There is no shortage of innovative ideas for behavioral interventions to improve health care delivery in the United States. Health care delivery reform has the potential to dramatically improve the health and health care experience. This is especially true for the aging population who interact with the health care system more frequently and suffer some of the gravest health problems. However, too little is known about which interventions could be effective for improving the health of these individuals. This proposal seeks to identify, fund, and support low-cost, high-impact Stage I trials of behavioral interventions for mid-life and older people. The Abdul Latif Jameel Poverty Action Lab (J-PAL), founded in 2003, is a network of more than 165 affiliated professors at over 55 universities, united by their use of randomized evaluations to answer critical policy questions. J-PAL North America (NA) was launched at the Massachusetts Institute of Technology (MIT) in 2013 by Amy Finkelstein (MIT) and Lawrence Katz (Harvard) to apply the J-PAL approach to the region. J-PAL NA?s Health Care Delivery Initiative (HCDI) focuses on catalyzing high-quality randomized controlled trials (RCTs) to test how best to improve health care delivery. We propose to leverage this foundation to spur and support early-stage RCTs to test behavioral interventions to improve health care delivery and health outcomes for older adults. The MIT Roybal Center will support two Stage I pilots in its first year, and will select additional pilot projects in Years 2-5 through a rigorous peer review process. Our proposed Year 1 projects are: Project 1: Deferring Agency at End-of-Life: The Role of Information and Advance Directives. This project focuses on policies related to medical care and decision-making at end-of-life, a topic that is broadly relevant to the aging population. Project 2: Post-Acute Pain Management for Opioid-Tolerant Patients: A Randomized Controlled Trial. This project seeks to provide rigorous evidence on how to effectively manage pain in patients who are already on high doses of opioids and thus at risk of a host of negative outcomes, including overdose. Each of these projects will be supported by (i) the Management and Administrative Core, which will provide overall leadership and coordination for the Center and (ii) the Pilot Core. The Pilot Core will support project development activities to identify promising Stage I research projects, coordinate selection of the most promising pilots for funding, support funded pilots, and create a sustained behavioral intervention development program to improve health outcomes for older adults.
The goal of the MIT Roybal Center is to develop and evaluate translational behavioral interventions to improve health and healthcare delivery for older people. The Management and Administrative Core and the Pilot Core will support the development of promising interventions and evaluations, provide support to pilot projects selected through a peer review process, and leverage lessons learned to create publicly-available resources.