Geriatric Health Services Research
Overview
Key Personnel

Ongoing Research Projects

1. Translating Research into Practice:  The Johns Hopkins Home Hospital.  PI:  Bruce Leff, MD.  The major goal of this project is to disseminate the Johns Hopkins Home Hospital care model into Medicare managed care and Veterans Administration health care systems.

• Leff B, Burton L, Mader S, Naughton B, Burl J, Inouye SK, Greenough WB, Guido S, Langston CA, Frick KD, Steinwachs D, Burton JR.  Hospital At Home: Feasibility and Outcomes of a Program to Provide Hospital-Level Care at Home for Acutely Ill Older Patients.  Ann Intern Med.  143:798-808, 2005.
• Leff B, Burton L, Mader S, Naughton B, Burl J, Clark R, Greenough WB, Guido S, Steinwachs D, Burton JR.  Satisfaction with Hospital at Home Care.  J Am Geriatr Soc.  54:1355-1363, 2006.
• Leff B, Burton L, Mader S, Naughton B, Burl J, Koehn D, Clark R, Greenough WB, Guido S, Steinwachs D, Burton JR.  Stress experienced by family members of patients treated in Hospital At Home compared with traditional acute hospital care.  J Am Geriatr Soc, 56:117-23, 2008.

2.  Planning Grant to Develop a Strategy and Implementation Plan for a National Technical Assistance Program in Geriatrics to Improve Access to, and Effectiveness of, Geriatrics Care in the U.S.  Co-PIs:  Bruce Leff, MD, Al Siu, MD.  The major goal of this project is to define methods to improve geriatric care for older adults, developing a plan, and identifying a longer-term funding stream to follow through. 

• Siu A, Spragens L, Leff B.  Can chronic care be improved using an acute platform?  The ironic business case for chronic care.  Health Affairs, In press.  

3.  Clarifying Multimorbidity for Medicaid Programs to Improve Targeting and Delivery of Clinical Services.  Cynthia Boyd, Bruce Leff, Carlos Weiss, Jennifer Wolff, Co-PIs.  The main goal of this grant is to define methodology and patterns of multimorbidity in national Medicaid datasets as prelude to designing appropriate care delivery models for multimorbid populations.

• Weiss CO, Boyd CM, Yu Q, Wolff J, Leff B.  A portrait of prevalent major chronic disease multimorbidity among older adults in the United States.  JAMA 298:1160-1162, 2007.

4.  Treatment Burden in Complex Older Patients as a Target for Intervention.  PI: Cynthia Boyd, Co-Is Bruce Leff, Cynthia Rand, Carlos Weiss, Jennifer Wolff, Qian-Li Xue.  The major goal of this award is to investigate associations between different patterns of multimorbidity, treatment burden,and other geriatric outcomes.

5.  Enhancing the Quality of “Medical Home” Services.  PI: Chad Boult.  Co-Investigators: Cynthia Boyd, Bruce Leff.  The major goal of this grant is to develop national curricula to strengthen physician competencies essential to development of high quality comprehensive patient care in “medical homes.”

6.  National Study of Disability Trends and Dynamics.  PI: Judy Kasper, PhD, Vicki Freedman, PhD.  Co-Investigators: Cynthia Boyd, Bruce Leff, Carlos Wolff.  The major goal of this award is to promote innovative scientific investigation in late-life disability trends and dynamics, and the social and economic consequences of late-life disability for individuals, families and society.

7.  Guided Care: Integrating High-Tech and High-Touch.  PI: Chad Boult.  Co-Investigators: Cynthia Boyd, Bruce Leff.  The major goals of this project are to measure the effects of Guided Care on the quality and outcomes of care for high-risk older persons, their unpaid caregivers and their primary care physicians. 

• Boyd CM, Shadmi E, Leff B, Brager R, Dunbar L, Wolff JL, Boult C.  Guided Care for Multi-Morbid Older Adults.  The Gerontologist, 47:697-704, 2007.
• Boult C, Reider L, Frey K, Leff B, Boyd CM, Wolff J, Wegner S, Marsteller J, Karm L, Scharfstein D.  The early effects of “guided care“ on the quality of health care for mulit-morbid older persons: a cluster-randomized trial.  J Gerontol A Biol Sci Med Sci. 63:321-7, 2008.
• Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, Sylvia M, Boult C.  A pilot test of the effect of guided care on the quality of primary care experiences for multi-morbid older adults.  J Gen Intern Med. 23:536-42, 2008.
• Leff B, Reider L, Frick K, Scharfstein D, Boyd C, Frey K, Karm L, Boult C.  The early effects of Guided Care on multimorbid older patients' use and cost of health services: a randomized controlled trial.  Am J Man Care, Submitted.

8.  The Care Report: Comprehensive Assessment of Resident Experience.  PI: Michele Bellantoni, Leslie Poole, Paul Willging, Co-Investigators. This project will provide meaningful caregiver- and customer-generated data designed to assist family members in the selection of a high-quality nursing home for their loved ones.

9.  Senior Strategy: A Seamless Integration of Care for the Elderly. PI: Penny Anderson, Ron Carlson, Mary Stuart, Paul Willging, Co-Investigators.  The goal of this project is to assess the outcomes (in terms both of quality as well as cost) of a program in Howard County, Maryland establishing a seamless system (including an electronic health record) for providing non-fragmented physical, mental and psychosocial services to Medicare-eligibles. 

10.  Altered Energy Expenditure as a Cause of Frailty and Mobility Disability in Older Adults. PI: Carlos Weiss.  Co-I: Linda Fried.  The major goal of this project is to determine whether changes in resting metabolism and the energy costs of essential tasks may be contributors to frailty and decline in physical function in older adults.

11.  Use of Medicare home health services and effects of physician evaluation and management visits on Medicare home health outcomes.  PI:  Jennifer Wolff, Co-investigators:  Cynthia Boyd, Bruce Leff, Carlos Weiss, Ann Meadow

• Wolff JL, Meadow A, Weiss CO, Boyd CM, Leff B.  Medicare home health and the post-acute care continuum.  Medical Care, In press.
• Wolff JL, Meadow A, Boyd CM, Weiss CO, Leff B.  Physician evaluation and management of Medicare home health patients.  Submitted

12.  Designing a universal assessment tool for older adults. In collaboration with Health Facilities Association of Maryland (HFAM). Funding by HFAM; planning pilot testing of tool in 2009.

13.  Evaluation of the burden and impact of medical co-morbidity in older residents of Assisted Living facilities (with and without dementia). In collaboration with the Department of Geriatric Psychiatry. Funded by NIMH/NIH (Rosenblatt, PI).

•      “McNabney MK, Samus QM, Lyketsos CG, Brandt J, Onyike CU, Baker A, Rosenblatt A. The spectrum of medical illness  and medication use among residents of assisted living facilities in central Maryland. J Am Med Dir Assoc 9: 558-564, 2008.

14.  Predictors of good outcomes with PACE. In collaboration with the Research Committee of the National PACE Association.  The goal is to utilize existing national database to identify characteristics that are associated with preferred outcomes for community-dwelling, nursing home-eligible older adults.

15.  Investigating Systems and Aspects of Care to Improve the Care Transitions of Older Adults.  PI: Alicia I. Arbaje, MD, MPH.  The purpose of the project is to obtain information that can be used to develop instruments and quality indicators for providers and health care organizations to use to optimize the transition of older patients from the hospital to the community.

• Arbaje AI, Wolff J, Yu Q, Powe NR, Anderson GF, Boult CE.  Post-Discharge Environmental and Socioeconomic Factors and the Likelihood of Early Hospital Readmission among Community-Dwelling Medicare Beneficiaries.  The Gerontologist. 2008; 48(4):495-504.

16.  Johns Hopkins Geriatrics Floating Interdisciplinary Transitions Team. Co-Principal Investigators:  Samuel C. Durso, MD, MBA, Alicia I. Arbaje, MD, MPH, Elizabeth Tanner, PhD, RN.  This project is designed to improve the care of frail older patients, ensure safe, efficient transitions of care and increase geriatrics knowledge, skill and attitudes of nurses and physicians.
                        
17.  Guided Care:  Integrating High-Tech and High-Touch.  PI:  Chad Boult, MD, MPH, MBA.  Co-Investigators: Cynthia Boyd, Bruce Leff, Alicia I. Arbaje, MD

• Boyd CM, Boult C, Shadmi E, Leff B, Brager R, Dunbar L, Wolff JL, Wegener S.  Guided care for multimorbid older adults. Gerontologist. 2007 Oct;47(5):697-704.
• Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, Sylvia M, Boult C.   A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med. 2008 May;23(5):536-42.
• Boult C, Reider L, Frey K, Leff B, Boyd CM, Wolff JL, Wegener S, Marsteller J, Karm L, Scharfstein D.   Early effects of "Guided Care" on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2008 Mar;63(3):321-7.

18. Providers' Perspectives on Striving toward Excellence in Care Transitions:  Relationship to Pay-for-Performance.  PI: Alicia I. Arbaje, MD, MPH.  The goal of this study is to utilize qualitative research methods to characterize providers’ perspectives on what constitutes successful and suboptimal care transitions of older adults during an episode of illness, and to describe providers’ suggestions for improving care transitions that may have implications for pay-for-performance.

19.  Understanding the Longitudinal Care Transition Patterns of Older Adults.  Co-PIs: Masayo Sato, Alicia I. Arbaje, MD, MPH, Ilene Zuckerman, PharmD. The goal of this study is to 1) use a national sample of Medicare beneficiaries to describe patterns of care transitions of older adults across residential living settings and hospitals; 2) characterize the consistency of these care transition patterns; and 3) Identify characteristics of those older adults with and without consistent care transition patterns.