Advancing emergency medicine in Rhode Island and beyond

Adam Aluisio, assistant professor of emergency medicine, whose sub-specialty is in global emergency medicine, works to improve delivery of HIV and other testing services among patients who present for emergency care in sub-Saharan Africa.

“Although treatment for HIV and testing is universally accessible and funded by either national governments or international funding agencies, HIV self testing is much less so,” he says. “There’s a desire to roll it out, but access to self-test kits and training resources are very limited. That’s something we’re really focusing on.”

Aluisio notes that emergency care is one of the few specialties that doesn’t have its own institute at the National Institutes for Health. And, many funding sources restrict the use of grants to research conducted in the U.S. 

“This is just an inherent structural barrier,” he says. “Everyone agrees our work is important and needs to get done, but finding funding for the work can be immensely difficult.”

Building capacity for change

Prior to the COVID-19 pandemic, Liz Goldberg — associate professor of emergency medicine and associate professor of health services, policy and practice at Brown — competed for a grant to adapt a program created at Emory University that aims to reduce adverse drug events for seniors.

“At Lifespan health facilities in Rhode Island, we see approximately 40,000 older adults throughout the year,” Goldberg says. “Using this evidence-based program, we were able to get emergency department clinicians and prescribers to stop prescribing medications that were dangerous for older adults. For example, Valium can increase falls or cause confusion in older adults. We significantly reduced use of that medication for this group. We would not have been able to do that program if not for this grant.”

The largest benefactor supporting medicine at Brown University during the BrownTogether campaign has been the Warren Alpert Foundation, which provides funding for multiple endowed professorships, research infrastructure, and medical education.

Endowed positions support emergency medical leaders like Dr. Megan Ranney MPH’10 RES’08, who worked with Goldberg to quickly plan, design, and create the mobile application MyCOVIDRisk, which has now been used more than one million times.

“At Brown, we are unusual in that we have a very robust research infrastructure in emergency medicine,” says Schuur. “This allows our faculty to launch studies rapidly and seamlessly.”

This was evident during the pandemic. Brown and its hospital partners became a significant enrolling site for therapeutic trials of COVID-19 treatments. In addition, Aluisio worked with faculty and clinicians in Brown’s Center for Human Rights and Humanitarian Studies to develop a COVID-response training program and deliver it in partnership with an international organization to approximately 80,000 health care workers across 40 different countries.

Thanks in part to philanthropy, Brown’s strong research infrastructure has also set the stage for promising explorations of digital health options, new treatments to address the opioid epidemic, and pediatric emergency medicine.

Goldberg has expanded her geriatric research to explore the prevention of repeat falls in the elderly population, using the Apple Watch as a tracking mechanism.

“A big goal for us in geriatric emergency medicine is helping people age in place so they don’t have to go to nursing homes,” she says. “It can be very hard to conduct this research because many older folks live on a fixed or low income. That’s a place where research funding can help: recruitment incentives and transportation for older people.”

Her lab team includes graduate students, medical students, and undergraduates who help obtain consent from patients, follow up with study participants and their caregivers, and collect and analyze data.

“With more funding, I could involve more students,” she says. “Right now I have to cap the lab size because there are so many people interested in digital health and this intersection between digital health and geriatric emergency medicine.”

Strengthening Brown’s impact on society

As part of the recent BrownTogether campaign extension, the University aims to double its research enterprise over the next five to seven years. Expanding support for scholars like those balancing research with clinical practice in the Department of Emergency Medicine will boost Brown’s ability to address urgent challenges and create essential learning opportunities for undergraduate, graduate, and medical students.

Both Aluisio and Goldberg say there are multiple aspects of their work that would benefit from additional philanthropic support.

“We have information from non-African settings about digital health and how to leverage that for increased access to care, linkage to testing, and connection to treatment after one test for HIV,” says Aluisio. “But the current funding we have isn’t sufficient to expand our translational and implementation work, even though the presence of smart phones in sub-Saharan Africa is near 96%.”

“Many older adults already have Apple Watches, but we need to get the word out that we’re doing a study that could be potentially helpful to them,” says Goldberg. “Those dollars to advertise, promote, and disseminate often don’t come with traditional grant mechanisms. The budget is created to do the research and not to actually share what you’ve done.”

Schuur notes that the Department of Emergency Medicine also works with The Warren Alpert Medical School at Brown to offer a summer research program for medical students who want to work with one of the department’s faculty members. This kind of training is crucial for building the next generation of physician-scientists in emergency medicine.

“There are many things that can be done to help people, both locally and around the world,” says Aluisio. “A moment of interaction in an emergency care setting could potentially change someone’s life in a way that's going to be impactful in both the near term and the long term.”