ICARE: The Fruits of Interagency Collaboration
By Terry Albanese, PhD
Four years ago, Kyle Allen DO, along with Senior Services staff, and researchers within Summa’s Health Services Research and Education Institute (HSREI) began meeting monthly with researchers from The University of Akron, Kent State University, and NEOUCOM who share an interest in geriatrics research and education. Also at the table were representatives from the Area Agency on Aging, who have a history of collaboration with Summa’s Senior Services. Representatives from these agencies included physicians, pharmacists, nurses, social workers, psychologists, sociologists, and psychiatrists who recognized the value of interdisciplinary collaboration and the exchange of essential knowledge, skills, and resources.
From these meetings the Interdisciplinary Consortium for Aging Research and Education (ICARE) was born. The mission of ICARE is to build a strong network and partnerships, creating a foundation for interdisciplinary geriatric research and education. Members share a vision for ICARE to become an internationally renowned center of excellence in geriatric education and research. To that end, members established a formal Memorandum of Understanding between organizations and subsequently developed policies for conducting interdisciplinary and interagency research. Currently, a website is being developed to broaden opportunities for information sharing and collaboration.
Today ICARE includes:
- Researchers from several of the Summa Foundation-funded core labs
- The University of Akron (College of Nursing, Institute for Health and Social Policy, Department of Psychology/Gerontology)
- Kent State University (College of Nursing, Department of Family Studies and Sociology, Department of Psychology)
- NEOUCOM, NEOUCOP
- The Area Agency on Aging 10B, Inc.
- Cleveland State University
- Creative Action LLC
- Benjamin Rose Institute’s Margaret Blenkner Research Center
ICARE is open to all researchers, practitioners, administrators, and students who share our mission.
ICARE members share the following goals:
- Support integration of clinical and academic research
- Build strong network of interdisciplinary and inter-institutional research focused on geriatric health, aging, chronic illness care issues, and end of life care issues
- Develop partnerships with community agencies
- Provide opportunities for development of academic and clinical faculty
- Strive for innovation in geriatric research, education, and practice
- Foster development of students in ongoing research and education to provide infrastructure for research projects for students
- Develop an infrastructure to support identification of beneficial grant opportunities as well as support in grant writing and a repository for information
- Promote educational initiatives through this consortium to enhance knowledge, educational programs, and curriculum for aging health and policy issues, geriatric medicine and nursing, and gerontology
Among the projects that are currently in progress:
The PEACE trial – Promoting Effective Advance Care for Elders (PEACE) is led by co-principal investigators Kyle Allen DO and Steven Radwany MD. The aim of this randomized pilot study is to determine the feasibility of a fully powered study which will test the effectiveness of an in-home interdisciplinary care management intervention to improve the quality of palliative care for consumers of Ohio’s community-based long-term care Medicaid waiver program, PASSPORT. This study addresses pain and symptom management, self management support, communication and models of health care delivery. The long-term goal of this research program is to inform policy-making that will improve access to and quality of palliative care across the continuum of care. A pre-pilot study was funded by the Summa Foundation for $10,000. The current pilot study is funded by a National Palliative Care Research Centers (NPCRC) Pilot/Exploratory Project Support Grant. The PEACE Trial was awarded $154,000 ($77,000/year for 2 years).
Additional studies conducted by ICARE members that are outgrowths of the PEACE trial include:
1) Kent State took the lead, in collaboration with ICARE researchers from NEOUCOM and Summa Health System, to conduct a survey of care managers from the Area Agency on Aging 10B and the Western Reserve Area Agency on Aging to measure knowledge and attitudes of care managers (both registered nurses and social workers) regarding palliative care issues and their role in delivering palliative care.
2) ICARE researchers from NEOUCOM are taking the lead in revising and expanding this survey to a state-wide survey of all Area Agencies of Aging throughout the state of Ohio.
3) A related survey is being conducted by Sarah Snyder DO, currently a geriatric fellow and future palliative medicine fellow. Her study involves a survey of all primary care physicians in the greater Akron area regarding their attitudes and practices about advance directives and end-of-life care discussions with their patients who have an advanced chronic or terminal illness.
4) A final outgrowth of the PEACE trial is the production of a palliative curriculum to teach care managers how to approach palliative care discussions and interventions with chronically ill patients who are not at the end of their lives. The University of Akron and Summa took the lead on this project which received funding from the FirstMerit Foundation.
Medication Adherence – Led by Sue Fosnight RPh, a series of studies is being conducted on medication adherence. An initial study supported by Summa’s Summer Research Fellowship program will focus on verifying the suspected causes of non-adherence and testing the practicality of a tool to discover these causes. In this study nurses will screen for medication non-adherence when patients are admitted. Researchers will then conduct more in-depth interviews with patients to determine the various contributors to medication non-adherence. A subsequent study will focus on interventions to improve adherence. Currently Sue has developed an algorithm to direct patients to specific solutions/interventions to overcome their barriers to medication adherence. Results from the initial study will be used by the research team to enhance the algorithm which will then be tested for effectiveness.
Nursing Home to Home Study – An interdisciplinary collaborative among HSREI, Kent State University College of Nursing and the Area Agency on Aging will be examining data from the AHRG-sponsored AD-LIFE trial – focusing on patients who were successfully discharged home from a nursing home. For most, a successful transition from nursing home to home means an increase in quality of life and reduced health care costs. Identifying the various factors that contribute to these successful transitions will help define the service design needed to support older adults who prefer to live at home.
Stroke Study - Creative Action LLC in partnership with Summa’s Health Services Research & Education Institute were funded by the National Institute on Aging to test the feasibility of developing an iPhone-based medication reminding and medical data collection system. The system is called iRxReminder. The project focused on delivering post-stroke recovery support including education and medication reminding to older adults recovering from a Stroke or TIA.
The system consists of web-based management software and an iPhone Application. The application allows customizable surveys, medication reminding, and study activity tracking in real time. The software reminds participants to take their pills, delivers interactive surveys, and multi-media educational materials. This enables researchers conducting drug interaction, behavioral, and healthcare studies to easily and affordably deploy real-time monitoring. The study was successful in tracking medication adherence with patients averaging 76% compliance among all drugs. The system was used to deliver education pod-casts based on materials developed for the STEPS Stroke Research trials conducted at Summa. Participants with iPhones had higher scores and 80% of participants gained in stroke knowledge over the 2-month study compared to those with a booklet, only 20% of whom showed a gain in stroke knowledge.