Background To support nurse workforce needs of rural areas and health professions shortage areas, the Health Resources and Services Administration's (HRSA) Nurse Corps program offers loan repayment and scholarships in exchange for service commitments in these areas. Purpose This study explores key financial factors associated with retention of participants in rural and shortage areas, including whether participants attended public or private school. Total amounts of loans and student scholarships as well as school type were combined with known predictors of retention to determine any significant outcomes. Methods Administrative and loan data from HRSA for all Nurse Corps applicants and participants were combined with data from a survey of recent program participants. Nurse Corps scholarship amounts and total loan balances of participants at the time of application were examined by participant attendance at either public or private schools. Associations with retention in rural and shortage areas were assessed using hierarchical logistic regression. Results Participants' age and satisfaction with their Nurse Corps site were the strongest predictors of retention in rural or medically underserved areas after their commitment. Whether the participant attended public school was significantly positively associated with retention when not controlling for other predictors. However, the significant relationship did not remain when controlling for age and site satisfaction. At the time of application to the Nurse Corps program, loan repayment program participants had close to $140,000 of loans on average, and this was significantly larger for participants that attended private school. Conclusion Retention in rural and medically underserved areas was significantly associated with age and satisfaction with workplace. Attendance at public institutions served as a mediating variable. Given new federal limits on student loans, the public institution pathway and the Nurse Corps program become more valuable options for future nurses as graduates leave with smaller loan balances and are more likely to serve communities in critical need of additional nurses.

Background: Heart failure (HF) affects over 6 million people in the United States and is a frequent cause of hospital readmissions. While interest in individual HF interventions like digital platforms and home-based care delivered by community health workers (CHWs) has risen, few studies have explored barriers and facilitators to engaging CHWs with digital or remote monitoring devices in HF populations. Methods: Three virtual focus groups were conducted from December 2020 to January 2021 with 14 CHWs. Key domains included: barriers and facilitators to managing HF at home; CHW care in HF; remote monitoring and technology in HF; and CHW ability to assist with remote technology in HF. Objective: To explore CHW perceptions about managing HF at home relevant to the use of home-based remote monitoring. Findings: Focus groups produced 4 themes: (1) patients with HF struggle to follow clinical care plans at home (i.e., medication adherence, diet, fluid intake); (2) CHWs clarify clinical care plans and provide psychosocial support; (3) CHWs connect patients to resources addressing unmet health-related social needs (e.g., transportation, rental assistance, and other needs); (4) patients face challenges understanding how to use clinician-prescribed technologies for remote monitoring that can be resolved with CHW coaching and instruction. Conclusions: CHWs reported specific ways they were able to assist patients with clinical, social, and clinician-prescribed health-related technology in HF. Partnerships with CHWs are well positioned to add important value to HF home management for clinical care plan adherence and engagement, remote monitoring, and technology use.

BACKGROUND:Most studies assessing digital interventions for people with heart failure (HF) focus on clinical outcomes and few include patient perspectives. Understanding patient experience with the use of a digital HF platform along with community health worker (CHW) care as part of a digitally-enabled CHW intervention, can inform management of HF at home and improve the post-discharge phase of care. OBJECTIVE:To identify patient perceptions related to the use of a digitally-enabled community health worker intervention. METHODS:This qualitative study includes interviews with adults (age ≥18) with HF who were assigned to the intervention arm of a pilot randomized controlled trial September 2022 through June 2023. For 30 days after hospital discharge, intervention participants were paired with a CHW and instructed to use a digital platform that tracked biometrics (e.g., heart rate, oxygenation, blood pressure, body weight, steps taken, symptoms) and offered educational videos. In-depth interviews were performed after the 30-day intervention was complete (between 31 to 45 days after hospital discharge). Key interview domains included: barriers and facilitators to the intervention, use of remote monitoring in HF, and the role of CHWs in HF home care. RESULTS:Interviews with participants (N=19; mean age 62.1, SD 15.1 years) yielded five key themes: (1) The combined intervention was well-received and CHWs made the use of the digital platform more approachable; (2) The digital platform enhanced HF knowledge and confidence in self-care; (3) Digital platform use was easy to integrate into daily routines; (4) In addition to assisting with navigation of unmet social needs (e.g., transportation, insurance benefits, food access), CHWs provided emotional support and increased motivation for clinical care plan adherence and platform use; (5) Connectivity issues and other technical challenges occurred with digital platform use. CONCLUSIONS:The digital platform was easily integrated into patient daily routines. CHWs played a key role in making the platform more approachable for participant use. Further research is needed to better understand the impact of this intervention in larger HF populations over more extended time intervals. INTERNATIONAL REGISTERED REPORT:RR2-10.2196/55687.

Abstract BackgroundMost studies assessing digital interventions for people with heart failure (HF) focus on clinical outcomes, and few include patient perspectives. Understanding patient experiences of the use of a digital HF platform along with community health worker (CHW) care as part of a digitally enabled CHW intervention can inform management of HF at home and improve the postdischarge phase of care. ObjectiveThis study aimed to identify patient perceptions related to the use of a digitally enabled CHW intervention. MethodsThis qualitative study included interviews with adults (aged ≥18 years) with HF who were assigned to the intervention arm of a pilot randomized controlled trial from September 2022 to June 2023. For 30 days after hospital discharge, intervention participants were paired with a CHW and instructed to use a digital platform that tracked biometrics (eg, heart rate, oxygenation, blood pressure, body weight, steps taken, and symptoms) and offered educational videos. In-depth interviews were conducted after the 30-day intervention was complete (between 31 and 45 days after hospital discharge). Key interview domains included barriers and facilitators to the intervention, use of remote monitoring in HF, and the role of CHWs in HF home care. ResultsInterviews with participants (N=19; mean age 62.1, SD 15.1 years) yielded five key themes: (1) the combined intervention was well received, and CHWs made the use of the digital platform more approachable; (2) the digital platform enhanced HF knowledge and confidence in self-care; (3) digital platform use was easy to integrate into daily routines; (4) in addition to assisting with navigation of unmet social needs (eg, transportation, insurance benefits, and food access), CHWs provided emotional support and increased motivation for clinical care plan adherence and platform use; and (5) connectivity issues and other technical challenges occurred with digital platform use. ConclusionsThe digital platform was easily integrated into patients’ daily routines. CHWs played a key role in making the platform more approachable for participant use. Further research is needed to better understand the impact of this intervention in larger HF populations over more extended time intervals.

Background Of 7.5 million American older adults who are completely homebound or cannot leave home without significant difficulty, half live with dementia. Home-based primary care (HBPC) practices provide longitudinal medical care in patients' homes but may not be equipped to provide high-quality dementia care.Methods Two HBPC practices and 50 caregivers of patients living with dementia (PLWD) participated in the Dementia Care Quality at Home (DCQH) intervention, which was adapted through the FRAME framework for the HBPC setting from the Care Ecosystem dementia care model and CRESCENT. DCQH leveraged the study team's clinical experience and input from focus groups of HBPC practices and caregivers of PLWD receiving HBPC to adapt the intervention to the home setting. DCQH consisted of a standardized baseline needs assessment, six dementia care modules prioritized based on assessment findings, and 60-min biweekly team-based case reviews. Outcomes measures included practice acceptability/feasibility (based on qualitative interviews, completion of needs assessment, and use of intervention materials) and caregiver acceptability (based on caregiver agreement to participate and satisfaction with DCQH).Results Study enrollment included 21 practice members and 50 caregivers; 63% of caregivers approached enrolled in the intervention. All caregivers completed baseline assessments and were given educational materials and community resources; 90% were satisfied with the intervention; 93% reported feeling "heard or understood," and the net promoter score on likelihood to recommend the intervention was 8.8/10.Conclusions This study demonstrates the feasibility and acceptability of an adapted dementia care intervention to meet the unique needs of HBPC patients with dementia, their caregivers, and the HBPC practices that serve them. Additional study of the efficacy and effectiveness of DCQH in HBPC is warranted.Trial Registration ClinicalTrials.gov identifier: NCT05849259

BACKGROUND:Childhood cancer survivors often face high healthcare costs to monitor and manage new or lasting effects of their treatment. Enhancing survivors' health insurance literacy (HIL) - the knowledge, ability, and confidence in enrolling in and navigating health plans - is vital for minimizing financial burden. Few studies have assessed the effect of a health insurance navigation program on improving HIL among survivors. We present the protocol for an ongoing randomized controlled trial (RCT) assessing the effectiveness of two health insurance navigation programs (HINT-S and HINT-A) on improving HIL, financial burden, out-of-pocket costs, and healthcare utilization for adult survivors of childhood cancer. METHODS:This three-arm RCT assesses the effectiveness of two digitally delivered health insurance navigation interventions and enhanced usual care (EUC) on improving HIL at six and 12 months in a national cohort of childhood cancer survivors. While HINT-S is composed of five synchronous, navigator-led sessions, HINT-A is an asynchronous, prerecorded set of five videos. EUC participants receive only a health insurance informational booklet. Financial burden, medical out-of-pocket costs, and healthcare utilization (receipt of preventive care, recommended screenings/vaccinations, and acute care) are assessed at 12 months. Moderators to the interventions' effectiveness will be investigated, as well as implementation outcomes (feasibility, acceptability, appropriateness, fidelity, and cost-effectiveness). CONCLUSIONS:There is a strong need for interventions to improve cancer survivors' HIL, helping them navigate the complexity of the U.S. healthcare system. This trial will elucidate the potential effectiveness and implementation of health insurance navigation programs that may benefit many cancer survivors. TRIAL REGISTRATION:NCT05527392.

We recruited caregivers of individuals ages 0-21 with Down syndrome (DS) to complete an electronic survey. Multiple recruitment sources and methods were used. From 2023-2024, we received 542 valid, complete survey responses. We found the most success with use of DS affiliate organizations, the DS-Connect® contact registry for DS, and outreach to DS clinic patients. Of those who started the screener, 1,569 people screened in and were eligible; of those eligible, 730 (46.5%) consented. We experienced bots and fraudsters despite efforts to minimize those respondents from the outset. We present lessons learned in surveying caregivers from a low-incidence medical condition, with focus on our experience with invalid respondents, to inform other researchers conducting survey research related to genetic syndromes.

Older adults with complex health and social care needs comprise some 5% of the United States population but contribute roughly half of healthcare costs. Patient and caregiver perspectives in qualitative studies emphasize care fragmentation in traditional care delivery models. The need for more streamlined and personalized care for these older adults is acute, particularly in value-based care systems such as Accountable Care Organizations (ACOs). Prior studies suggest that older adults with complex health needs are best cared for through person-centered care plans conducted by interdisciplinary teams of healthcare professionals, but adoption remains suboptimal. In this study, we compare two different geriatric-focused approaches to care for older adults: Annual Wellness Visits (AWV) and/or AWV augmented with GRACE (Geriatric Resources for Assessment and Care of Elders). AWVs are a Medicare benefit with a brief geriatric assessment; GRACE is a geriatric model of care that uses a home-based geriatric assessment, structured protocols, team-based care planning and primary care co-management to support older adults with complex care needs. The two-phase study includes a Phase 1 feasibility pilot, conducted in two primary care practices in one health system; and a Phase 2 cluster-randomized trial conducted in 32 primary care practices in four ACOs. Phase 2 assesses the comparative effectiveness of AWVs vs. AWV with GRACE, with primary outcomes of hospitalizations and patient experience, and secondary outcomes of caregiver strain and clinician professional fulfillment. Results will help inform personalized care among older adults with complex health needs.NCT06287801

In the United States, the field of women's health faces critical challenges. This article, part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2025 initiative, emphasizes the need for a holistic, lifespan approach to women's health that considers biological sex, gender, and intersecting social factors. We identify three key challenges: broadening the understanding of women's health beyond reproductive issues, improving the research ecosystem, and addressing workforce limitations. With innovative policies and investments across all areas of health, attention to structural determinants, and emphasis on the upstream factors affecting women's lives, significant improvements in women's health outcomes and substantial societal benefits can be achieved in 2025 and beyond.

BACKGROUND:The Health Resources and Services Administration's Nurse Corps program offers loan repayment and scholarships in exchange for service commitments in underserved areas and schools of nursing. PURPOSE:This study describes the extent and predictors of nurse retention in these areas after program participants' service commitments are complete. METHODS:Survey data from current participants and program alumni (N = 4,890) were merged with administrative data for the analysis. DISCUSSION:About 80.8% of all alumni respondents were retained at the time of the survey; even 6 years after their commitments ended, 76.0% remained in underserved areas or schools of nursing. Satisfaction with the Nurse Corps service site and burnout were key predictors of retention. CONCLUSION:The Nurse Corps program has been successful in meeting its goal of increasing access to nursing care in underserved areas. Interventions are discussed to increase satisfaction and reduce burnout to maximize retention of nurses in underserved areas.

OBJECTIVE:To develop a caregiver-reported measure to evaluate the overall health of individuals with Down syndrome (DS). STUDY DESIGN:After developing and testing a pool of items, a survey was constructed and administered to a large national sample of caregivers of individuals with DS aged 0-21 years from February 2023 to February 2024; pediatricians and teachers were also surveyed. Item distribution and principal components analysis were performed, followed by confirmatory factor analysis. Internal consistency, test-retest reliability, construct validity, and known-group validity were evaluated. RESULTS:The survey was completed by 542 caregivers. Item response and distribution properties were excellent with minimal to no missing data, ceiling, or floor effects. Final confirmatory factor analysis with oblique rotation resulted in 7 scales across 3 domains (25 items) with acceptable to excellent internal consistency (Cronbach's α: 0.7734-0.9587) and moderate to excellent test-retest reliability (intraclass correlation coefficients: 0.711-0.942). The 7 subscale scores and the total score each correlated strongly, as hypothesized, with external measures (P < .001). Known-group validity demonstrated the ability to differentiate individuals with DS and individuals with autism spectrum disorder. CONCLUSIONS:A 25-item caregiver Down Syndrome Health Measure consisting of 3 domains and 7 scales demonstrated acceptable psychometric properties. This measure can be utilized to better understand the health needs and improve the management of children and adolescents with DS. TRIAL REGISTRATION:ClinicalTrials.gov-NCT04631237.

Objectives The objective of this study was to assess the impact of the pandemic on the health, well-being, and access to services of paid staff and unpaid caregivers of persons living with dementia. Design Questionnaires were developed to capture the experiences of paid staff and unpaid caregivers throughout the pandemic, leveraging a pre-existing clinical trial collaborative. Setting Community and long-term care locations in Miami, Florida, Boston, Massachusetts, and the greater Baltimore, Maryland, and D.C. areas. Participants Paid staff from Miami Jewish and Benchmark who worked with patients with dementia during the first two years of the pandemic. Unpaid caregivers who lived within the catchment area of the study sites and provided care for community-based persons with dementia. Measurements Measures included the Coronavirus Impact Scale, the Herth Hope Index, NPI-Q, the Modified Caregiver Strain Index, PHQ-8, items about workplace changes, caregiving relationship, and changes to caregiver support. Results Paid staff were statistically more likely to have been exposed to, tested for, hospitalized, or seriously ill with COVID-19 and indicated moderate to severe impacts to medical and mental health services compared to unpaid caregivers. Unpaid caregivers exhibited significantly higher rates of depressive symptom severity and overall lower scores on the Herth Hope Scale compared to paid staff. Conclusions Our findings suggest that the pandemic had significant impacts on the mental health and general well-being of unpaid caregivers. While notable that paid staff suffered from increased exposure and decreased access to services, policies supporting both workforces should respond to the unique outcomes that each faced, post-pandemic.

Abstract Background People with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus general best practice COVID-19 prevention program in group homes (GHs) for people with SMI or ID/DD in Massachusetts (MA). Methods A hybrid effectiveness-implementation cluster randomized control trial compared a four-component implementation strategy (Tailored Best Practices: TBP) to dissemination of standard prevention guidelines (General Best-Practices: GBP) in GHs across six MA behavioral health agencies. GBP consisted of standard best practices for preventing COVID-19. TBP included GBP plus four components including: (1) trusted-messenger peer testimonials on benefits of vaccination; (2) motivational interviewing; (3) interactive education on preventive practices; and (4) fidelity feedback dashboards for GHs. Primary implementation outcomes were full COVID-19 vaccination rates (baseline: 1/1/2021–3/31/2021) and fidelity scores (baseline: 5/1/21–7/30/21), at 3-month intervals to 15-month follow-up until October 2022. The primary effectiveness outcome was COVID-19 infection (baseline: 1/1/2021–3/31/2021), measured every 3 months to 15-month follow-up. Cumulative incidence of vaccinations were estimated using Kaplan-Meier curves. Cox frailty models evaluate differences in vaccination uptake and secondary outcomes. Linear mixed models (LMMs) and Poisson generalized linear mixed models (GLMMs) were used to evaluate differences in fidelity scores and incidence of COVID-19 infections. Results GHs (n=415) were randomized to TBP (n=208) and GBP (n=207) including 3,836 residents (1,041 ID/DD; 2,795 SMI) and 5,538 staff. No differences were found in fidelity scores or COVID-19 incidence rates between TBP and GBP, however TBP had greater acceptability, appropriateness, and feasibility. No overall differences in vaccination rates were found between TBP and GBP. However, among unvaccinated group home residents with mental disabilities, non-White residents achieved full vaccination status at double the rate for TBP (28.6%) compared to GBP (14.4%) at 15 months. Additionally, the impact of TBP on vaccine uptake was over two-times greater for non-White residents compared to non-Hispanic White residents (ratio of HR for TBP between non-White and non-Hispanic White: 2.28, p = 0.03). Conclusion Tailored COVID-19 prevention strategies are beneficial as a feasible and acceptable implementation strategy with the potential to reduce disparities in vaccine acceptance among the subgroup of non-White individuals with mental disabilities. Trial registration ClinicalTrials.gov, NCT04726371, 27/01/2021. https://clinicaltrials.gov/study/NCT04726371 .

BACKGROUND:Heart failure (HF) is a burdensome condition and a leading cause of 30-day hospital readmissions in the United States. Clinical and social factors are key drivers of hospitalization. These 2 strategies, digital platforms and home-based social needs care, have shown preliminary effectiveness in improving adherence to clinical care plans and reducing acute care use in HF. Few studies, if any, have tested combining these 2 strategies in a single intervention. OBJECTIVE:This study aims to perform a pilot randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of a 30-day digitally-enabled community health worker (CHW) intervention in HF. METHODS:Adults hospitalized with a diagnosis of HF at an academic hospital were randomly assigned to receive digitally-enabled CHW care (intervention; digital platform +CHW) or CHW-enhanced usual care (control; CHW only) for 30 days after hospital discharge. Primary outcomes were feasibility (use of the platform) and acceptability (willingness to use the platform in the future). Secondary outcomes assessed preliminary effectiveness (30-day readmissions, emergency department visits, and missed clinic appointments). RESULTS:A total of 56 participants were randomized (control: n=31; intervention: n=25) and 47 participants (control: n=28; intervention: n=19) completed all trial activities. Intervention participants who completed trial activities wore the digital sensor on 78% of study days with mean use of 11.4 (SD 4.6) hours/day, completed symptom questionnaires on 75% of study days, used the blood pressure monitor 1.1 (SD 0.19) times/day, and used the digital weight scale 1 (SD 0.13) time/day. Of intervention participants, 100% responded very or somewhat true to the statement "If I have access to the [platform] moving forward, I will use it." Some (n=9, 47%) intervention participants indicated they required support to use the digital platform. A total of 19 (100%) intervention participants and 25 (89%) control participants had ≥5 CHW interactions during the 30-day study period. All intervention (n=19, 100%) and control (n=26, 93%) participants who completed trial activities indicated their CHW interactions were "very satisfying." In the full sample (N=56), fewer participants in the intervention group were readmitted 30 days after hospital discharge compared to the control group (n=3, 12% vs n=8, 26%; P=.12). Both arms had similar rates of missed clinic appointments and emergency department visits. CONCLUSIONS:This pilot trial of a digitally-enabled CHW intervention for HF demonstrated feasibility, acceptability, and a clinically relevant reduction in 30-day readmissions among participants who received the intervention. Additional investigation is needed in a larger trial to determine the effect of this intervention on HF home management and clinical outcomes. TRIAL REGISTRATION:Clinicaltrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.2196/55687.

Adults with down syndrome (DS) have a lifetime dementia risk in excess of 95%, with a median age of onset of 55 years, due to trisomy 21. Co-occurring Alzheimer's disease (AD) has increased morbidity and mortality, and it is now recommended to screen for AD in all adults with DS beginning at 40 years of age. In this manuscript, we present two clinical cases of adults with DS who developed AD summarizing their medical histories, presenting symptoms, path to diagnosis and psychosocial aspects of care collected from retrospective chart review with caregiver consent. These two cases were chosen due to their complexity and interwoven nature of the medical and psychosocial aspects, and highlight the complexity and nuance of caring for patients with DS and AD.

Objective The prevalence of Alzheimer's Disease (AD) and related dementias is escalating, with substantial societal and economic impact. Existing dementia care is often inadequate due to underdiagnosis, delayed diagnosis, and insufficient resources, especially for caregivers. Behavioral symptoms of dementia further complicate care, contributing to negative outcomes. Collaborative care programs show promise, yet resource-intensive models can be challenging to scale. This study aimed to assess the feasibility of CRESCENT (CaReEcoSystem primary Care Embedded dementia Treatment), an adaptation of the CareEcosystem intervention, providing dementia care training to nurse care managers in a primary care setting. Design Embedded pilot cluster randomized controlled study. Participants The thirty nurse care managers enrolled in the trial had 393 patients with an ICD-10 diagnosis code consistent with dementia on their panels, 206 patients corresponding to the 15 intervention nurses and 187 patients corresponding to the 15 control nurses. Measurements Primary outcome: Feasibility of capturing ED utilization using Medicare claims data and of implementing the intervention in a care management program. Secondary outcomes: ED use and change in caregiver distress (via survey) between baseline and 6-month follow-up using the Neuropsychiatric Inventory Questionnaire (NPI-Q) Distress scale. Results We demonstrated the feasibility of collecting ED visit data through Medicare claims and of implementing the intervention in a busy care management program. In the 6-month follow-up, there were no changes in ED visits post-intervention. A non-significant 2.7-point greater reduction in caregiver distress among caregivers of PWD in the intervention cohort was observed. Conclusion A dementia care coordination program can be integrated into a care management program. Future trials will explore the effectiveness of CRESCENT in a fully powered clinical trial, aiming to address the rising dementia epidemic and improve dementia-informed care in healthcare systems.

Adapting interventions to new contexts requires consideration of the needs, norms, and delivery structures of the new setting. We describe how we followed the ORBIT model of intervention development to create Health Insurance Navigation Tools (HINT), a health insurance patient navigation intervention for childhood cancer survivors. By engaging stakeholders and leveraging institutional resources, we identified and preemptively addressed real-world barriers, which may improve the feasibility and efficacy of the intervention. Using evidence-based implementation science models to adapt and refine interventions enhances rigor and reproducibility, implements checks and balances, and surmounts challenges of intervention rollout to accelerate the delivery of health insurance education to childhood cancer survivors.

BACKGROUND:Implementation research generally assumes established evidence-based practices and prior piloting of implementation strategies, which may not be feasible during a public health emergency. We describe the use of a simulation model of the effectiveness of COVID-19 mitigation strategies to inform a stakeholder-engaged process of rapidly designing a tailored intervention and implementation strategy for individuals with serious mental illness (SMI) and intellectual/developmental disabilities (ID/DD) in group homes in a hybrid effectiveness-implementation randomized trial. METHODS:We used a validated dynamic microsimulation model of COVID-19 transmission and disease in late 2020/early 2021 to determine the most effective strategies to mitigate infections among Massachusetts group home staff and residents. Model inputs were informed by data from stakeholders, public records, and published literature. We assessed different prevention strategies, iterated over time with input from multidisciplinary stakeholders and pandemic evolution, including varying symptom screening, testing frequency, isolation, contact-time, use of personal protective equipment, and vaccination. Model outcomes included new infections in group home residents, new infections in group home staff, and resident hospital days. Sensitivity analyses were performed to account for parameter uncertainty. Results of the simulations informed a stakeholder-engaged process to select components of a tailored best practice intervention and implementation strategy. RESULTS:The largest projected decrease in infections was with initial vaccination, with minimal benefit for additional routine testing. The initial level of actual vaccination in the group homes was estimated to reduce resident infections by 72.4% and staff infections by 55.9% over the 90-day time horizon. Increasing resident and staff vaccination uptake to a target goal of 90% further decreased resident infections by 45.2% and staff infections by 51.3%. Subsequent simulated removal of masking led to a 6.5% increase in infections among residents and 3.2% among staff. The simulation model results were presented to multidisciplinary stakeholders and policymakers to inform the "Tailored Best Practice" package for the hybrid effectiveness-implementation trial. CONCLUSIONS:Vaccination and decreasing vaccine hesitancy among staff were predicted to have the greatest impact in mitigating COVID-19 risk in vulnerable populations of group home residents and staff. Simulation modeling was effective in rapidly informing the selection of the prevention and implementation strategy in a hybrid effectiveness-implementation trial. Future implementation may benefit from this approach when rapid deployment is necessary in the absence of data on tailored interventions. TRIAL REGISTRATION:ClinicalTrials.gov NCT04726371.

BACKGROUND:The registered nurse (RN) workforce experienced critical pre-pandemic and pandemic shortages of labor in some areas in the United States. People living in these health professional shortage areas (HPSAs) may have less access to health services. The Bureau of Health Workforce within the Health Resources and Services Administration administers Nurse Corps scholarship and loan repayment programs to increase healthcare access by increasing the supply and distribution of RNs, nurse practitioners, and nurse faculty to HPSAs. The American Rescue Plan Act of 2021 (ARPA) made available considerable new resources for the program. PURPOSE:This paper reports on Nurse Corps applications, awards, and distribution in 2 cohorts in the period 2017 to 2022 to assess the impact of receiving an additional $200 million appropriated in 2021. DISCUSSION:Additional funds through ARPA were associated with nearly threefold increases in the number of Nurse Corps awards. Program participants worked in a total of 1,316 counties (42% of all U.S. counties) in 2020 to 2022, a 76% increase from 749 counties in 2017 to 2019. CONCLUSION:Increased funding for scholarship and loan repayment can help to improve the distribution of nurse labor to a greater number of critical shortage areas in the United States.