This is a competing renewal application (Years 06-10) for the Indiana University Edward R. Roybal Center. The lU-Roybal facilitates research on improving support and education for self-management among vulnerable older adults cared for by generalist physicians. This thematic focus stems from our broad experience in designing and studying models of care for physically and socioeconomically vulnerable older adults. Our research recognizes the fundamental role of generalist physicians in providing care to older adults and the fundamental role of patient self-management in achieving excellent outcomes. In the first four years of the lU-Roybal, we supported 17 pilot projects that span cognitive, emotional, and physical domains of health as well as basic and applied research. Three Year 05 projects are now underway. Our pilots have largely operated in a laboratory of Community Health Centers (CHCs), which are part of an expanding national network of publicly-funded primary care sites serving persons regardless of ability to pay. The laboratory facilitates access to end-users (providers and patients and their families) who identify priorities and improve the translational potential of our interventions. Our 17 pilot projects have led to 11 externally funded grants and four pending grants. Translation to clinical pracitce outcomes to date include a cognitive care clinic, a lifestyle self-management program operating in seven CHCs, and a model academic-community research partnership to facilitate translation to clinical practice in an urban public health system. This competing renewal builds on our considerable strengths from the first five years of operations and proposes innovative new pilots and an expansion of our translational science laboratory. The pilots proposed represent use-inspired research that will asses a multi-modal self-management program to prevent or postpone cognitive decline, a study of the social factors that may prevent planned transitions out of nursing homes, decision support to facilitate patient-provider decision-making for complex preventive health services, and expansion of a two-way, interactive group video-conferencing project to promote physical activity among older adults. Each of these pilots addresses lessons learned and new opportunities identified in our first five years of funding. The four proposed pilots, as well as the 20 previous pilots, represent examples of the types of research projects that we will pursue in Years 6-10 of the lU-Roybal and represent the strengths of our real-world clinical laboratory.
Primary care is the site of care where most older adults receive their health care. Older adults often suffer from multiple chronic medical conditions and socioeconomic stressors. The Chronic Care Model identifies self-management as a core tenet in improving patient outcomes. Because there is a paucity of research on supporting patient self-management, we focus the lU-Roybal Center resources on this important topic.
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