respectively. Only 5.0% met all four categories. In adjusted analyses, factors most strongly associated with SNFs not meeting the proposed minimums were: higher Medicaid census, larger bed size, for-profit ownership, higher county SNF competition; and, for RNs specifically, higher community poverty and lower Medicare census. Rural SNFs were less likely to meet all categories and this was explained primarily by county SNF competition. We estimate that achieving the proposed federal minimums across SNFs nationwide would require an estimated additional 35,804 RN, 3509 LPN, and 116,929 CNA FTEs at $7.25 billion annually in salary costs based on current wage rates and prepandemic resident census levels. CONCLUSIONS: Achieving proposed minimum nurse staffing levels in SNFs will require substantial financial investment in the workforce and targeted support of low-resource facilities. Extensive recruitment and retention efforts are needed to overcome supply constraints, particularly in the aftermath of the COVID-19 pandemic.

  PublisherDOI

• Advancing clinical trials in nursing homes: A proposed roadmap to success

  Geriatric Nursing · 2022-03-29 · 6 citations

  articleOpen access
  PublisherOA PDFDOI

• Pragmatic trials in long-term care: Challenges, opportunities, recommendations

  Geriatric Nursing · 2022-02-24 · 6 citations

  articleOpen access
  PublisherOA PDFDOI

• Pragmatic Trials in <scp>Long‐Term</scp> Care: Implementation and Dissemination Challenges and Opportunities

  Journal of the American Geriatrics Society · 2022-02-23 · 5 citations

  articleOpen access

  Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce findings that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants identified 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) stakeholder engagement, (2) diversity and inclusion, (3) organizational strain and readiness, and (4) learn from adaptations. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.

  PublisherOA PDFDOI

• Evaluating the Findings of the IMPACT-C Randomized Clinical Trial to Improve COVID-19 Vaccine Coverage in Skilled Nursing Facilities

  JAMA Internal Medicine · 2022-01-31 · 28 citations

  articleOpen access

  IMPORTANCE: Identifying successful strategies to increase COVID-19 vaccination among skilled nursing facility (SNF) residents and staff is integral to preventing future outbreaks in a continually overwhelmed system. OBJECTIVE: To determine whether a multicomponent vaccine campaign would increase vaccine rates among SNF residents and staff. DESIGN, SETTING, AND PARTICIPANTS: This was a cluster randomized trial with a rapid timeline (December 2020-March 2021) coinciding with the Pharmacy Partnership Program (PPP). It included 133 SNFs in 4 health care systems across 16 states: 63 and 70 facilities in the intervention and control arms, respectively, and participants included 7496 long-stay residents (>100 days) and 17 963 staff. INTERVENTIONS: Multicomponent interventions were introduced at the facility level that included: (1) educational material and electronic messaging for staff; (2) town hall meetings with frontline staff (nurses, nurse aides, dietary, housekeeping); (3) messaging from community leaders; (4) gifts (eg, T-shirts) with socially concerned messaging; (5) use of a specialist to facilitate consent with residents' proxies; and (6) funds for additional COVID-19 testing of staff/residents. MAIN OUTCOMES AND MEASURES: The primary outcomes of this study were the proportion of residents (from electronic medical records) and staff (from facility logs) who received a COVID-19 vaccine (any), examined as 2 separate outcomes. Mixed-effects generalized linear models with a binomial distribution were used to compare outcomes between arms, using intent-to-treat approach. Race was examined as an effect modifier in the resident outcome model. RESULTS: Most facilities were for-profit (95; 71.4%), and 1973 (26.3%) of residents were Black. Among residents, 82.5% (95% CI, 81.2%-83.7%) were vaccinated in the intervention arm, compared with 79.8% (95% CI, 78.5%-81.0%) in the usual care arm (marginal difference 0.8%; 95% CI, -1.9% to 3.7%). Among staff, 49.5% (95% CI, 48.4%-50.6%) were vaccinated in the intervention arm, compared with 47.9% (95% CI, 46.9%-48.9%) in usual care arm (marginal difference: -0.4%; 95% CI, -4.2% to 3.1%). There was no association of race with the outcome among residents. CONCLUSIONS AND RELEVANCE: A multicomponent vaccine campaign did not have a significant effect on vaccination rates among SNF residents or staff. Among residents, vaccination rates were high. However, half the staff remained unvaccinated despite these efforts. Vaccination campaigns to target SNF staff will likely need to use additional approaches. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04732819.

  PublisherOA PDFDOI

• Long-Term Care in the United States — Problems and Solutions

  New England Journal of Medicine · 2022-05-14 · 7 citations

  article
  PublisherDOI

Frequent coauthors

• Vincent Mor

  Providence College

  58 shared

• Barbara G. Vickrey

  Icahn School of Medicine at Mount Sinai

  43 shared

• Rosa Baier

  Providence College

  38 shared

• Martin R. Frankel

  27 shared

• Robert G. Holloway

  University of Rochester

  26 shared

• Rebecca Meyerson

  Brown University

  25 shared

• Carol L. Albright

  Providence College

  25 shared

• Stephen J. Huot

  25 shared

Education

• M.D.

  Case Western Reserve University

• Other

  University of California, Los Angeles

Awards & honors

• National Governor’s Distinguished Service Award for State Of…