This K23 mentored patient oriented research career development award is designed to prepared Dr. Friedman for becoming an independent investigator in patient-oriented health services research. This will be accomplished through a coordinated of research and educational experiences, focusing on the PACE model of care. PACE (the Program of All-inclusive Care for the Elderly) is a national long-term care replication program with a central goal of promoting health and function in a frail, nursing home-eligible population. Many questions remain as to the benefits of the program, and the outcomes of enrollees in PACE. The efficacy of the PACE model is particularly important to investigate, because of the public finances being invested in existing programs, and because studies of other innovative long-term care program have had disappointing results, both in terms of minimizing cost as well as improving functional outcomes. This 2-part project will examine some of these outcomes, including function, quality of life, and nursing home utilization, using two different approaches. First, we will use secondary data on 7,819 participants in the PACE replication programs to evaluate risk and predictors of nursing home admission in PACE. The results from this analysis will help to generate hypotheses that can then be tested in the second part of the project. In this study, which will involve the majority of the time for this K23 proposal, we will conduct a prospective analysis of function, quality of life, and nursing home utilization in enrollees and non-enrollees in PACE, using primary data collected at one PACE site-Hopkins ElderPlus (HEP). These studies will be performed concurrently with a comprehensive educational plan, with an ultimate goal of preparing Dr. Friedman to become an independent investigator in clinically-based health services research.
