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The Roger C. Lipitz Center for Integrated Health Care

Lipitz Center Research Projects

PROGNOSTIC SIGNIFICANCE OF FAMILY CAREGIVER FACTORS FOR OLDER ADULT HEALTH EVENTS

Principal Investigator: Jennifer Wolff, PhD
Supported by: National Institute on Aging
Project Period: ​09/15/2015- 05/31/2019
Award: $1,336,751

In this study, we will draw on national surveys of disabled older adult-family caregiver dyads to comprehensively and systematically elucidate the potential significance of family caregiver factors to disabled older adults' risk for diverse and consequential adverse health events that are of both fiscal and public health importance. To accomplish this work we will construct a unique population-based dataset with information on social, economic, cognitive, health, and interpersonal domains of risk reported by 3,023 disabled older adult-family caregiver dyads who responded to linked nationally representative disability and family caregiver surveys (the 1999 and 2004 National Long-Term Care Surveys, and 2011 National Health and Aging Trends Study). All three survey waves will be linked to Medicare claims, Minimum Data Set assessments, and mortality/vital statistics files, which will contribute longitudinal information on older adults' health events. Together, these study aims will provide new knowledge regarding the relevance of family caregiver factors to diverse and consequential events among disabled older adults, as well as develop practical tools to translate this knowledge into clinical practice.

INVOLVING FAMILY TO IMPROVE PRIMARY CARE VISITS FOR COGNITIVELY IMPAIRED PATIENTS

Principal Investigator: Jennifer Wolff, PhD
Supported by: National Institute on Aging
Project Period: ​09/1/2015- 05/31/2017
Award: $445,493

Dementia is among the most profoundly disabling and costly health conditions. Family caregivers play a vital role in dementia care, and are typically present and actively involved in medical visits. However, knowledge of how to involve family caregivers in medical visits is lacking. This study will refine a brief intervention to effectively and purposely involve family caregivers ("companions") who accompany persons with cognitive impairment to primary care visits. The study team has developed a checklist to be used by patients and their companions prior to medical visits. The checklist is designed to elicit and align patient and companion perspectives concerning health concerns to discuss with the doctor, and to clarify the role of the companion in the visit. The intervention has the potential to advance a low cost and practical approach to improving medical communication for a highly prevalent, vulnerable, and costly patient population whose care is especially challenging. Study activities will pave the way for a larger multi-site trial in primary care.

“Strengthening Informal Support Resources with Strategic Methodological Advances” 
P30AG048773 (Roth, PI)
Supported by:National Institute on Aging ($1,800,000) 09/30/2014 – 05/31/2019
Co-Investigator: Jennifer Wolff, PhD
Pilot Study PI, $45,000 direct costs (0.6CM) 01/01/2015-12/31/2015

“Involving Family to Improve Communication about Safe and Effective Medication Use for Older Primary Care Patients with Dementia”
This study will elicit the perspectives of older persons with dementia, family caregivers, and primary care providers regarding challenges of effective medication-related communication.  The goal of this work will be to better understand complex and multidimensional medication-related challenges within the context of the older adult-family caregiver partnership and to identify strategies to overcome challenges that can be implemented in primary care.  

Comprehensive Home-based Dementia Care Coordination for Medicare-Medicaid Dual Eligibles in Maryland
Principal Investigator: Quincy Samus, PhD
Supported by: Centers for Medicare and Medicaid (CMS)
Project Period: ​09/1/2014- 08/31/2017
Award: $6,384,190

This project will test the implementation of Maximizing Independence at Home (MIND), an Alzheimer’s disease / Dementia (AD) -targeted care coordination model that systematically assesses and addresses the critical barriers to adults with AD remaining in their home. The target population is adults eligible for Medicare and Medicaid (Duals) in the Baltimore region. The model creates a broad link between community health agencies, medical providers and community resources, and innovatively synthesizes the expertise and experience of non-clinical community workers, nurses, physicians, and occupational therapists.

Delivered over 18 months, MIND addresses 21 care need domains for patients and caregivers. The interdisciplinary team performs comprehensive, in-home, AD-related needs assessments followed by individualized care planning and implementation of six basic care strategies (resource referrals, environmental safety, dementia care education, behavior management skills training, informal counseling, problem-solving), on-going monitoring, and assessment and planning for emergent needs. Each component of the intervention is based on clinical practice guidelines and prior research, and is combined for maximum impact.

Identifying Successful Programs for Managing Care for High-Cost Populations, 2014
Principal Investigator: Gerard Anderson, PhD
Supported by: The Commonwealth Fund
Project Period: 05/01/2014-05/15/2015  
                   
Award: $270,000

Patients referred to as “high need” require a range of medical, behavioral, social, and long-term support services, all of which need to be coordinated. This high level of care today often comes at a high cost. This project will involve a comprehensive scan of public and private programs across the nation that have demonstrated success in improving outcomes for complex patients while lowering the costs of care.

Selected programs targeting specific patient subpopulations will be studied in greater detail to learn about the intervention’s features, care settings, implementation processes, success factors, and impacts on quality and costs. The team will then identify commonalities across programs, as well as individual features that need to be tailored to patient subgroups. Findings from this work will enable health system leaders to be strategic in selecting and deploying an approach to treating these patients effectively and efficiently.

Medicare at 50
Principal Investigator: Karen Davis, PhD
Supported by: The Commonwealth Fund
Project Period: 01/01/2014-06/30/2015
Award: $399,525

Karen Davis, Gerard Anderson, Judy Kasper, Martin Andersen, and Lauren Nicholas of Johns Hopkins, as well as a external experts, will produce a series of papers to mark Medicare's 50th anniversary and frame the debate over the program's future direction. The papers will cover the following topics: 1) a review of Medicare's signal accomplishments; 2) an examination of the Affordable Care Act's implications for Medicare's future; 3) options for redesigning Medicare to strengthen its beneficiary protections and encourage better health care choices; 4) highlighting of Medicare's role in developing health care payment and delivery system reforms; and 6) discussion of policies to improve Medicare's financing and ensure its long-term solvency.

Informing the National Policy Debate on Medicare's Future and Provider Payment Reform
Principal Investigator: Karen Davis, PhD
Supported By: The Commonwealth Fund

Project Period: 01/01/2013-12/31/2013
Award: $132,818

Since enactment of the Affordable Care Act, projected Medicare spending has slowed to a level below the projected growth in gross domestic product (GDP) per capita. Maintaining that reduced rate of growth will depend on: 1) spreading successful pilot innovations in health care delivery and payment through the Medicare program; 2) providing an incentive for beneficiaries to choose high-value health systems and providers; and 3) reducing administrative costs and complexity through provision of comprehensive, integrated Medicare benefits through traditional Medicare and high-performing Medicare Advantage plans.

A project team led by Karen Davis prepared analyses relevant to the national policy debate on Medicare's future and provider payment reform. Some significant elements of this project were publication of an article on a proposed comprehensive Medicare benefit, analysis by Davis and colleagues comparing the performances of traditional Medicare and private Medicare Advantage plans with employer-based private health insurance, and dissemination activities on the rationale, promise, and challenges of new payment methods and an integrated high-performance health system.

National Study of Disability Trends and Dynamics (now the National Health and Aging Trends Study or NHATS)
Principal Investigator: Judith A. Kasper, PhD
Supported by: National Institute of Aging

Original Project Period: 9/30/2008 - 8/31/2014
Renewed for: 9/01/2014 - 04/30/2019
Award: $36,642,933

Study to design, test, field and disseminate a new national study to enable analyses of disablity trends and trajectories in older people. The new study will be a platform for scientific inquiry to guide efforts to reduce disability, maximized functioning, and enhance older adults' quality of life.

SES Disparities in Breast Cancer: Effect of Pharmaceutical Coverage
Principal Investigator: Ann Nattinger, MD
Co-Investigator: Judith A. Kasper, PhD
Supported by: National Cancer Institute
Project Period: 03/01/09 - 01/31/14

Award: $600,133

Study of SES differences in Meidcare Part D enrollment, co-morbidity, mortality and use of adjuvant hormone therapy among Medicare-eligible breast cancer patients.

Patient, Family and Community Intervention to Address Hypertension Disparities
Principal Investigator: L. Boulware, MD, MPH
Co-Investigator, Jennifer Wolff, PhD
Supported by: National Heart Lung and Blood Institute
Project Period: 07/01/2010 – 03/31/2015
Award: $518,199

To develop and rigorously test the effectiveness of an intervention that simultaneously engages patient, family, and community-level strengths to improve African American hypertensive patients’ blood pressure by enhancing their sustained performance of hypertension self-management behaviors.

Sustaining Palliative Care to Drug Users with HIV/AIDS & Health Disparities
Principal Investigator: Amy Knowlton, ScD
Co-Investigator: Jennifer Wolff, PhD
Supported By: NINR
Project Period: 06/1/2013 - 05/31/2018 
Award: $475,757

This mixed methods longitudinal study is based on a social ecological, network resource framework and builds on the study team’s novel HIV caregiving research program, pediatric HIV PC clinic program, and research on patient-provider communication on EOL issues.

Evaluation of the Impact of the Spread of OpenNotes at the Geisinger Health System, Caregivers
Principal Investigator: Jonathan Darer, MD, MPH
Co-Investigator: Jennifer Wolff, PhD
Supported by: Robert Wood Johnson Foundation 
Project Period: 07/1/2013 - 06/31/2015
Award: $50,000

This mixed methods project will evaluate the spread of OpenNotes into new clinical venues – specifically sharing information with informal caregivers.

Health and Aging Policy Fellowship
Principal Investigator: Jennifer Wolff, PhD
Supported by: Atlantic Philanthropies 
Project Period: 10/1/2013 – 9/30/2014

An Integrative Multilevel Study for Improving Patient-Centered Care Delivery Among Patients with Chronic Obstructive Pulmonary Disease
Principal Investigator: Hanan Aboumatar, MD, MPH
Co-Investigator: Jennifer Wolff, PhD
Supported by: PCORIProject Period: 10/1/2013 – 9/30/2016

This study will develop and evaluate a comprehensive patient and family-centered transitional care intervention to improve patient-centered outcomes among hospitalized COPD patients.

Optimizing Family Involvement in Late-Life Depression Care
Principal Investigator: Jennifer Wolff, PhD
Supported by: National Institute on Mental Health
Project Period: 01/01/2009-07/01/2014
Award: $143,857

Geographic Variation in Health and Economic Determinants and Outcomes of Elective Surgery
Principal Investigator: Lauren Hersch Nicholas, PhD
Supported by: The National Institute of Aging

Project Period: 05/15/2013-05/14/2014
Award: $622,350

The value of high levels of healthcare spending and utilization in the United States is frequently questioned. Using Medicare claims data, Dartmouth Atlas Project researchers identify significant geographic variation in overall spending and use of discretionary and expensive services though patients in higher spending regions do not live longer or report greater overall satisfaction with care received. While more intensive healthcare utilization may not extend patients' lives, there may be important and currently unappreciated consequences of additional treatments for multiple dimensions of patient well-being, including functional status and productive engagement (e.g., working for pay, volunteering, and providing unpaid care to family members).

This study assesses the effect of elective surgery to treat four common chronic conditions (arthritis, back pain, cataracts and heart disease) on health and disability outcomes related to quality of life including mobility and depression, and economic outcomes including paid and unpaid work. Longitudinal survey data from the Health and Retirement Study linked to respondents' Medicare claims and national Medicare data will facilitate a difference-in-differences approach to estimating a causal effect of surgery by comparing recipients to non-recipients over time. Geographic variation in practice patterns will allow comparisons of patients receiving surgery at different levels of disease severity.

The results of this study will facilitate evidence-based policymaking by the Centers for Medicare and Medicaid Services and other payers, and make timely methodological contributions to the growing field of cost- effectiveness research. Patients, their families, and employers will be the ultimate beneficiaries of these findings as providers and payers can account for the effectiveness of healthcare interventions in preserving typically unmeasured aspects of health and productive engagement. This research will provide important information to policymakers implementing the Affordable Care Act and considering further changes to the Medicare program to address rising healthcare costs and the rapid growth of the over-65 population.

Long-term Health Impacts Of Physical and Cognitive Occupational Exposures
Principal Investigator: Lauren Hersch Nicholas, PhD
Supported by: The National Institute on Aging
Project Period: 09/15/2013-08/31/2014
Award: $81,000

The majority of American adults work for pay for many years between early adulthood and Medicare eligibility at age 65. Work is a critical component of most people's lives and increasingly appreciated as a determinant of long-term health outcomes and mortality, though little is known about how the cumulative health effects of occupations influence subsequent demand for healthcare utilization among beneficiaries.

This project will create a new, publicly available dataset of job characteristics by linking all jobs reported by Health and Retirement Study (HRS) respondents to a comprehensive set of job and worker characteristics collected by the Department of Labor's Occupational Information Network. We will use factor analysis techniques to develop summary measures of job characteristics such as whether positions require strength or repetitive motion (physical demands); provide cognitive stimulation (cognitive complexity); or offer little control over task completion (physiological demands). We use these job characteristics linked to survey data and respondents' Medicare claims to examine the relationship between job characteristics and subsequent Medicare utilization, focusing on claims-based measures utilization measures for conditions such as arthritis and Alzheimer's Disease that are plausibly determined by cumulative job characteristics (for example repetitive physical motions or non-cognitively complex jobs).

The results of this study will provide important information about the health consequences of increasing the number of years that older workers, especially those with physically demanding jobs, spend working and implications for subsequent Medicare utilization. This study will provide new information about the extent that variation in employment patterns and industry and cumulative exposure to job characteristics contribute to regional variation in health and healthcare utilization among older adults across the United States. The dataset containing characteristics of HRS respondents' jobs will significantly expand the amount of information available to researchers for studies of job demand, health, disability, and retirement outcomes.

AIG III Medical Deterioration
Principal Investigator: Gerard Anderson, PhD
Supported by: American International Group

Project Period: 07/01/2013-03/31/2014
Award: $745,000

This project seeks to further data analysis from prior AIG project results.

Predicting Mortality Rates
Principal Investigator: Gerard Anderson, PhD
Supported by: American International Group
Project Period: 05/01/2012-03/31/2013
Award: $955,000

This project was focused on identifying factors that predict life expectancy.

Research Projects Archives