The central goal of the Pilot Core of this proposed Roybal Center is to launch and complete NIH Stage 0-III studies that position Center investigators to compete for independent funding for Stage IV-V effectiveness and implementation trials of interventions to improve palliative care for persons with dementia (PWD) in long-term services and support (LTSS) facilities. To achieve its primary goal of selecting and supporting pilot projects that translate ideas from behavioral economics and data science into improvements in care for PWD residing in LTSS facilities, the Steering Committee will issue an annual request for applications to all Affiliated Investigators and their trainees. Pilot Core PI Jason Karlawish, MD and other Committee members will rate each application on seven criteria and assign each an overall score using the 9-point NIH scale. The Committee will then propose the highest-scored pilots for final funding decisions to (1) the Roybal Center's Advisory Committee; (2) the Genesis HealthCare leadership (for projects proposing studies within Genesis facilities); and (3) NIA officials and the Roybal Coordinating Center. The Pilot Core has three other specific aims. First, we aim to mentor junior faculty and post-doctoral fellows in developing and testing behavior change interventions. Several Steering Committee members and numerous Affiliated Investigators are leading behavioral research mentors, and have committed substantial portions of their careers to mentorship. We expect junior investigators to feature prominently in at least half of the pilot projects supported through this Center, and will use the Center's annual Symposium to launch new mentoring relationships among junior and senior investigators. Second, we aim to foster new collaborations among the Center's Affiliated Investigators, particularly by linking those with expertise in Stage 0-III behavioral intervention research with investigators who possess methodological expertise in behavioral economics, data science, qualitative methods, statistics, and implementation science. These collaborations between behavioral scientists and methodologists will enable us to develop scalable interventions that measurably improve outcomes. Third, the Pilot Core will provide centralized data and safety monitoring plans and oversight for all Roybal Center pilots. Pilot Core PI Karlawish and Overall PI Halpern are both experts in research ethics. In conjunction with the Center's highly experienced senior staff, they will develop data and safety monitoring plans for all pilot projects as a shared resource of the Center. This pilot core proposes a Stage I and a Stage 0 project for funding in year 1, and describes these projects in detail. These two pilot projects were selected following an initial call for applications in preparation of this Center proposal. Although this initial call operated on an abridged timeline, many exceptional applications were submitted. We therefore also provide brief descriptions of four other exemplary proposals that will be considered for funding in future years.
