The Johns Hopkins Center on Aging and Health is home to professors, researchers, clinicians, fellows, students and staff with a wide range of scientific expertise and interests, all connected in the common goal of improving health and well-being for older adults. (January 2010)
 This month's featured faculty is Dr. Alicia I. Arbaje. Dr. Arbaje is an Assistant Professor at the Johns Hopkins University School of Medicine in the Department of Medicine, Division of Geriatric Medicine and Gerontology, and Associate Director of Transitional Care Research. Her research interests include:
Dr. Arbaje is a frequent speaker and enjoys providing education around eldercare issues- she recently presented at the annual JHU Women’s Health Conference in November 2009 and discussed medication management in older adults. In October 2009, she was invited to present at the University of the Third Age (Universidad de la Tercera Edad) in Santo Domingo, Dominican Republic where she gave a talk to psychology students on the role of geriatric medicine and gerontology in the management of psychological issues in older adults.
Dr. Arbaje also appears monthly on ABC 2 News in Baltimore to discuss issues relevant to older adults. Her most recent TV segments have dealt with managing blood pressure, the importance of volunteering, and avoiding unpleasant holiday healthcare surprises.
Dr. Arbaje also has been disseminating her research locally and nationally. She was invited to be a visiting professor to Aurora Health Care/ University of Wisconsin School of Medicine and Public Health. There, she had the opportunity during two presentations and three site visits to talk about the work she and her colleagues have been doing at Hopkins on transitions and readmissions. She was also able to learn from, and give constructive feedback to, members of their health system regarding their Acute Care for Elders units. In December 2009, she was invited by the Centers for Medicare and Medicaid Services (CMS) to speak about improving care transitions for older adults at their annual quality conference designed to discuss new directions for quality improvement work at CMS. In January 2010, she will chair the upcoming World Health Care Congress Leadership Summit on Hospital Readmissions to discuss bridging the gap between health plans and providers to improve patient adherence to follow-up care, medication reconciliation and physician incentives through discharge strategies. We recently had the opportunity to sit down with Dr. Arbaje to talk about her research and what she hopes to accomplish over the coming years. Here are some highlights from our conversation:
I have always been interested in the interface between public health and medicine, specifically how healthcare providers respond to changes in the structure of the healthcare system within which they function. During my clinical training in internal medicine and my subsequent research training through the Robert Wood Johnson Clinical Scholars Program, I began to understand that older adults were particularly vulnerable to lapses in their medical care. I realized that it is critical for our healthcare system to be organized in such a way as to provide incentives for best practices for the clinical care of older adults. I then initiated a research agenda to help provide evidence for those best practices. I feel that if we can redesign our healthcare system to provide excellent care for older adults, then it also becomes a healthcare system that can provide excellent care for everyone in our society. I became interested in the field of aging after looking back at my personal and professional experiences thus far. I grew up with my grandmother as an integral figure in our household. I saw the important role she played in our family, and I also saw the care giving difficulties that arose as she got older. As I progressed through my clinical training, I was struck by challenges older adults face as they navigate through our fragmented healthcare system. I also recognized healthcare providers' challenges in caring for older adults with complex medical disease and even more complex medical regimens. I also found it to be a privilege to be with older adults and their families at critical moments in their lives, including at the end of life.
Transitions of care can be danger points during an older adult's episode of illness in which critical information can be lost about the plan of care. This can lead to suboptimal outcomes, including poor patient satisfaction, increased caregiver burden, and preventable hospitalizations or readmissions. I hope to generate evidence that can be used to generate best practices in the clinical care of older adults as they transition across healthcare settings. Specifically, I seek to identify hospital factors that place older adults at risk for hospital readmission, understand the care processes that improve care transitions, and develop measures to evaluate interventions for improve the quality of transitional care and reduce hospital readmissions.
Geriatric health services research is a very exciting field that has the potential to contribute to significant changes to the delivery of care within our healthcare system. Both quantitative and qualitative research methods are important to answer the complex questions in health services research. It is important to be comfortable with the level of uncertainty that can arise in health services research, as there are many confounding factors that are not easily taken into account. Because even studying a small component of the healthcare system can be overwhelming, my advice is for researchers to first develop a conceptual framework that describes the problems they see in the healthcare system and what factors they think contribute to these problems. This leads to a series of questions for further exploration. Then it is important to find mentors and colleagues who are familiar with the research methodology to begin to address these questions.
:
Dr. Ravi Varadhan (November 2009)
Dr. Cynthia Boyd (October 2009)
Dr. Jeremy Walston (August 2009)
Dr. Sarah Szanton (July 2009) | 
