About

Rosa R. Baier is the Director of the Center for Long-Term Care Quality and Innovation and a Professor of the Practice of Health Services, Policy and Practice at Brown University. Her work focuses on partnered, pragmatic research that aims to generate practical, real-world evidence to improve care for older adults in various settings. She leads the Long-Term Care Quality & Innovation (Q&I) Lab at Brown, collaborating with providers, health systems, and entrepreneurs nationwide to support embedded studies and improve care delivery. Baier co-developed the Readiness Assessment for Pragmatic Trials (RAPT) model to help teams assess and strengthen interventions for real-world testing. Before joining Brown in 2015 to establish Q&I, she spent 12 years directing Medicare- and state-funded quality improvement and reporting initiatives, including Rhode Island’s healthcare quality reporting program and a national goal-setting system used by most U.S. nursing homes. Her extensive experience in healthcare quality improvement continues to inform her research efforts, which are grounded in improving care for older adults at scale. Her research areas include assisted living, COVID-19, improvement science, infection prevention, nursing homes, pragmatic research, quality measurement, and implementation in the United States.

Research topics

• Medicine
• Computer Science
• Nursing
• Gerontology
• Internal medicine
• Database
• Virology

Selected publications

• Partner-Engaged Pragmatic Research in Aging Care: Case Studies from the Long-Term Care Quality & Innovation Lab.

  PubMed · 2026-04-01

  article1st authorCorresponding

  Since 2015, the Long-Term Care Quality & Innovation (Q&I) Lab at the Brown University School of Public Health has advanced pragmatic, partner-engaged research to improve care for older adults and chronically ill individuals receiving post-acute and long-term care. Rather than evaluating interventions under controlled conditions, Q&I researchers conduct embedded studies in real-world care settings, working with clinicians and frontline staff to implement interventions and assess their effectiveness and feasibility in routine practice. In parallel, researchers also collaborate with health systems and public agencies to generate practice-relevant evidence on operational priorities, positioning the lab as a translational research platform. This article presents two nursing home case studies: a pragmatic trial of a personalized music intervention for residents living with dementia and a portfolio of COVID-19-related partnered research. Together, these examples demonstrate how embedded, partner-engaged approaches generate actionable evidence, inform practice and policy, and position Rhode Island health system partners as contributors to evidence generation at scale in aging care.

  Publisher

• Letter in response to “Multisociety Guidance for Infection Prevention and Control in Nursing Homes”

  Infection Control and Hospital Epidemiology · 2026-01-22

  article1st authorCorresponding
  PublisherDOI

• Harnessing Technology and Data to Unlock Actionable Insights in Implementation Research - Sleep Research Examples

  Innovation in Aging · 2025-12-01

  articleOpen accessSenior author

  Abstract Effective implementation of cutting-edge technology and data is dependent upon the development of solutions that are responsive to the unique needs of older adults and their environments. This symposium includes five presentations from the world of sleep research reflecting on efforts to develop and refine technology and data solutions for real-world implementation. The first and second presentations describe how interdisciplinary collaborations can result in new ways of bundling and using packages of multiple technologies to solve implementation complexities in the challenging arena of sleep environments. By using iterative pilot testing and multidisciplinary collaboration to inform technological development, the final technologies are much more acceptable and feasible than would be possible without collaborative iterative design. The third presentation reviews commercially available sleep tracking technologies, describes how technologies have evolved over time, and considers their implementation advantages and disadvantages. The final two presentations consider innovative ways of bringing data out of the analyst’s office and into the field so it can be dynamically used to inform and shape quality improvement and research in real time. The discussant, Dr. Rosa Baier, will reflect on the implications of these presentations for implementation research and quality improvement practice. Using the complexities of sleep research as a backdrop, this group of presentations offer an opportunity to consider how new insights can be stimulated through iterative field-informed packaging of technologies and data.

  PublisherOA PDFDOI

• Applying Iterative RE-AIM to Translate Evaluation Data Into Real-Time Adaptations

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Iterative RE-AIM provides a novel approach to evaluating interventions in real-time and translating those insights into actionable adaptations. Using the principles of iterative RE-AIM, we conducted a midpoint survey with the members of the coaching intervention team and the implementation evaluation team for 40Winks, a nursing home-based sleep trial. We convened a facilitated meeting with these two teams to discuss results and priorities, evaluate existing adaptations, review the effectiveness of the current intervention plan, propose future adaptations, and formulate a plan for implementation. The aggregated survey data were displayed and discussed by the two teams together as part of this process. While iterative RE-AIM outlines a process for evaluating an intervention’s adherence to the RE-AIM model, we applied this framework to evaluate the intervention’s components rather than the RE-AIM dimensions. This modification allowed us to bring all levels of the intervention and evaluation teams together to have a combined voice in the direction and evaluation of the intervention, and to make critical, real-time adaptations to enhance the effectiveness and reach of the intervention. This presentation will provide a roadmap of the process our team developed, guided by the principles of iterative RE-AIM, to display the evaluation survey and data and discuss strategies for implementing the results of this survey to lead real-time adaptations. This novel methodology allows the teams to learn from and act upon their own data in real time, allowing for iterative and systematic improvements in an intervention as a trial progresses.

  PublisherOA PDFDOI

• Moderators of Adherence Within a Nursing Home Pragmatic Trial of Personalized Music

  The Gerontologist · 2025-04-17

  articleOpen access

  BACKGROUND AND OBJECTIVES: To describe factors affecting nursing home adherence in an embedded pragmatic randomized controlled trial of a personalized music intervention to manage agitation in residents living with dementia. RESEARCH DESIGN AND METHODS: Semistructured qualitative interviews with 4 corporate leaders and 27 nursing home staff. We used thematic analysis to develop a codebook and map findings to potential adherence moderators in the Conceptual Framework for Implementation Fidelity (CFIF): recruitment, participant responsiveness, strategies to facilitate implementation, intervention complexity, quality of delivery, and context. RESULTS: Recruitment: Corporate leaders noted research participation compensation did support corporate implementation. Resident turnover frequently occurred and led to delays in implementation due to the need to personalize music to each resident. Participant responsiveness (dose received): Interviewees noted the intervention improved dementia behaviors and enhanced engagement with exceptions. Strategies to facilitate implementation: Interviewees voiced differing views on whether nurses or activities staff should lead implementation and how to pilot the program. Intervention complexity: Interviewees described complexities including tailoring delivery to each resident, updating music, and sustainability concerns. Quality of delivery: Champions discussed protocol deviations; for example, providing residents with music that was not personalized. Context: Interviewees noted how the SARS-CoV-2 pandemic exacerbated turnover, but the intervention did engage residents during staffing shortages. DISCUSSION AND IMPLICATIONS: Interviewees described contextual barriers associated with pragmatic implementation of a personalized music intervention. While they also described facilitators, our findings highlight limits to pragmatic delivery in nursing homes with chronic under-resourcing and staffing, exacerbated by the pandemic.

  PublisherOA PDFDOI

• Engaging Assisted Living Residents in the Development of an Evaluation Plan for a Future Trial of an Exercise Program

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Many trials are conducted without first assessing which outcomes are important to patients receiving the interventions. The goal of this work was to ask participants of an ongoing exercise program what they believed the most important impacts of the program were to better align outcomes for a future trial with participant priorities. The Rev6 program is a seated, 30-minute exercise class designed for older adults with varying cognitive abilities. The program is offered twice a week by a large assisted living community (ALC) in Rhode Island. We observed three Rev6 sessions and held a focus group with seven Rev6 participants. We also interviewed one ALC staff member responsible for delivering the Rev6 program and two corporate leaders. Three members of the research team analyzed the focus group and interview transcripts to identify themes. Themes related to physical health included staff- and participant-reported impact of the Rev6 program on balance and walking, strength, and pain. Themes related to mental health included staff- and participant-reported impact of the Rev6 program on “feeling better” and increased social connection. With input from ALC staff, researchers developed visual cue cards for each theme and met with nine program participants to vote on the most important theme to evaluate as an outcome measure for a future study. Four residents voted for balance and walking, three residents voted for feeling better, and two residents voted for pain as the most important impact of the program. This framework for evaluation codesign includes the voices of people with dementia.

  PublisherDOI

• Resident and Nursing Home Factors Associated With Adherence to a Personalized Music Intervention: Secondary Analyses From Music & MEmory: A Pragmatic TRial for Nursing Home Residents With ALzheimer’s Disease (METRIcAL)

  Journal of Aging Research · 2025-01-01

  articleOpen access

  Objectives: Music offers a promising nonpharmacological alternative for managing agitation in people with Alzheimer’s disease and other dementias (ADRD). We report resident and nursing home (NH) characteristics associated with uptake of a personalized music intervention. Design: Post hoc analysis of a cluster‐randomized embedded pragmatic clinical trial (ePCT) involving delivering resident‐preferred music to manage agitated behaviors. Setting and Participants: A total of 463 residents with ADRD in 27 NHs randomized to receive the intervention. Methods: We obtained resident and NH characteristics from Minimum Data Set and Long‐Term Care FocUS data. In addition, we created a study‐specific engagement measure, which describes the proportion of enrolled residents in a given NH with any nursing staff use of the intervention. We used hierarchical models to estimate associations between resident and NH characteristics and (1) any exposure to the personalized music intervention and (2) minutes of music received per study day. Results: This post hoc analysis included 463 residents from 27 NHs (mean age: 80 years (standard deviation, SD: 12.2), 68.5% female, and 25.3% Black or African American). Resident characteristics associated with a greater likelihood of any exposure to the music included being Black or African American ( p = 0.02). NH characteristics were associated with greater likelihood of any exposure included higher quality star ratings ( p = 0.01) and nursing staff engagement with the intervention ( p = 0.01). Among those exposed to the music, younger residents ( p = 0.02), Black residents ( p = 0.03), and those with less health instability ( p = 0.03) received greater doses. Residents living in NHs with high nursing staff engagement also received higher doses ( p ≤ 0.001). Conclusions and Implications: Black race was associated with a greater probability of exposure and more use of a personalized music intervention, after controlling for NH quality. Nursing staff engagement with a personalized music intervention increased uptake. These findings are useful for future ePCTs of behavioral interventions in NHs. Trial Registration: Clinicaltrials.gov Identifier: NCT03821844

  PublisherOA PDFDOI

• Recruiting and Consenting Community-Dwelling Adults With Dementia to Test Sleep Tracking Devices

  Innovation in Aging · 2025-12-01

  articleOpen access1st authorCorresponding

  Abstract Poor sleep is associated with decreased physical and cognitive function, poor mood, and increased falls. Understanding sleep patterns may help physicians better recommend behavioral programs for improving sleep. Researchers partnered with the PACE Organization of Rhode Island (PACE-RI) to recruit community-dwelling older adults living with dementia to pilot test sleep-tracking devices. PACE-RI provides healthcare to adults 55+ with complex medical conditions, with a focus on maintaining their independence. Participants in this study used a wearable sleep tracking device and a sleep tracking mat for three consecutive nights. Caregivers residing with participants completed a four-question sleep diary for each of the three nights. We encountered challenges recruiting up to 15 participants in this study, with only 5 participant-caregiver dyads enrolled over a one-year period. Key barriers to recruitment included: lack of Spanish language materials / bilingual recruiters, requirement to have a cohabitating caregiver, no internet service at home, lack of trust of researchers and/or technology, and concerns about researchers entering homes. At PACE-RI, approximately 45% of their clients have dementia, but most do not have a family caregiver living with them. In an effort to establish greater trust and connection with participants, the research team visited each participant three times (at consent / equipment setup, at equipment pickup, and after personalized findings were available) and called daily. We will share our one-page participant reports that summarize each participant’s sleep data using simple language and pictures. In this ongoing pilot, the follow-up visits and reports have increased snowball-based recruitment.

  PublisherOA PDFDOI

• Recombinant vs Egg-Based Quadrivalent Influenza Vaccination for Nursing Home Residents

  JAMA Network Open · 2025-01-02 · 3 citations

  articleOpen access

  Importance: Influenza vaccination remains the most important intervention to prevent influenza morbidity and mortality among nursing home residents. The additional effectiveness of recombinant influenza vaccine vs standard dose vaccines was demonstrated in outpatient older adults but has not been evaluated in nursing home populations. Objective: To compare hospitalization rates among residents in nursing homes immunized with a recombinant vs a standard dose egg-based influenza vaccine. Design, Setting, and Participants: This pragmatic cluster randomized trial assessed nursing home residents 65 years or older residing in a US facility for 100 or more days before the start of influenza season (October 1). The study was conducted across the 2019 to 2020 and 2020 to 2021 influenza seasons and randomly assigned nursing homes 1:1 within blocks categorized by proportion of Black residents and prior resident hospitalization rates. Medicare claims data were used to evaluate resident-level hospitalization outcomes. Enrollment and allocation to treatment groups began on July 20, 2019. Data analysis began on January 1, 2021, with primary end points finalized June 30, 2024. Intervention: Nursing homes were cluster randomized to vaccinate all residents with recombinant quadrivalent influenza vaccine (RIV4) or standard egg-based quadrivalent inactivated influenza vaccine (IIV4). Main Outcome and Measures: The primary outcome was respiratory-related hospitalization. Secondary outcomes included death and hospitalization due to any cause. Results: A total of 144 565 person observations (mean [SD] age, 77.4 [13.1] years; 63.0% female) at 1078 nursing homes were included, with 72 005 residents in nursing homes randomized to provide RIV4 and 72 560 residents in nursing home randomized to provide IIV4. In total, 85.6% of the residents received influenza vaccination. Baseline resident characteristics were comparable across treatment groups. For the primary end point of respiratory-related hospitalizations, there were 1387 hospitalizations (1.9%) in the RIV4 group vs 1424 (2.0%) in the IIV4 group (hazard ratio, 1.01; 95% CI, 0.62-2.17). Hospitalization rates by vaccine were similar for other hospitalization outcomes and death, overall, and by season and subgroups (gender, race, and comorbidities). Conclusions and Relevance: In this cluster randomized trial of nursing homes, there was no significant difference between recombinant or standard dose vaccine for reducing hospitalizations associated with influenza illness. However, the COVID-19 pandemic restricting influenza activity along with poor vaccine match to circulating strains substantially limits the conclusions. Trial Registration: Clinicaltrials.gov Identifier: NCT03965195.

  PublisherDOI

• Modifications of the readiness assessment for pragmatic trials tool for appropriate use with Indigenous populations

  BMC Medical Research Methodology · 2024-05-31 · 3 citations

  articleOpen accessSenior author

  BACKGROUND: Inequities in health access and outcomes exist between Indigenous and non-Indigenous populations. Embedded pragmatic randomized, controlled trials (ePCTs) can test the real-world effectiveness of health care interventions. Assessing readiness for ePCT, with tools such as the Readiness Assessment for Pragmatic Trials (RAPT) model, is an important component. Although equity must be explicitly incorporated in the design, testing, and widespread implementation of any health care intervention to achieve equity, RAPT does not explicitly consider equity. This study aimed to identify adaptions necessary for the application of the 'Readiness Assessment for Pragmatic Trials' (RAPT) tool in embedded pragmatic randomized, controlled trials (ePCTs) with Indigenous communities. METHODS: We surveyed and interviewed participants (researchers with experience in research involving Indigenous communities) over three phases (July-December 2022) in this mixed-methods study to explore the appropriateness and recommended adaptions of current RAPT domains and to identify new domains that would be appropriate to include. We thematically analyzed responses and used an iterative process to modify RAPT. RESULTS: The 21 participants identified that RAPT needed to be modified to strengthen readiness assessment in Indigenous research. In addition, five new domains were proposed to support Indigenous communities' power within the research processes: Indigenous Data Sovereignty; Acceptability - Indigenous Communities; Risk of Research; Research Team Experience; Established Partnership). We propose a modified tool, RAPT-Indigenous (RAPT-I) for use in research with Indigenous communities to increase the robustness and cultural appropriateness of readiness assessment for ePCT. In addition to producing a tool for use, it outlines a methodological approach to adopting research tools for use in and with Indigenous communities by drawing on the experience of researchers who are part of, and/or working with, Indigenous communities to undertake interventional research, as well as those with expertise in health equity, implementation science, and public health. CONCLUSION: RAPT-I has the potential to provide a useful framework for readiness assessment prior to ePCT in Indigenous communities. RAPT-I also has potential use by bodies charged with critically reviewing proposed pragmatic research including funding and ethics review boards.

  PublisherOA PDFDOI

Recent grants

• Data Management and Methods Core

  NIH · $54.2M · 2007–2029

• Evaluating the impact of patient-centric home health quality reports

  NIH · $836k · 2012–2016

Frequent coauthors

• Stefan Gravenstein

  Brown University

  128 shared

• R. L. Gardner

  94 shared

• Ellen McCreedy

  Issues Research

  92 shared

• Vincent Mor

  Providence College

  79 shared

• Andrew R. Zullo

  Brown University

  47 shared

• Eric Jutkowitz

  Brown University

  40 shared

• Kali S. Thomas

  Johns Hopkins University

  40 shared

• A. Lynn Snow

  Tuscaloosa VA Medical Center

  38 shared

Education

• MPH, Program in Public Health

  Brown University School of Public Health

  2004

• BA

  Wellesley College

  2000