The aims of this proposal are to (1) further develop the candidate?s expertise in aging research and her skills and capacity as a mentor in order to improve her ability to mentor clinician investigators who study aging issues in diverse populations, and (2) build on the strengths of the candidate?s research program focused on clinical communication, language barriers and health outcomes for older patients in primary care to examine the impact of family caregiver presence at visits, as well as the experiences and preferences of patients and caregivers for caregiver engagement in primary care. The candidate is a General Internist and Health Services Researcher committed to a career in health equity and patient-oriented research, and to mentoring the next generation of clinical investigators. The candidate has developed an independent research program to include multiple linked topic areas relevant to aging research: language barriers and access to professional interpreters, breast cancer diagnosis and communication, and evidence-based treatment of chronic kidney disease in primary care. These areas are unified by a focus on generation and implementation of evidence to advance health care quality, equity, and communication for diverse older adults. She is internationally recognized as an expert on language barriers and interpreter access. The candidate has previously received R01 funding from the National Institute on Aging studying Chinese and Spanish speaking hospitalized older adults as well as their caregivers, and R21 funding from the National Cancer Institute to investigate women and primary care physicians? perspectives on systems and communication barriers to timely follow-up of abnormal mammograms. She currently is PI on a Patient Centered Outcomes Research grant to evaluate the impact of improved language access on older patients? communication and clinical outcomes in a primary care setting, and co-PI on a NIDDK R18 focused on guideline concordant CKD treatment in primary care. The candidate has been an active mentor throughout her career. Her commitment to mentoring is demonstrated by her new role as Director of the Center for Aging in Diverse Communities (CADC), which she took over in 2017. CADC is an NIA funded Resource Center for Minority Aging Research (RCMAR) focused on elucidating mechanisms in health disparities research and developing and evaluating interventions to eliminate those disparities. As a Center its most important mission is to train and mentor to independence junior underrepresented investigators in health disparities and aging issues. With the aging of the population as a whole, and of minority communities which suffer from health disparities, it is important to bring together health disparities and aging research; the candidate is the ideal clinical investigator to bridge these two research worlds. This proposal would enable the candidate to obtain additional training to enhance her aging research and mentorship skills to ensure her success as PI of the CADC, while also allowing her to expand her skills and mentorship beyond the CADC in collaboration with aging researchers at UCSF.
This proposal will have unique public health importance because (1) it will increase mentoring of junior clinical investigators interested in conducting patient-oriented research on aging and health disparities/health equity for the rapidly growing elderly population, and (2) it will inform future intervention studies to create and test culturally appropriate tools aimed at identifying and including family caregivers in primary care before older patients experience severe health and functional decline.