Summary:

The Center bridges geriatrics and palliative care and serve as a model for a new focused area of research within geriatrics. These collaborations are the source for new research projects and junior faculty with interests in geriatrics and palliative care. The OAIC recruits and trains academic leaders, and it supports pilot and exploratory studies. It has established 2 research cores (research design and analysis, measurement and data management) that apply innovative methods not currently in widespread use in aging research but that are highly applicable to aging. The Center brings together a) leadership by senior geriatricians who are long-standing colleagues with a shared track record of successful research and training program building; b) senior faculty with a substantial body of research contributions; and c) promising junior investigators. Our Center's theme has its roots in the deepest traditions of medicine: attention to the primacy of the relief of suffering. Ancient though this priority may be, medical research in general, and geriatric research in particular, are poised to bring modern techniques and knowledge to what is in fact a new area of focus for the OAIC program - the effective amelioration of pain and other symptoms to improve function and promote independence in older adults.

Summary:

Continuation of RCMAR work at a national level, to foster health measurement in diverse populations and mentoring of minority aging research.

Objective:

This randomized controlled trial evaluates medical informatics and telemedicine care for Medicare beneficiaries with diabetes living in underserved urban and rural settings. Participants in the intervention arm each receive a home telemedicine unit, a modified computer with attachments to measure blood pressure and blood glucose. Each participant is assigned a nurse case manager with whom remote televisits are conducted. Recommendations are provided by the nurse case managers to the participants’ PCPs. In addition, the American Diabetes Association created websites (in both English and Spanish) for use specifically with this project. Delivery of telemedicine resulted in positive clinical outcomes, including reduction in blood glucose levels, blood pressure, and lipids.

The primary aims are to examine outcomes in an observational phase of the Northern Manhattan Caregiver Intervention Project (NOCIP; see below), create a longitudinal registry of Hispanic relative caregivers of persons with dementia, and develop and evaluate a web-based personal health information management system. An overarching goal is to examine the characteristics of Hispanic caregivers and use this knowledge to design and test technology based interventions.

Overarching Goal:

To examine the characteristics of Hispanic caregivers and use this knowledge to design and test technology based interventions.

SA1:

To compare caregiver change in depressive symptoms and burden between the Northern Manhattan Caregiver Intervention Project (NOCIP) study arms in a 5-year observational study phase (NOCIP-OS) 1 and 5 years after NOCIP enrollment.

SA2:

To examine the interplay by key socio-demographic characteristics, caregiver burden, stress, and depressive symptoms in 300 members from our newly formed register. Key characteristics include sex and family position, employment, acculturation, socioeconomic status (SES), social support, and coping.

SA3:

To iteratively develop and refine a web-based Family-HIMS in participation with caregivers enrolled in the NHIRP registry and evaluate the impact of Family-HIMS use on caregivers’ perceptions of ease of use and usefulness and on caregiving outcomes.

This project is a consortium of NYU, Columbia University , Visiting Nurse Service of New York and the Research Division of the Hebrew Home at Riverdale. It includes a stroke prevention/intervention project with the goal of reducing systolic blood pressure and reoccurrence of strokes and TIAs in a minority, low income population and two additional evaluation projects examining factors related to stroke risk.

Objectives of the Center for Stroke Disparities Solutions

1. To create a consortium that will expand the capacity for conducting implementation research targeted at reducing stroke disparities and stroke-related disability, as well as improving stroke literacy among minority populations in New York.

2. To develop a health disparities research and education/ training program that will train and mentor the next generation of minority investigators with interest in stroke disparities research.

3. To advance stroke disparities research by evaluating the implementation of innovative solutions and culturally tailored approaches targeted at prevention of recurrent stroke among Black and Hispanic stroke survivors, across the continuum of stroke care.

Research demonstrates patient-reported healthcare discrimination is significantly associated with low cancer screening rates, low adherence rates, low overall satisfaction rates and delays in seeking needed healthcare. This project hopes to address substantial gaps in the emerging field of patient-reported healthcare discrimination.

Objectives of the Center for Stroke Disparities Solutions

A1. Apply advanced psychometric approaches to finalize items for inclusion on the Patient-Reported Experiences of Discrimination in Care Tool (PreDict) (n=20 hospitals across three states; target n= 6000 patients).

A2. Conduct between-hospital comparisons of PreDict performance and analyze patient-level data to identify associations between reported healthcare discrimination and self-reported outcomes.

A3. Determine the association between hospital-level performance on PreDict and performance on publicly-reported hospital quality measures.