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Title:  Patient-Reported Outcomes Measurement Information System (PROMIS)

Specific Characteristics:                   June 2008 Summit

Key Staff:

·         David Cella, PhD, PI of the Statistical Coordinating Center to PROMIS

·         Jeanne Teresi, EdD. PhD, Consultant to the SCC

Funding Source: National Institutes of Health-NIH Roadmap for Medical Research Initiative

Objective:  May 2007 Summit

This roadmap project endeavors to provide an infrastructure for clinicians and researchers by establishing item banks and Computerized Adaptive Testing (CAT) methodology to evaluate patient-reported outcomes in clinical research involving diverse populations and a variety of chronic diseases.  This item bank will be publicly available to researchers and it will continue to evolve as it is modified and updated.   

 

 

 

 

Title:   Validation of Patient-Reported Outcomes Measurement Information System (PROMIS) in Diverse Cancer Populations.

Specific Characteristics:

Key Staff:

·         Arnold Potosky, MD, Georgetown University Medical Center

·         Jeanne Teresi, EdD, PhD, PI, Methods and Statistics

Summary: 

This proposal’s four specific aims will evaluate the usefulness of PROMIS item banks in diverse cancer patient populations and in clinical settings to: (1) Assess differences in the measurement properties of selected PROMIS item banks using IRT-based methods across age and racial-ethnic groups; (2) Compare PROMIS measures versus legacy instruments to detect differences in patient-reported outcomes for selected domains across age, race-ethnicity, and cancer clinical sub-groups; (3) Assess the association of selected PROMIS item banks with clinical events and disease/treatment states  in cancer patients treated in diverse health care settings; (4) Assess the responsiveness of selected PROMIS domains to changes in clinical status among groups versus individual cancer patients.

  

 

Title:   Treating Both Hypertension and Colon Cancer Prevention in Community Based Research

Funding:  Centers for Disease Control

PI:   Scott Braithwaite, MD, MS, with Joseph Ravenell, MD, MS, NYU School of Medicine

Subcontract PI:   Jeanne Teresi, EdD, PhD

Primary Aim:  This is a comparative effectiveness study. This project adds a third arm to previously funded studies that examine a hypertension counseling intervention and a colon cancer navigation intervention in African American men aged >50.

Recruitment occurs at churches and barber shops. The additional third arm will receive both the hypertension and colon cancer screening interventions.

   

 

Title:   Health Disparities Core (COHD) in NOCEMHD

Funding:  National Institute on Minority Health and Health Disparities

PI:   Jose Luchsinger, MD, MPH, Columbia University Medical Center

Project Leader: Bruce Link, PhD, NY State Psychiatric Institute/ Dana March, PhD, Mailman School of Public Health
Subcontract PI: Jeanne Teresi, EdD, PhD

 Specific Aim 1:   To examine in NOMEM cross-sectional analyses the respective contributions of Health Disparity Environmental Factors (HDEF) at the national, state, city, neighborhood, and individual levels to proximal behavioral and biological risk and protective factors for diabetes and depression in a midlife Hispanic population.

 Specific Aim 2:   To examine how HDEF at the national, state, city, neighborhood, and individual levels modify the response to the community-based interventions in NOCHOP, NOMA-CERED, and COACH (NYU).

   

 

Title:  Model Screening and Intervention Program for Early Dementia in Primary Care

Specific Characteristics:

Key Staff:

·        Ellen Grober, PhD, Albert Einstein College of   Medicine and Montefiore Medical Center

·         Jeanne Teresi, EdD. PhD, ( Statistical Coordinating Center subcontract)

Funding Source:  National Institute on Aging

Objective:  

Aim 1: Improve the recognition of early dementia in primary care by providing PCPs with training and the results of screening tests

Aim 2: Improve the discrimination of AD from vascular and other dementias

Aim 3: Increase the proportion of patients with dementia who receive appropriate treatment by implementing a system of care for early dementia

   

 

Title:  Staff Training in Resident-to-Resident Elder Mistreatment

Specific Characteristics:

Key Staff: 

·         Jeanne Teresi, EdD. PhD, PI

Subcontract Associates:

·        Terry Fulmer, RN, Ph.D., FAAN, Dean, NYU School of Nursing ,

·        Mark Lachs, M.D., Weill Cornell Medical College

·        Karl Pillemer, Ph.D., Weill Cornell Medical College

·        Joy Solomon, J.D., Weinberg Center on Elder Abuse

Funding Source:  New York State Department of Health Dementia Grant

Objective:

Working with the top experts in elder mistreatment, including a leading geriatrician at Weill Cornell Medical College and an elder abuse research pioneer at NYU, this project addresses the problem of violence and aggression committed by nursing home residents that is directed toward other residents. A three module training program for staff will be developed that enhances identification and intervention with respect to episodes of resident-to-resident elder mistreatment (R-REM) in long term care facilities. The modules are titled (a) Recognition and Risk Factors; (b) Management of Resident-to-Resident Elder Mistreatment; and (c) Implementation of Best Practices Related to Resident-to-Resident Elder Mistreatment.  The training modules will be evaluated with respect to impact on resident falls, accidents and injuries and on quality of life   

   

 

Title:   Prevalence of Resident to Resident Elder Mistreatment (RREM) in Long Term Care

Specific Characteristics:

Key Staff:

·        Mark Lachs, MD, Weill Cornell Medical College , PI

·        Jeanne Teresi, EdD, PhD, PI Implementation subcontract

Lead Organization: Weill Cornell Medical College

Funding Source:  National Institutes of Health

Summary: 

This research project aims to: (1) refine methodology for identifying cases of resident-to-resident elder mistreatment (RREM) in long-term care facilities using triangulation methodology that derives information from resident, staff, and incident reports; (2) conduct the first systematic prevalence study of RREM in a representative sample of 10 long-term care facilities; and (3) describe the victims and perpetrators of RREM with respect to clinical, functional, and other characteristics and the environmental and situational contexts in which RREM episodes occur. 

   

 

Title:   Physician Documentation of Resident-To-Resident Mistreatment in Residential Care Facilities 

Specific Characteristics:

Key Staff:

·        Mark Lachs, MD, Weill Cornell Medical College, PI

·        Jeanne A. Teresi, EdD, PhD, Mildred Ramirez, Co-PIs  

Funding Source:  National Institutes of Justice

Summary: 

While mistreatment of long term care residents by staff is unconscionable, this proposal asserts that the greatest threat of elder abuse to American nursing home residents comes not from staff, but from other cohabitants in the form of resident-to-resident elder mistreatment (R-REM).  Despite pilot data suggesting R-REM is prevalent, it is both under-studied and under-reported.  Accordingly, the specific aims of this project are to: 1) enhance institutional recognition of R-REM by deriving R-REM information from five different sources, including two added for this project: forensic medical record review, and accident/incident reports. Additionally, a gold standard consensus conference classification is proposed for a random sample of residents; 2) examine the convergence of R-REM reports across the five different methodologies; 3) identify the most accurate mechanism for detecting and reporting R-REM; 4) develop profiles to describe the types of people reported by each different source; 5) investigate the existing policies and procedures for reporting R-REM in each facility; 6) develop institutional guidelines for the reporting of R-REM episodes.

 

Title:  Northern Manhattan Center of Excellence on Minority Health and Health Disparities (CEMHD) at Columbia University (formerly Columbia Center for the Health of Urban Minorities (CHUM))

Specific Characteristics:

PI:   Jose Luchsinger, MD, MPH, Columbia University Medical Center

Subcontract PI:   Jeanne Teresi, EdD, PhD

Funding source: National Center on Minority Health and Health Disparities

Objectives:

The center is aimed at reducing and ultimately eliminating racial and ethnic disparities in health care among Latinos and African Americans. The foci of the three research projects are:

a) Northern Manhattan Diabetes Community Health Worker Project (NOCHOP), Walter Palmas, MD, MS, Columbia School of Medicine

b) Informatics in Diabetes Education and Telemedicine – Cognition (IDEATel-COG), Jose Luchsinger, MD, MPH Columbia University School of Medicine

c) Counseling Older Adults to Control Hypertension (COACH), Olugbenga Ogedegbe, MD, MY School of Medicine

   

 

Title:  Efficacy of Treating Anemia in Heart Failure with a Normal Ejection Fraction on Ventricular Function Exercise Capacity and Health Status

Specific Characteristics:

Key Staff:

·         Mathew Mauer, MD, (PI)

·         Jeanne Teresi, Ed.D., Ph.D. (PI, subcontract)

Lead Organization: Columbia Medical Center

Funding Source: National Institutes of Health

Objective:

This is a randomized, prospective, double blind study of 120 subjects (60 per treatment arm) with 1:1 randomization of patients to subcutaneous erythropoietin or placebo (saline injection) over a 6 month follow-up period. The project aims to evaluate the effect of erythropoietin on left ventricular structure, specifically end diastolic volume (EDV) in order to determine if treating anemia significantly decreases EDV.

   

 

Title:  Faith-based Approaches to Treating Hypertension and Colon Cancer Prevention

Specific Characteristics:

Key Staff:

·         Joseph E. Ravenell, MD, MS, New York University Department of Medicine, PI

·         Jeanne Teresi, EdD, PhD, PI,  Evaluation subcontract

Summary:

 

This project simultaneously evaluates in a randomized controlled trial, the effectiveness of two evidence-based interventions targeted at blood pressure reduction and colorectal cancer screening among Black men in NYC. The long-term goal is to develop a program that could serve as a new nontraditional model of disseminating proven interventions for cardiovascular risk reduction and colorectal cancer prevention in black men nationwide. In translating these proven interventions to community-based settings, community health promotion is linked to the healthcare system. Thus, this program could serve as a new nontraditional model of disseminating proven interventions for cardiovascular risk reduction and colon cancer prevention in black men nationwide - a group that is often underrepresented in traditional clinical practices. The potential for dissemination is high, as there is at least one church in virtually every neighborhood across the United States .  

   

 

Title:  Coordinating Center to the Dementia Special Care Projects 

Specific Characteristics:

Key Staff:

·         D. Holmes, Ph.D., PI/Director

 ·         J. Teresi, Ed.D., Ph.D., Co-Director; National Institute on Aging

 

The National Institute on Aging (NIA) funded a set of collaborative research projects nationally located at ten sites. These projects were designed to examine the nature and effectiveness of special care unit (SCU) care in institutional settings using state-of-the-art research methods.  A common core data set was used across all sites to examine issues such as resident and environmental characteristics, prevalence of dementia, costs of care, and resident outcomes.  According to the NIA, results from these studies have made a significant contribution to current knowledge about the organization and impact of these settings.

   

 

Title:  Health Information Technology (HIT) Evaluation

Specific Characteristics          Trainng Session

Key Staff:                                                 

·         Karl Pillemer, Ph.D., PI

·         Jeanne Teresi, Ed.D., Ph.D. (Evaluation subcontract)

Lead Organization: Weill Cornell Medical College

Funding Source: New York State Department of Health

Objective:

The overall purpose of this demonstration project is the implementation and evaluation of a mobile electronic medical records (EMR) system (SigmaCareTM) to help nursing homes in New York State improve care delivery, decrease medical records, and lower health care costs.  The SigmaCareTM system (eHealth Solutions), which allows health care providers to access medical records for every resident at any time, will be put into operation in 24 facilities in New York State. EMRs have the potential to revolutionize care delivery and result in enhanced quality of care in long-term care settings.  

   

 

Title:   New York City Elder Abuse Center (MDT)

Funding Source:  Samuels Foundation/ Health Aging Program

PI:  Mark Lachs, MD, Cornell Medical College

Subcontract PI:  Jeanne Teresi, EdD, PhD

Specific aims:

   

 

Title:   Therapeutic Lifestyle Counseling to Control Hypertension in African American Adults

Funding Source: NIH/ NHLBI- Challenge Grant

PI: Olugbenga Ogedegbe, MD, NYU

Subcontract PI: Jeanne Teresi, EdD, PhD

This project will evaluate the efficacy of a practice-based comprehensive therapeutic lifestyle intervention, delivered through group classes and individual motivational interviewing (MINT-TLC) to African Americans (n=200) with poorly controlled hypertension at 6 months

   

 

Title:   Evaluation of the Senior Advocacy Project (“SAP”)

Funding Source:   The Fan Fox and Leslie R. Samuels   Foundation

PI:   Randye Retkin, Esq,  LegalHealth,   New York Legal Assistance Group            

Subcontract PI:   Mildred Ramirez, PhD

The Senior Advocay Program overall goal is to provide onsite legal services to seniors at the hospitals or community based programs where they receive their medical care. This project is recruiting seniors from the Wright Center. The project aims are to evaluate the impact of the program on the participants’ quality of life and to provide legal services to older people in need of interventions such as housing.

   

 

Title:   The Northern Manhattan Center of Excellence in Comparative Effectiveness Research

PI:   Jose Luchsinger, MD, MPH, Columbia University Medical Center

Subcontract PI:  Jeanne Teresi, EdD, PhD

This Center is a supplement to the previously reviewed Center for the Health of Urban Minorities (CHUM- currently named CEMHD).

Research AIM:   To compare the effectiveness of an existing evidence-based dementia caregiver intervention, the New York University Caregiver Intervention (NYUCI), to Usual Care in the Latino community of Northern Manhattan.

Primary outcomes:  Changes in caregiver depressive symptoms

Secondary outcomes:  Changes in caregiver depression prevalence, changes in quality of life, changes in biomarkers of stress and vascular risk, and a composite score of hospitalizations, death, institutionalization, and unscheduled physician visits.

   

 

Title:   Evaluation of New York State Geriatric Education Centers

Funding Source:   Health Resources and Services Administration (HRSA)

PI:   Judith Howe, PhD, Mount Sinai School of Medicine

Subcontract PI:  Jeanne Teresi, EdD, PhD

 The study consortium includes departments within Brookdale, Columbia University, Hunter College and NYU.

Objective 1:  To improve statewide access to geriatrics training of interdisciplinary health professionals in NY State by using the results of a statewide needs assessment.

Establish content areas for training based on the needs assessment in areas including: a) mental health, b) chronic illness, c) geriatric care management, d) dying/palliative care, e) wellness/prevention, and f) pain management.

Train primary care practitioners in geriatrics and palliative care

Recruit culturally diverse health care professionals

Target training sessions in MUAs and HPSAs

Objective 2:  To develop and disseminate evidence-based curricula relating to the treatment of health problems of the elderly 

Objective 3:  To support the training and re-training of faculty to provide geriatric instruction

Objective 4:  To support the continuing education of health professionals in geriatrics

Objective 5:  To provide students new and expanded clinical training in geriatrics in nursing homes, chronic and acute disease hospitals, ambulatory care centers and senior centers.

   

  

Title: Northern Manhattan Hispanic Caregiver intervention Effectiveness Study (NHiCE)

Funding Source: PCORI

Key Staff:

·         PI - Jose Luchsinger, MD, Columbia University

·         Subcontract PI - Jeanne Teresi, EdD, PhD

Goals: to compare the effectiveness of two dementia caregiver interventions, the New York University Caregiver Intervention, and the translation of the Resources for Enhancing Caregiver’s Health (REACH OUT) in a pragmatic randomized trial of 200 Hispanic relative caregivers of persons with dementia.

Primary Aim: To compare the effectiveness of the NYUCI and REACH OUT in 200 Hispanic caregivers of persons with dementia in New York City in a pragmatic randomized trial. Primary outcomes compared:

  1. Changes in caregiver depressive symptoms, measured with the Geriatric Depression Scale (GDS)
  2. Changes in caregiver burden using the Zarit caregiver burden interview at 6 months

Exploratory Aim #1: Compare the NYUCI and REACH OUT in changes in caregiver  health (measured with the Caregiver Physical health form and the Patient Reported Outcomes Measurement Information System physical health scale) and stress (measured with the Perceived Stress Scale)

Exploratory Aim #2: Examine the predictors (demographics, family position, acculturation, and social support) of acceptance and success of the NYUCI and REACH OUT

   

 

Title: Berman/Reid Mentoring Project

Funding Source: Cornell University Clinical and Translational Science Center

Key Staff:

·         PI – Nathaniel Berman, MD, M. Carrington Reid, MD, Weill-Cornell Medical College

·         Subcontract PI - Jeanne Teresi, EdD, PhD

This study will generate feasibility data for a trial that attempts to reduce symptom burden in high-risk dialysis patients that are not transplant eligible by modifying treatment targets.  The intervention includes reductions in some medications and relaxation of blood pressure targets.

The following interventions will be applied (as applicable):

   

 

Title:  Measurement and Method and Data Cores III, Resource Center for Minority Aging Research.

Specific Characteristics:                 RCMAR Conference

Key Staff:

·         Jeanne Teresi, EdD. PhD

·         Mildred Ramirez, PhD

Funding Source:  National Institute on Aging

Objective:  

Implemented in six sites, nationwide, focusing on health disparities, one of the mandates of this program is to investigate measures in terms of their performance across ethnically diverse groups.

 

 

Title:  Improving Oral Care Delivery for the Homebound Elderly

Specific Characteristics:

Key Staff: 

·         Kavita Ahluwalia, DDS, MPH, PI

Lead Organization: Columbia University , College of Dental Medicine

Funding Source:  Centers for Disease Control

Objective:

This is a project aimed to determine the feasibility of using ADL as a framework to predict oral care needs in the homebound. The novel tool (profile of oral care needs) will be implemented in the homecare system for use by nurses. In addition to improving oral care delivery such an intervention will help to integrate oral health with general health, further underscoring the importance of oral health to general health and well-being.

  

 

Title: Understanding Disparities in Mental Status Assessment

Specific Characteristics:   

Key Staff:

·         Richard Jones, ScD

·         Jeanne Teresi, EdD. PhD

·         Mildred Ramirez, PhD

Funding Source:  National Institute on Aging (NIA)

Objective:  

This project involves conducting methodological research, namely comparative analyses of simulated and real data using different approaches to detecting item bias or differential item functioning, a particular form of measurement bias or measurement noninvariance.  The research team includes investigators from different institutions who have studied measurement invariance using the methods of item response theory. The substantive issue that motivates this proposal concerns the relationship of race/ethnicity and years of completed education and performance on mental status measures among older adults.  The overarching goal of this research project is to evaluate the extent that item and test bias by race/ethnicity and level of educational attainment influence performance on cognitive assessment measures in late life.      This project uses MIMIC to examine the performance of depression measures among older individuals. It also used scale equating to provide response scale across studies. For example, the Health and Retirement Study is aimed at examining aging and depression longitudinally; however, different response categories used by the Center for Epidemiologic Studies Depression (CESD) scales across waves, makes comparison problematic. The use of IRT allows more legitimate comparison.     

 

 

Title:  Nurse Improving Care for Health System Elders (NICHE)

Specific Characteristics

Key Staff:

·         Elizabeth Capezuti, PhD, RN, FAAN, PI,

·         Mathy Mezey, Ed.D., RN, FAAN, Co-PI

·         Jeanne Teresi, Ed.D., Ph.D. (Evaluation subcontract)

Lead Organization: Hartford Foundation Institute for Geriatric Nursing, New York University College of Nursing

Funding Source: The Atlantic Philanthropies

Objective:

NICHE is a national system improvement program that aims to improve patient-centered care for older adults.  Started in 1992, there are currently 143 active sites in 34 states, as well as in parts of Canada and The Netherlands. NICHE sites use the Geriatric Institutional Assessment Profile (GIAP) to assess their institutional readiness to provide quality care to older adults and to document improvement in geriatric care delivery.  The GIAP serves as a benchmarking tool to assist hospitals in identifying gaps in knowledge about geriatric care, attitudes and perceptions that influence how staff works with older patients, specific practice issues and concerns, and organization attributes of the hospital relevant to geriatric care. The staff-level outcome measures include attitudes and knowledge for each of the defined clinical syndromes in the project.

 

 

Title:  Resource Center for Minority Aging Research (1997-2007): Executive Committee

Specific Characteristics

Key Staff:

·         Rafael Lantigua, MD, PI

·         Steve Shea, MD

·         Olveen Carrasquillo , MD , MPH

·         Jeanne Teresi, Ed.D., Ph.D.

·         Mildred Ramirez, Ph.D.

Lead Organization: Columbia University Faculty of Medicine

Funding Source: National Institute on Aging

Objective:

 

The overarching goal of all funded centers is to reduce health disparities in older minority populations.  This Center endeavored to do so by funding and mentoring minority researchers with research projects related to the theme of enhancing the active life, health and cognition of urban Latino and Black elders.  This Center added to the science of health disparities by funding 42 pilot studies related to social and behavioral sciences, and medical and clinical issues. Additionally, several special issues of medical and science journals were produced devoted to minority health-related topics.  Evidence of success of the program can be measured by the number of pilot investigators who went on to receive additional funding based on their pilot research; pilot investigators have retained 50 grant awards as Principal Investigator (PI), and an additional 55 as Co-PI.  They have published a total of 384 papers in peer reviewed journals; 62 of which were directly related to their pilot projects.  In addition to mentoring activities, the Center evaluated current measures for cultural sensitivity and developed methodological techniques used in developing new culturally-sensitive measures.  CALME also sponsored 357 health, education and recruitment lectures in the community (80% bilingual) and mailed seventeen newsletters containing health-related information to members of the community.

 

 

Title:  Resource Center for Minority Aging Research: Measurement Core

Specific Characteristics

Key Staff:

·         Mildred Ramirez, Ph.D.

·         Jeanne Teresi, Ed.D., Ph.D.

Lead Organization: Columbia University Faculty of Medicine

Funding Source: National Institute on Aging

Objective:

The general objective of this core was to assist the nationwide Measurement Core in developing a protocol for evaluating current measures for cultural sensitivity. Under the leadership of Dr. Ramirez, existing measures were screened and reviewed. Cross-cultural relevance and applicability of existing measures are under investigation.

  

 

Title:  Resource Center for Minority Aging Research: Methods and Data Core

Specific Characteristics

Key Staff:

·         Jeanne Teresi, Ed.D., Ph.D.

Lead Organization: Columbia University Faculty of Medicine

Funding Source: National Institute on Aging

Objective:

The goals of the MDC were to (a) assist the Measurement Core in developing a protocol for evaluating current measures for cultural sensitivity; (b) promote the development and/or application of methodological techniques which can be used in developing new culturally-sensitive measures; (c) provide consultation to investigators regarding their data analyses; (d) assist investigators in the development of new R01's; and (e) assist in scale construction and analyses using common core data across pilot projects.

 

Title:  Diabetes, Obesity, and Vascular Depression

Specific Characteristics:

Key Staff: 

·         Richard Francoeur, PhD

·         Jeanne Teresi, EdD. PhD

Funding Source:  National Institutes of Health (NIH)

Objective:  

The purpose of this study was to investigate the etiology of masked depression in each physiological condition (vascular disease, diastolic hypotension) among respondents from these two subgroups (diabetes, obesity).  The aims were to: (1) clarify distinct patterns of items for depressed affect, low positive affect, and other depressive symptoms; and (2) identify diabetic and obese subgroups and age-related stressors that predict these different patterns of masked depression. This project also used MIMIC to examine the etiology of masked depression among subsamples of blacks and whites in order to clarify distinct patterns of items for depressed affect, low positive affect and other depressive symptoms. One goal was to identify age-related and depression-specific correlates of these specific patterns that can better inform understanding of late-life depression. The New Haven Established Populations for the Epidemiological Study for the Elderly (EPESE) data were used. 

 

Title:  Cognitive and Physical Basis for Disablement in Older Adults

Specific Characteristics:

Key Staff: 

·         Steve Albert, Principal Investigator

·         Jeanne Teresi, EdD. PhD, Subcontract  

Funding Source:

Objective:  

The aim of this study was to examine the effects of impairment on disability among groups of African-American, Latino and white non-Latino elderly from the Washington Heights-Inwood Columbia Aging Project (WHICAP) sample. Groups, defined by disability and cognitive status, were followed longitudinally to examine the relationship between changes in reported disability and changes in motor and cognitive skills. IRT was performed to examine the psychometric properties of these physical function measures. The accuracy of self and proxy reports of disability relative to clinical judgment of disability was examined. The extensive physical function data (task observations and physical impairment measures) collected in this project is a possible source of data for item banking.  

 

 

Title:  Different Approaches to Information Dissemination Partnerships for Quality

Specific Characteristics:

Key Staff: 

·         Douglas Holmes, Subcontractor

·         Jeanne Teresi, EdD. PhD, Subcontractor

Lead Organization: New York State Department of health

Funding Source:  Agency for Healthcare Research and Quality

Objective:

This project aimed to identify evidence-based best practice training modules, and to evaluate two methods for disseminating these best practices into nursing homes and adult care facilities: special training modules provided to facility staffs, or special training modules augmented by the training of surveyors. Three best evidence-based modules targeted for impact on quality indicators and outcomes (falls, affect, and behavior) were selected.  Nursing homes received training in “Bathing Without a Battle,” a program intended to reduce agitation and aggression during bathing among residents with dementia, and “Vision Awareness,” a low cost intervention that aims to increase staff knowledge of visual impairments and improve resident function and quality of life.  Adult care facilities received training in “Vision Awareness” and “Staff Training in Assisted Living Residences” (STAR), a program aimed at helping direct care staff to understand difficult behavior problems and lessen their effects.  Initiation of the training program was associated with reduced falls and enhanced quality of life in nursing homes.

 

 

Title:    Service use, self–reported health and cognitive impairment of community-residing Latino elders

Specific Characteristics:

Key Staff:

·         Mildred Ramirez, Ph.D. PI

·         Jeanne Teresi, Ed.D., Ph.D.

·         Douglas Holmes, Ph.D.

Funded by:   National Institute on Aging

Objectives:

The aims of the study were 1) to provide service use estimates and prevalence estimates of cognitive impairment from a probability sample of Latino elders, most of whom were Puerto Ricans; 2) to provide a profile of those individuals with cognitive impairment; 3) to examine predictors of cognitive impairment, and the association between depressive symptomatology and cognitive impairment were examined. This is one of the few studies that examined the health status and cognitive impairment of older Puerto Ricans residing in the United States .  The study identified rates of cognitive impairment of 15% among low income, medically, underserved older Latinos in New York City .  High rates of comorbid conditions as well as high levels of depressive symptomatology were documented among individuals with cognitive impairment.  Study findings underscore the importance of considering symptoms of depression, particularly in the presence of cognitive disorders when assessing general functioning of older Latinos. Results are relevant to the public health community; evidence suggests that mental health needs of ethnic minorities, and of individuals with low levels of socio-economic status are often addressed by primary care services where they frequently go unrecognized, and/or where the treatment (for such conditions) is not optimal.

 

 

Title: The Development and Psychometric Analyses of the Assessment of Doctor-Elderly Patient Transactions (ADEPT) instrument.

 Specific Characteristics:

Key Staff:       Jeanne Teresi

                        Mildred Ramirez

                        Katja Ocepeck-Welikson

Funded by:   National Institute on Aging

Objectives:

The ADEPT aims to assess interactions between doctors and their elderly patients. It was based on recommendations of an expert panel and designed around the three-function model of the medical interview.   This project examined the development, qualitative analyses, and psychometric testing. The findings indicate that credible scales can be developed for assessing communication behaviors.

 

   

Title: An Evaluation of the Vigil Nurse Call and Passive Monitoring System

Specific Characteristics:  

Key Staff:       Douglas Holmes

                        Jeanne Teresi

                        Mildred Ramirez

Funded by:      New York State Department of Health

Objectives:

This project assessed the extent to which modern technology can augment, and/or substitute for direct staff intervention in non-acute late evening and night-time situations on special care units for persons with dementing illness in the nursing home. The VIGIL monitoring system, evaluated in this study, is comprised of a bed exit sensor, which is positioned under each resident’s bed sheet, and bathroom and bedroom exit monitors. VIGIL alerts caregivers via a silent pager when a high risk resident exits her bed, bedroom, or bathroom according to rules that are established for each resident. This allows caregivers to aid the resident and potentially reduce falls. The impacts associated with the presence of such technology on resident falls and accidents and injuries, and the quality of care provided to, and quality of life experienced by nursing home residents with dementing illness were evaluated.  The program was associated with improved quality-of-life among residents.

 

 

Title:  Analysis of the NIA/Fetzer Foundation Multi-dimensional Instrument and the Daily Spirituality Experience Scale (DSES)

Specific Characteristics:

Key Staff:

·         Jeanne Teresi, Ed.D., Ph.D. PI

·         Douglas Holmes, Ph.D. Co-PI

Funded by:  The Fetzer Foundation

Objectives:

This project aimed to perform psychometric analyses appropriate to the development of scales measuring religiosity and spirituality The DSES evidenced good reliability across several studies with internal consistency estimates in the .90’s. Preliminary evidence showed that daily spiritual experience is related to decreased total alcohol intake, improved quality of life, and positive psychosocial status.

 

 

Title:  Recognition of Depression Among Residents With Dementing Illness

Specific characteristics:

Key Staff:

·         Jeanne Teresi, Ed.D., Ph.D. Principal Investigator

·         Douglas Holmes, Ph.D. Co-PI

·         Robert Abrams, M.D. Psychiatrist Cornell Med Col.

Funding Source:   NYS Department of Health 1/1/94 - 12/31/95

Objectives:

This project assessed the degree to which depression among dementia patients is not recognized by nursing staff. The study sample consisted of thirty residents from the HHAR and three other sites.  Depression is under-recognized in nursing homes, especially among residents with dementing illness.  Heretofore, it had been estimated that approximately 4% - 5% of such residents were depressed; in this study, based on psychiatric appraisal, it was determined that upwards of 16% of demented residents are depressed.

 

 

Title:  Oral Disease Prevention in Seniors: Community Approach

Specific Characteristics:

Key Staff: 

·         Kavita Ahluwalia, DDS, MPH, PI

Funding Source:  Centers for Disease Control and Prevention

Objective:

Oral health training programs for nurses and home attendants caring for homebound seniors were designed, implemented and evaluated as part of this project.

 

 

Title: Clinical Trial of BUSPIRONE

This Phase 4 clinical trial is part of a multi-site investigation involving a total of 12 nursing homes.

Specific Characteristics:

Key Staff

·         Douglas Holmes, Ph.D. PI HHAR

·         Richard Hodder, M.D. Co-PI HHAR

·         Susie Abraham, M.D. Co-PI HHAR

·         Carol Shapiro, RN, MSN

Funding Source:   Bristol Meyers-Squibb

Objectives:

Buspirone is a medication which has been available (and used) for some years in the treatment of anxiety. There is some preliminary evidence that it may be effective in the treatment of behavior disorders of the type found among nursing home residents with dementing illness. Buspirone seemed as a particularly valuable palliative medication, because it has relatively fewer side effects than do other commonly-used medications. The Home participated in a multi-site clinical trial of this medication.

 

 

Title:  Coordinating Center to the Dementia Special Care Projects

Specific Characteristics:

Key Personnel:

·         Douglas Holmes, Ph.D. PI

·         Jeanne Teresi, Ed.D., Ph.D. Co-PI

Funding Source:   National Institute on Aging

Objectives:

The National Institute on Aging (NIA) funded a set of collaborative research projects nationally located at ten sites. These projects were designed to examine the nature and effectiveness of special care unit (SCU) care in institutional settings using state-of-the-art research methods.  A common core data set was used across all sites to examine issues such as resident and environmental characteristics, prevalence of dementia, costs of care, and resident outcomes.  According to the NIA, results from these studies have made a significant contribution to current knowledge about the organization and impact of these settings.

 

   

Title:  Impacts of Special Care Units (SCUs)

Originally investigator-initiated, this project became the "11th" of the 10 cooperative studies supported by the National Institute on Aging.

Specific Characteristics:

Key Personnel:

·         Jeanne Teresi, Ed.D., Ph.D. PI

·         Douglas Holmes, Ph.D. Co-PI

·         Mildred Ramirez, Ph.D. Co-PI

Funding Source:   National Institute on Aging

Objectives:

Following an earlier study of SCU impacts in four facilities, this project examined in great detail the effects of SCU placement on residents with dementia and on non-demented residents who, as an outgrowth of SCU placement, no longer are commingled with persons exhibiting of cognitive and behavioral impairment. Comprehensive information was collected from residents and staffs in a random sample of 12 New York state nursing homes; all data were collected at six-month intervals on three occasions, permitting an analysis of change over time.

 

 

Title:  Service Costs Associated With Dementia Special Care Units

This is one of the 12 National Institute on Aging Collaborative Studies of Special Dementia Care

Specific Characteristics:

 Key staff:

·         Douglas Holmes, Ph.D. PI HHAR

·         Jeanne Teresi, Ed.D., Ph.D. Co-PI HHAR

Funding Source:  National Institute on Aging

Objectives:

To date there has been little or no effort to establish the costs of caring for nursing home residents with dementing illness in general, or of residents of Special Dementia Care Units (SCU's) in particular. Using an innovative barcode recording and database system (InfoAide©) developed at the Research Division, this study will provide precise information concerning staff inputs: who did what, for whom, and for how long. Inputs other than personal services also are recorded, using a combination of barcode technology and handwritten entries. These data then are merged with individual resident health and status data collected through the ongoing study of impacts. Using the same technique (leased to the investigators), a "sister" study was conducted by the University of California at Berkeley .  Few systematic differences between SCUs and non-SCUs were found.  Such statistically significant differences as have emerged are relatively trivial in terms of magnitude.  However, using advanced statistical modeling techniques, it appears that incremental staff inputs made in SCUs have substantially (and statistically significant) greater impacts on residents than they do in traditional units.

 

 

Title:  Impacts of Racial Diversity in Nursing Homes: Demoralization and Attitudes Toward Residents Among Certified Nurse Assistants in Relation to Job Stressors and Work Resources

Specific Characteristics:

Key staff:

·         Mildred Ramirez Ph.D. PI

·         Jeanne Teresi, Ed.D., Ph.D. Co-PI

Funding Source:  National Institute on Aging

 Objectives:

In many nursing homes, the great majority of staff are persons of color while the residents are predominantly white, non-Hispanic. Accompanying these differences, our pilot surveys have shown high prevalence of racially-tinged epithets used by persons with dementing illness. The premise on which this study was based is that resident care is almost bound to suffer from the very fact of consistent racial differences between residents and caregivers, coupled with the unwitting use of racial invective. Certified Nurse Assistants (CNAs) (n=104) caring for a probability sample of residents in 22 New York State nursing homes were interviewed, longitudinally, regarding work demands and stressors, support and training, and job-stress outcomes.  Twenty-seven percent of CNAs reported pejorative name-calling by their residents.  Hierarchical regression analyses showed that (a) increase in perceived pressure to complete tasks, (b) assignment size, and (c) attendance at support groups were associated with CNAs’ demoralization at follow-up. A decrease in perceived racism and increased in-services about confused residents contributed to more positive attitudes toward residents. Examination of the quality of long-term care should include consideration of cultural diversity.

 

 

 Title:  Barcode Technology Applied to Physician Medicare Billing

 Specific characteristics:

Collaborating Institution:    Hebrew Rehabilitation Center for the Aged ( Boston )

Key staff

·         Douglas Holmes, Ph.D. PI (HHAR)

·         Claire Gutkin, Ph.D. Co-PI (HRCA)

Funding Source:   National Institute on Aging

Objectives:

Working with the Hebrew Rehabilitation Center for the Aged in Boston (HRCA), the Research Division developed a variant of the InfoAide system aimed to be used by physicians as the basis for chart entry and for Medicare billing. The HRCA estimates multiple thousands of dollars lost, yearly, as a function of physician under-billing for services provided. InfoAide is intended to correct this situation, while simultaneously facilitating physician record-keeping.

 

  

Title:  Study of Physician Extenders in Nursing Homes

Specific characteristics:

Collaborating Organization:  NYS Department of Health

Key Staff:

·         Douglas Holmes, Ph.D. PI

·         Stephen Yorke Field Coordinator.

·         Roger Logan Field Cordinator.

Funding Source:   New York State Department of Health

Objectives:

With the growing numbers of persons in nursing homes, there is corollary need for innovative approaches in the provision of medical care. One such approach involves the use of "physician extenders," in this case taken to include Physician Assistants, and Nurse Practitioners. Using the InfoAide barcode system, all inputs made by physicians and by the physician extenders were measured for a period of one week, 24 hours per day, in 23 New York State nursing homes. This information is useful in determining the extent to which there is overlap of function among the three groups, and as a basis for the development of associated reimbursement policy.

 

 

Title:  National Workgroup on Research and Evaluation of Special Care  (WRESCU)

Specific Characteristics:

Key Staff:

·         Douglas Holmes, Ph.D. (Founder/Director)

Funding Sources:

·         Helen Bader Foundation 1993 - 1996

·         Retirement Research Foundation 1997-1999

·         National Institute on Aging 1993 - 2000

·         Intramural 1996 -

Objectives:

At a 1991 meeting in St. Louis , Missouri , of almost 500 persons involved with the delivery of services in SCUs, Dr. Holmes saw the need for a national workgroup consisting of researchers and policy planners in the field of dementia research. Working closely with the National Institute on Aging and with representatives of the Alzheimer's Association, he created the national Workgroup on Research and Evaluation of Special Care Units ("WRESCU"). At first, costs associated with the maintenance of this organization were met entirely by the Hebrew Home; soon, as WRESCU gained prominence, it was possible to attract support from the Helen Bader Foundation for WRESCU expansion, and for the allied development of written materials. The Supplement to the Alzheimer's Journal is an example of such materials, of which more are in the planning process. By design, WRESCU membership has been kept small, being confined to persons who are relatively prominent in the field of dementia research: there currently are approximately 150 members. However, as a measure of its prominence, WRESCU is supported as a "Formal Interest Group by the Gerontological Society of America."

 

 

Title:  Depression Recognition Program for Nursing Home Staff

Specific Characteristics:

Collaborating Institution:   Cornell Medical College

Key Project Staff:

·         Jeanne Teresi, Ed.D., Ph.D

·         Douglas Holmes, Ph.D. Co-PI

·         Carol Shapiro, RN, MSN Training Spec.

·         Danielle Butin, MPH, OTR Training Spec.

Funding Source:   National Institute for Nursing Research

Objectives: 

This study dovetails with the study of depression funded by the New York State Department of Health, in that it supports in-depth examination of the relationships among resident characteristics, manifestations of depression, and recognition of depression. Probability sample of nursing homes across the State of New York , and of residents within each of the facilities were the study participants. African Americans were generally seen by psychiatrists as having less depressive symptomatology than residents from other ethnic groups. The data suggest that nurse aides, perhaps because they see residents more often or because they are less influenced by demographic characteristics, may be the most valid source of information about residents’ depression. In contrast, after partialing out the degree of depression severity, nurses tended to overrecognize depression among African-American residents. Social workers underrecognized depression among residents with cognitive impairment and/or Parkinson disease and among women, and overrecognized depression among African Americans.

Product:

Taken with the NYSDOH study, the RD-HHAR developed comprehensive, definitive materials relating to specific recognition, measurement, and intervention strategies. The NCNR supported the rigorous assessment of both the process of recognition and the impacts of the training materials. 

 

 

Title:  Pilot Study of Impacts of Senior Center Participation Among Clients Enrolled in a Cluster Homecare Program

Specific Characteristics:

Key Staff:

·         Jeanne Teresi, Ph.D.

·         Jacqueline Savinon, BA Project Coordinator

Funding Source:   United Hospital Fund (NYC)

Objectives:

"Cluster care" constitutes a new approach to the delivery of in-home services to persons who qualify for home attendant care. Adhering to this model, one worker is assigned to two or more clients who live in close proximity (usually in the same building). The worker rotates the care delivery schedule among the several clients, at the same time being responsive to "emergency" calls from any individual client. The United Hospital Fund ("UHF") funded a pilot study which provided training, transportation, and supervision associated with an extension of this concept, to include workers' taking clients to a neighboring senior center and working with the clients while at the center.

 

 

Title:  Evaluation of Training Program for Community-Dwelling Elders with CHSP

Specific Characteristics:

Primary Organization:   Visiting Nurse Services of New York City (VNS) 

Key Staff:

·         Jeanne Teresi, Ed.D., Ph.D. Field Director

·         Gabriel Boratgis, MSW Field Coordinator

Funding Source:  Visiting Nurse Service of NY

Objectives:  

This project aimed to conduct interviews among a probability sample of 350 CHSP discharges from acute care, experimentally assigned to either an experimental (training) program or to control status. Follow-up data were collected 6 months later; telephone interviews were conducted with key informants at Time 1.

 

 

Title: A Study to Determine Whether Training Materials Dealing With Resident Sexual Expression Should Be Developed for Family Members and for Nursing Home Staff.

Specific Characteristics:

Key Personnel: 

·         Douglas Holmes, Ph.D.

Funding Source:  Fan Fox and Leslie Samuels Foundation

Objectives: 

Through a combination of focus groups and a mailed survey to nursing homes in New York City , to identify the specific foci which should be represented in a training program to be developed for nursing home staff and residents' families, dealing with resident intimacy and sexual expression.

Sample:

Population of nursing homes in New York City

Product:

The RD-HHAR completed an award-winning training video titled “Freedom of Sexual Expression: Dementia and Resident Rights in Long-term Care Facilities” sponsored by a grant from the New York State Department of Health and by the Fan Fox and Leslie Samuels Foundation. Narrated by Anne Meara, this program looks at sexuality and intimacy as basic human rights that should not be denied simply because the person has a level of decreased cognizance and lives in a nursing home. The video tastefully shows various sexual expressions, the effect of those expressions on the residents and those around them, and methods to allow freedom of sexual expression while maintaining a comfortable environment for other residents and staff. It also provides staff members with effective strategies to deal with inappropriate sexual behaviors, encourages family members to understand and respect their loved one's continued need for intimacy, and provides sample policies and procedures on residents' rights regarding sexual expression and physical protection. “Freedom of Sexual Expression: Dementia and Resident Rights in Long-term Care Facilities” has received national media attention.   

  

 

Title:  Clinical trial of Donepezil Hydrochloride (E-2020)

Specific Characteristics:

Collaborating organization(s):  Part of national, multi-site trial

Key Project Staff:

·         Douglas Holmes, Ph.D. PI

·         Susie Abraham, M.D. Co-PI

·         Carol Shapiro, RN, MSN Study Coordinator

Funding Source:  ESAI America, Inc./Pfizer Pharmaceuticals

Objectives:

E-2020 is a highly specific acetylcholinesterase re-uptake inhibitor which holds particular promise for attenuating the rate of cognitive decline among persons with Alzheimer's disease.  E-2020 seemed as a particularly valuable palliative medication, because it has relatively fewer side effects than do earlier drugs of this category, most notably Tacrine ("Cognex"). The Home participated in a multi-site clinical trial of this medication.  

 

 

Title:  Clinical trial of Risperidone

Specific Characteristics:

Primary Organization:   Nathan Kline Institute, contracted to the Hebrew Home for the Aged at Riverdale

Collaborating Organizations:   Part of a multi-site investigation

Key Staff:  

·         Douglas Holmes, Ph.D. PI HHAR

·         Susie Abraham, M.D. Co-PI HHAR

·         Carol Shapiro, RN, MSN Study Coordinator. HHAR

Funding Source:   Janssen Pharmaceuticals

Objectives:

This study aimed to demonstrate the efficacy of Risperidone in the amelioration of behavior disorder among nursing home residents suffering from dementia. This particular medication holds particular promise because its use is not accompanied by side effects typically associated with neuroleptics commonly used in nursing homes. The Home participated in a clinical trial of this medication

 

 

Title:  Development and Maintenance of a Website Dealing with the Care of Persons with Dementia

Specific Characteristics:

Key Staff:

·         Douglas Holmes, Ph.D. PI

·         Jeanne Teresi, Ed.D., Ph.D. Co-PI

·         Mildred Ramirez, Ph.D. Co-Investigator

·         David Lindeman, Ph.D. Primary Consultant

Funding Source:   The Retirement Research Foundation

Objectives:

Using a panel of experts drawn from sites across the United States , this project aimed to develop:

·         A single, "user-friendly" source of current "wisdom" relating to quality institutional and community-based dementia care.

·         A panel of consultants and/or lecturers reflecting the various aspects of dementia care.

·         A website which will serve as the primary means for making this information available.

·         A structure which would guarantee continued upgrading and distribution of such a manual -- after various forms of grant support are exhausted.

HHAR staff worked on the implementation of an Internet Website, accessible on a membership basis, to provide information regarding findings, works in progress, consultants, and speakers.

 

 

Title:  Survey of Assisted Living Facilities

Specific Characteristics:

Collaborating Institution:  Island Peer Review Organization

Key Staff:

·          Gabriel Boratgis, MPH

·         Stephanie Silver, MPH

Funding Source:  New York State Department of Health

Objectives:

The purpose of this study was to develop an objective description of the residents of residents of assisted living facilities in New York State .  Data were obtained through in-person interviews with assisted living residents and staff, chart reviews, and in-person or telephone interviews with family members.  Measures included a number of standardized scales, focusing particularly on scales found which comprise the CARE measure, and the Patient Review Instrument, formerly used by the NYSDOH in developing Resource Utilization Group Scores for nursing home residents.  Primary results were useful to the State and to the NYS Legislature in decision-making regarding reimbursement for this form of service.

 

 

Title:  Behavioral Consequences of Vision Care for Persons with Dementia

Specific Characteristics;

Key Staff:

Funding Source:   New York State Department of Health

Objectives:

The prevalence of low vision in nursing homes is high, generally estimated at 36% to 48%, which is 13 to 15 time higher than found among community residents of similar age. Prevalence of low vision accompanying Alzheimer's Disease is even higher; moreover there is a higher likelihood of concomitant visual disorders associated with the presence of Alzheimer's Disease.  While Low vision can be improved or enhanced through use of corrective lenses, excess disability and behavior disorder can result from undiagnosed and uncorrected vision impairment. This can lead to falls, reduced functional capacity, ambulatory ability and poor quality of life.  Prevention of excess disability associated with correctable low vision is key. It has been estimated that 20% of functional blindness and 37 percent of visual impairment could be remedied by adequate refractive correction. However, it also has been estimated that vision assessment and treatment is provided on a routine basis for less than 20% of nursing home residents.  This study employed a quasi-experimental design to examine outcomes associated with a low cost intervention which included: (a) diagnosing vision disorder among cognitively impaired individuals, (b) correcting the disorder through prescription of glasses with an attachment to secure the glasses and (c) providing staff training in vision recognition and reinforcement methods to insure that glasses are worn by residents with cognitive impairment. It was found that a significantly decreased decline in function was associated with the provision of both eyeglasses and Croakies to the residents and staff training to recognize vision problems and provide reinforcement techniques, rather than only the provision of eyeglasses and Croakies.