MOUNT SINAI MEDICAL CENTER
Claude D. Pepper Older Americans Independence Center

Albert L. Siu, M.D.
Principal Investigator
  212-241-4290   albert.siu@mssm.edu
R. Sean Morrison, MD
Co-Principle Investigator
  212-241-1466   sean.morrison@mssm.edu
Christian Espino
Program Administrator
  212-241-4632   christian.espino@mssm.edu
     
CENTER DESCRIPTION

The overarching goal of the Mount Sinai OAIC is to improve independence for older adults with serious illness and to consolidate the substantial progress made in the first eight years of the OAIC at the Icahn School of Medicine at Mount Sinai (ISMMS).  The OAIC supports research in seriously ill older adults (geriatric palliative care research) with the overall goal of creating the needed evidence base that, in the words of Claude D. Pepper, will  “…lighten the burden of those who suffer.” Our specific aims are:

1.    To expand a transdisciplinary research program focused on: a) improving quality of life and  independence and b) healthcare delivery models that improve care for seriously ill older adults and their families.

2.    To identify, recruit, and train leaders in aging and palliative care research through: a) mentoring relationships with successful investigators; b) strengthening and expanding Mount Sinai’s existing research training programs in aging and palliative care; and c) support for pilot projects, statistical and analytic consultation, use of population-based data, and instrument development and measurement.

3.    To expand research infrastructure that will support new and ongoing research in the care of seriously ill older adults by a) providing expertise in research design, measurement, and analysis, b) developing and applying innovative research designs, analytic techniques, and measures to OAIC and externally supported projects, c) applying to aging research relevant methods not currently in widespread use (e.g. item response theory, propensity score methods, latent class growth analyses), d) supporting innovative research employing newly available population-based data; and e) supporting two new cross-cutting themes focused on dementia and implantation science.

4.    To expand ongoing collaborations with other OAICs and National Palliative Care Research Center (NPCRC) and create new collaborations with NIA’s ADRCs,  RCMARs, and others

5.    To develop a research center that bridges geriatrics and palliative care and that will serve as a model for research that has not been well addressed previously by these two transdisciplinary specialties.

The OAIC consists of the following cores:  1) Leadership and Administrative Core (LAC), 2) Research Education Component (REC), 3) Pilot Exploratory Studies Core (PESC), 4) Measurement, Methods, and Analyses Core (RC-MMA), 5) Population Research and Methods Core (RC-PRM), and 6) Population Data Use and Management Core (RC-PDM).    Through the REC, we are providing junior faculty with educational activities and training experiences in improving the care of older adults with serious illness. These young investigators will have opportunities to participate in research through the PESC and external projects linked to the OAIC.  They and research supported in the OAIC are supported by three resource cores.  Our RC-MMA core provides statistical, methodological and programming expertise to investigators, as well as mentoring in those areas. The RC-MMA provides our investigators with access to measurement support including measures developed through item response theory.  The new RC-PDM core was developed to assist investigators with database management, sampling procedures, and analytic techniques needed for the increasing numbers of population-based datasets (e.g., NIA”s Health and Retirement Study [HRS] and National Health and Aging Trends Study [NHATS]).  All these cores are coordinated and integrated by the LAC In sum, our aim is to ensure that all health care professionals have the knowledge and evidence base necessary, and that our institutions have the necessary clinical models to provide high quality geriatric palliative care to the rapidly increasing numbers of older adults living with serious illness and their families.


CORES
Leadership and Administrative Core (LAC)
Leader 1:    Albert Siu, MD, MSPH   albert.siu@mssm.edu
Leader 2:    R. Sean Morrison, MD   sean.morrison@mssm.edu
The Leadership and Administrative Core is housed in the offices of the Chairman of the Mount Sinai Department of Geriatrics. Core staff consists of: Center Primary Investigator and Core Leader: Albert L. Siu, MD The Leaders of the Research Education Component: Nathan Goldstein, MD, R. Sean Morrison, MD, and Juan Wisnivesky, MD, PhD; Pilot and Exploratory Studies Core leaders: Kenneth Boockvar, MD; Population Research and Effectiveness Core leaders: Melissa Aldridge, PhD; Measurement and Data Management Core: Jeanne Teresi, PhD Vice Chair for Education of the Department of Geriatrics and Palliative Medicine: Rosanne Leipzig, MD, PhD Director of the Center to Advance Palliative Care: Diane Meier, MD Three standing committees advise the Center regarding policy and conduct of its programs: An OAIC Executive Committee (OAIC EC or EC) of OAIC core leaders and institutional leadership A Research Advisory Committee (RAC) of senior investigators not currently involved in the OAIC as investigators or mentors

Research Education Component (REC)
Leader 1:    Nathan Goldstein, MD   nathan.goldstein@mssm.edu
Leader 2:    Juan Wisnivesky, MD, PhD   juan.wisnivesky@mountsinai.org
The OAIC’s Research Education Component (REC) at the Icahn School of Medicine reinforces junior faculty’s interest in improving the care of seriously ill, older adults with educational activities and training experiences while promoting the development of future research leaders. The REC’s specific objectives are to: Recruit talented faculty from different disciplines who are committed to academic careers improving the care of older adults with serious illness Provide advanced training in research methodologies needed to conduct high quality, ethical, and multidisciplinary palliative care research for seriously ill older adults Provide multidisciplinary mentorship and individually tailored career development plans Support trainees in conducting and disseminating research studies to assess questions related to the health and independence of older adults or related palliative care issues Facilitate attainment of academic and life skills to sustain long-term success as independent investigators and future leaders in geriatric and palliative care medicine Prepare and assist trainees in obtaining external funding to continue an academic research career.

Pilot and Exploratory Studies Core (PESC)
Leader 1:    Kenneth Boockvar, MD, MS   kenneth.boockvar@mssm.edu
Leader 2:    Barbara Vickrey, MD, MPH   barbara.vickrey@mssm.edu
The Pilot and Exploratory Studies Core (PESC), builds upon a 15-year foundation of research in palliative care, disability, and function at Mount Sinai; an established record of successful mentorship by the OAIC senior investigators; and a strong and consistent track record in conducting collaborative and interdisciplinary research that will accomplish the following specific aims: Facilitate pilot and exploratory studies that will examine the relationship of pain and other distressing symptoms to independence, function, and disability; develop interventions directed at the treatment of pain and other distressing symptoms in older adults; and explore interventions to improve quality of life and promote function and independence for older adults living with serious and chronic illness Encourage the development of junior faculty by providing a mechanism to obtain mentored, hands-on research training and develop preliminary data in aging and palliative care that will lead to the development of larger federally or foundation-funded research projects and career development awards focused on improving care and promoting independence for older adults with advanced illness Support senior and mid-level faculty who are conducting studies in palliative care and aging who are embarking on new research projects requiring pilot data; palliative care research in younger populations who would like to expand or shift their research into aging; and aging research unrelated to palliative care who would like to refocus their work to fit within our OAIC theme Foster collaborative research among investigators from different disciplines, specialties, and institutions

Measurement, Methods and Analysis Core (RC-MMA)
Leader 1:    Jeanne Teresi, PhD   teresimeas@aol.com
Leader 2:    Mildred Ramirez, PhD   milramirez@aol.com
The goal of the proposed RC-MMA is to improve independence for older adults with serious illness through research and leadership training in geriatric palliative care methods. RC-MMA will support this effort by providing measurement consultation, evaluation and analyses for selected core projects.

Population Data Use and Management Core (RC-PDM)
Leader 1:    Amy Kelley, MD, MSHS   amy.kelley.mssm.edu
Leader 2:    Katherine Ornstein, PhD   katherine.ornstein@mssmn.edu
The Population Data Use and Management (RC-PDM) Core has pursued its objectives of leveraging existing national survey, administrative and health system data to support OAIC research on geriatric palliative care. As a newly established Core, this core has been highly productive in providing data management and operational support to OAIC investigators working with existing data sources through close partnership with RC-PRM and RC-MMA.

Population Research and Methods Core (RC-PRM)
Leader 1:    Melissa Aldridge, PhD   melissa.aldridge@mssm.edu
Leader 2:    Carolyn Zhu, PhD   carolyn.zhu@mssm.edu
The Population Research and Effectiveness (PRE) Core contributes to the goals of the OAIC by providing statistical, methodological, and programming expertise, as well as mentoring in those areas, to investigators in the School’s OAIC. This core has been highly productive in providing consultations and support for numerous OAIC investigators confronted with methodological and analytic issues that occur in the study of older adults with serious illness. Our Core’s consultants have a broad range of knowledge regarding research methods to serve as potential consults to OAIC investigators. Resources and expertise are provided in a variety of ways and throughout all phases of the research process—from design to interpretation and presentation of findings to: To provide sophisticated, cutting edge methodological, statistical, and programming support to OAIC investigators. To apply advanced research and statistical methodology (e.g., propensity scores, instrumental variable estimation, competing risk analysis) used in other fields but not commonly applied to aging-related research. To collaborate closely with the RCDC and RCDSC to ensure that junior faculty obtain research methods training to advance their current knowledge and expertise. To develop the infrastructure for population based research by hiring and training data analysts who will conduct data management and programming functions and provide statistical expertise in cutting edge research methods.

CAREER DEVELOPMENT
REC Scholar, Research & Grants Funded During Pepper Supported Time Years /
Publications
 
Rita C Crooms
Instructor / Mount Sinai Department of Neurology
Palliative Care for High-Grade Glioma
Specific Aims: High grade gliomas (HGG) account for 80-85% of primary brain tumors. Despite advances in cancer-directed therapy, patients with HGG have poor prognosis and median survival on the order of months. Patients have significant supportive care needs, but are referred to palliative care and hospice less frequently and later in their disease course than patients of other cancer types. The reasons for these discrepancies are not clearly described in the literature. There have been a number of studies, both qualitative and quantitative, suggesting that this population has a high burden of physical and psychosocial symptoms and substantial unmet need for comprehensive symptom management and palliation. However, despite evidence of unmet symptom management and advance care planning needs for glioma patients, it is not clear how much different potential barriers (at the level of patient, provider, and system) contribute to these gaps in care and thus should be the targets of clinical and/or policy interventions. To characterize these barriers and the extent to which they impact care quality, this proposal has the following aims: 1. a. To quantify the degree to which palliative care needs, including comprehensive symptom assessment, psychosocial support, and advance care planning for HGG patients are currently being met relative to established standards of palliative care, as well as to characterize at what point in the disease trajectory specialty palliative care involvement becomes appropriate. Hypothesis: HGG patients have a broad range of palliative care needs that are not being met or are addressed at a very advanced stage of disease. b. To assess existing structural approaches to providing supportive care services in a range of neuro-oncology treatment settings. Hypothesis: Some neuro-oncology centers have some supportive care structures in place that incompletely address palliative care needs and should be taken into account when designing new interventions. 2. a. To determine the preferences of HGG patients and their caregivers regarding approaches for introducing palliative care closer to time of diagnosis. Hypothesis: HGG patients are open to receiving palliative care when it is introduced and framed in a way that accurately reflects the role of palliative care as an additional layer of specialized support to augment, rather than replace, cancer-directed treatment and that emphasizes palliative care as distinct from hospice and end of life care. b. To characterize neuro-oncologist attitudes regarding the timing, method of delivery, and perceived impact of palliative care for HGG patients. Hypothesis: Neuro-oncologists are reluctant to refer patients to palliative care
2020-2022 /
6 (total)
5 (1st/Sr)
 
Leah Blank
Assistant Professor / Mount Sinai Department of Neurology
Guideline Concordant Prescription in Older Adults with New Epilepsy: Determinants and Outcomes
Epilepsy incidence peaks in older adults and over 95% of persons with epilepsy (PWE) are on anti-seizure medication (ASM), yet up to 40% of newly diagnosed patients are still started on medications that carry unnecessary risk. Older adults are more vulnerable to medication adverse effects due to comorbidities and polypharmacy. While neurologic societies have created evidence-based recommendations for the initial use of particular agents (e.g. levetiracetam, lamotrigine) that mitigate drug adverse events, these recommendations remain inconsistently applied, likely related to ineffective knowledge dissemination strategies. Initial drug choice in epilepsy is particularly important because once a drug is prescribed it is often not changed. This clinical inertia exists because 1) most will experience seizure reduction with their first drug, and 2) drug switching can be dangerous, leading to breakthrough seizures. Therefore, older adults with epilepsy are often exposed to their first drug long-term. Furthermore, initial drug discontinuation is associated with future non-adherence, putting those who receive sub-optimal first prescriptions at higher risk of long-term seizure related injury and mortality. As our population ages, epilepsy incidence is expected to continue to grow with the overwhelming majority of new cases in the older adult population. In this growing population, epilepsy is associated with a range of cognitive and psychological comorbidities which may additional complicate decision-making around prescription choice. The ultimate goal of this work is to improve epilepsy outcomes in older adults by improving evidence-based prescribing in new-onset epilepsy. In order to develop and implement a point-of-care decision aid for evidence-based first prescription we must first define determinants of suboptimal prescription as well as the short-term adverse outcomes associated with non-guideline-concordant prescription.
2020-2022 /
17 (total)
9 (1st/Sr)
 
Julia L. Frydman
Instructor / Mount Sinai Department of Geriatrics & Palliative Medicine
Predictors of Inpatient Palliative Care Consultation for Older Adults with COVID-19
Specific Aims: Current literature regarding palliative care for patients with COVID-19 is limited, documenting challenges of prognostication in the setting of limited clinical information, changes in code status after consultation, and expansion of palliative care services during the pandemic. Understanding referral patterns to specialty palliative care consultation is crucial to ensuring all patients have equal access to high-quality serious illness communication at the right time in their illness trajectories. Given the widely recognized disparities in morbidity and mortality during the COVID-19 pandemic, it is particularly important to assess whether race was a predictor of inpatient palliative care consultation. Significant racial disparities in palliative care existed prior to the pandemic. Although not studied in the context of palliative care specifically, provider implicit racial bias, or the unconscious reliance on negative cultural stereotypes, is hypothesized to be one determinant of racial disparities in healthcare. Studies have shown that physicians, like the population at large, have pro-White implicit bias. Furthermore, there is evidence that implicit racial bias has a tangible impact on provider behavior. It is important to know whether primary providers’ implicit racial bias may have influenced consultative practice for patients with COVID-19. The exacerbators of implicit bias – time pressure and clinical uncertainty – were ubiquitous at the height of the pandemic, potentially leading to reliance on negative cultural stereotypes: Did providers assume that Black patients had worse prognoses compared to White patients of similar illness severity? And, did this assumption lead them to pursue palliative care consults earlier as a substitute for disease-directed therapy?
2020-2022 /
12 (total)
7 (1st/Sr)
 
Zainab Toteh Osakwe
PhD, MSN, RN, NP. Assistant Professor / College of Nursing and Public Health, Adelphi University
National Perspectives of Nurse Practitioner (NP) Provider Home Based Medical Care (HBMC) in Assisted Living Communities
Persons with Alzheimer’s disease and related dementias (ADRD) who live in the community have particularly high unmet needs for consistent medical care and use the emergency department (ED) for episodic care more frequently than their counterparts in nursing homes.1,2 By bringing medical care to the homes of individuals who have difficulty accessing office-based care, home based medical care (HBMC) appears to be one approach to preventing poor outcomes associated with potentially avoidable hospital use. 3,4 Despite the apparent benefits, wide scale implementation of HBMC has been slow, mainly because of the critical shortage of HBMC providers.4 Consequently, other health care providers such as physician assistants and nurse practitioners (NPs) have been utilized to augment the physician workforce in the delivery of HBMC. In 2013, NPs made 1.1 million home visits and were the most common provider of home visits to rural residents in the U.S.5,6 In 2017, NPs provided over 2 million home visits and continued to be the predominant provider of home visits to older Americans including rural residents.7 Despite this high utilization of NP-provided HBMC, factors that may impact utilization of NP-home visits has not been adequately studied. Studies show wide variation in utilization of NP-HBMC based on NP state scope -of-practice laws.8 Recent data highlights that the growth of HBMC is driven by care delivered in the assisted living(AL) setting, and not private homes. Although a large share of AL residents are living with cognitive impairment and dementia, 9,10 we do not have insight into factors such as NP scope of practice laws, that may impact the use of NP-HBMC in AL settings. The proposed study will take a comprehensive approach to account for state and community-level factors that impact the use of NP-HBMC in AL communities nationwide. The proposed research builds upon an existing longitudinal study (Home-Based Clinical Care for Persons with Dementia; NIH P01 AG066605/ RP4), to achieve 2 specific aims. Aim 1. Examine variations in use of NP-HBMC across states in relations to state regulators environment in AL communities’ policies. We will use Medicare Provider Utilization and Payment Data will be linked to Census/American Community Survey (socioeconomic disadvantage predictors), to examine the effect of state regulations (NP SOP and AL staffing for regulations for nursing – [ registered nurse (RN) or licensed practical nurse (LPN) on NP provider availability in the delivery of HBMC. Our working hypothesis is that restricted state NP SOP and AL regulations will be associated with decreased utilization of NP-HBMC. Aim 2. Identify factors associated with use of NP-HBMC in AL settings. We will identify areas with high and low/no utilization of NP HBMC and examine provider and community-level factors associated with greater use of NP-HBMC. Data on community characteristics of NP-HBMC provider locations will be linked to Medicare Provider Utilization and Payment Data
2021-2022 /
8 (total)
5 (1st/Sr)
 

Past Scholars
Lili Chan, Mount Sinai Division of Nephrology (2019-2020)
Raj G. Kumar, Mount Sinai Department of Rehabilitation and Human Performance (2020-2021)
Aaron Baum, Mount Sinai Division of General Internal Medicine (2020-2021)
Matthew R Augustine, Mount Sinai Division of General Internal Medicine (2020-2021)

PILOT/EXPLORATORY PROJECTS (5 Pilot Projects Listed)
1. Project Title: Geriatric Surgery Co-Management Program: A New Model to Optimize Pre-Operative Care For Frail Older Adults
  Leader: Stephanie Chow, MD, MPH; Fred Ko, MD, MSCR
 

ABSTRACT: Frail older adults undergoing surgery encounter higher rates of adverse post-operative outcomes as compared to non-frail older adults. Currently, much of geriatric surgery co-management takes place in the inpatient setting, as a collaboration primarily between surgeons and geriatricians, and without deliberate social work guidance on the social determinants of health. This Pepper Center pilot study proposes to explore Geriatric Surgery CO-Management (SCOM) in the ambulatory setting as a pre-emptive approach to optimizing comprehensive geriatric medical and social work care in the frail older patient. It aims to characterize patients referred to and enrolled in SCOM and evaluate their relevant clinical outcomes, examine the feasibility of delivering SCOM program elements in real-world clinical settings, and identify facilitators and barriers to SCOM implementation. This knowledge will provide the foundation to inform future grant proposals and definitive effectiveness trials that aim to study the post-surgical benefits of a pre-operative, collaborative interprofessional co-management intervention in frail older patients in the Mount Sinai Health System.

 
2. Project Title: Developing Training for MyChart Use for Older Persons with Mild Cognitive Impairment: A pilot study
  Leader: Maria Loizos, PhD
 

There is an increasing number of patients who utilize technology to promote a healthy lifestyle. Various forms of telehealth services, including text messaging, email, patient portals, videoconferencing visits, and evisits are becoming increasingly available. In fact, patients are increasingly utilizing electronic personal health records (PHR), which include the most up to date information about a patient’s health care. At the Icahn School of Medicine at Mount Sinai, patients can use MyChart, which is linked to EPIC (electronic medical record). Utilizing PHR allows patients the ability to more easily manage their health, increase their independence, increase access to care, and reduce health disparities among rural and underserved populations. However, older adults, and especially older adults with Mild Cognitive Impairment (MCI) overwhelmingly underutilize PHR. Not having access to and being able to use technology may put older adults with MCI at a disadvantage in terms of their ability to live independently. Additionally, many older adults with MCI depend on spouses or other family members to assist with telehealth visits, and these are often also older frail individuals. Rapidly changing technology does not allow for patient ease of use, and many older adults with MCI become agitated and more symptomatic trying to adapt to it. Presently, there exists a need to assist older persons with MCI with utilizing PHR to manage their health and maintain their independence. To address the issue of older adults with MCI underutilizing PHR, we will develop a training module which will utilize feedback from patients and caregivers both familiar and unfamiliar with MyChart. Utilizing direct patient feedback allows the training module to be tailored specifically to patient need and will allow the inclusion of language and verbiage that older patients are familiar with. The proposed project is supported by the fact that while these patient portal systems are not intuitive for older adults with MCI, they can be trained to utilize these systems by incorporating their preferred learning method. Thus, it is hypothesized that older individuals with MCI can identify what makes it difficult for them to use MyChart and can inform a training module to improve their utilization. The potential increase in use of patient portals will promote independence in managing health care which is particularly important for older adults. The specific aims of this project are: 1) Understand nature of user difficulties and knowledge needs with regard to MyChart use and determine preferred training method for older adults with MCI and their caregivers with and without MyChart experience. This includes multiple focus groups with older adults with MCI consumers of MyChart and novice older adults with MCI users and their caregivers. Focus groups will be carried out by a clinical psychologist. Feedback generated from these focus groups will provide the basis for the development of the training module. 2) Develop a MyChart training module based on identified knowledge needs. The training module will be created utilizing direct feedback regarding the way older adult consumers with MCI and their caregivers prefer to receive information and training regarding technology (e.g., video, written materials, or live instruction). Identified difficulties gleamed from prior focus groups will be reviewed and verbiage that older adult consumers with MCI and their caregivers have identified will be utilized. 3) Assess the feasibility of providing training to improve use of MyChart amongst older adults with MCI. This includes utilizing multiple focus groups with older adults unfamiliar with MyChart and ascertaining participant satisfaction via questionnaire as well as participant’s ability to carry out health tasks via MyChart. It is hypothesized that older individuals can identify what makes it difficult for them to use MyChart and can inform a training module to improve their utilization. Results will demonstrate the feasibility of providing a training module to improve MyChart usage amongst older adults as well as determine the preferred learning method of older adults with MCI. The goal of this proposed pilot project is to identify the causes of low use of MyChart among older adults and assess the feasibility of using a training module based on patient feedback and experience regarding the use of MyChart.

 
3. Project Title: Understanding discordance between goals of care and admission to the emergency department at the end of life (2.0)
  Leader: Bevin Cohen PhD, MPH, MS, RN, Associate Professor; Kimberly Souffront, PhD, RN, FNP-BC, Assistant Professor
  The purpose of this mixed methods study is to characterize the patient, family, provider, and system level processes and factors that lead to ED admissions near the end of life when this is inconsistent with patients’ documented advance directives and goals of care (DADGOC). The specific aims are: 1. To describe the prevalence and characteristics of patients with advanced serious illness who are admitted to the ED at the end of life, and within this cohort: a. Describe the differences in characteristics between patients who have DADGOC that are inconsistent with admission to the ED versus those who do not; b. Describe the proportion and characteristics of DADGOC that contain inconsistent, contradictory, outdated, or vague statements regarding goals of care. 2. To qualitatively explore the factors that contribute to discordance between DADGOC and admission to the ED at the end of life by interviewing patients, family members, and healthcare workers. 3. To characterize the factors that contribute to discordance between DADGOC and admission to the ED using a process mapping approach.
 
4. Project Title: Home Health Aide Continuity Among Home-based Long-Term Care Clients and Its Relationship with Health Outcomes
  Leader: Jennifer M. Reckrey, MD Associate Professor Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
  Due to both individual and family preference as well as growing evidence that community-based long-term services and supports (LTSS) can be cost effective, the locus of long-term care is shifting from institutions into the community. Concerns about safety in congregate settings like nursing homes during the COVID-19 pandemic may accelerate this trend. While paid caregivers (e.g., home health aides, personal care attendants, and other direct care workers in the home) play an important role making sure older adults receive needed assistance, few studies have examined how paid caregivers themselves or the characteristics of the services they provide shapes health outcomes for care recipients. Consistency in the paid caregiver(s) providing care to an individual with long-term care needs may make it possible for paid caregivers to establish trust, support, and familiarity with their client’s personal care and health needs. This in turn may enable paid caregivers to meaningfully contribute to the health outcomes of their clients. A large body of health services research suggests that consistency in the individual providing healthcare services (e.g., doctors, nurses, physical therapists) is important for patient outcomes; this is known as “provider continuity”. However, limited research has empirically explored continuity of paid caregivers such as home health aides (i.e., “home health aide continuity”) in the home-based long-term care setting. Previous work on this topic has largely been qualitative, conducted outside of the U.S., or focused on paid caregivers providing short-term post-acute home-based care. The impact of home health aide continuity on home-based long-term care clients has not been studied. Given the integral but often underappreciated role that paid caregivers play in the health care team, information about home health aide continuity is essential to both guide paid caregiver workforce development and to maximize the potentially positive impact of paid caregivers on those for whom they care. Existing data from the Visiting Nurse Service of New York (VNSNY) provides a unique opportunity to simultaneously explore long-term care client health outcomes (using Medicaid Managed Long-Term Care records) and patterns of continuity among the home health aides who care for them (using Licensed Home Care Service Agency records). We propose to conduct a retrospective cohort study using secondary analysis of these data in order to: Aim 1. Describe home health aide continuity (i.e., number of home health aides providing care to a given client over time) among a population of older adults receiving Medicaid-funded, home-based long term care. Aim 2: Identify client factors associated with greater home health aide continuity. H2: Those with greater service needs will experience greater discontinuity of home health aides. Aim 3: Determine the association between home health aide continuity and client health outcomes across multiple domains (i.e., quality of life, safety, psychosocial well-being, and healthcare utilization). H3: Greater home health aide continuity will be associated with better health outcomes
 
5. Project Title: “TIER PALLIATIVE CARE: A palliative care delivery model to match palliative care services for community-based patients with heart failure or cancer”
  Leader: Laura P. Gelfman, MD, MPH: Associate Professor Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
  Older adults with serious illness suffer from poor symptom control, decreased quality of life (QoL) and poor communication with their healthcare providers, especially with regards to goals of care discussions (GOCD). Palliative care, when offered alongside disease management, offers the benefits of improved symptom control, QoL and communication (increased prognostic awareness, GOCDs, goal concordant care). Due to a limited specialty-trained palliative care workforce, patients often cannot access these benefits, particularly outside of the hospital. These needs are particularly acute in advanced cancer and HF, which are the two leading causes of death in the US and the prototypical examples of the most common illness trajectories. Indeed the dynamic nature of these two illnesses present distinct symptom patterns and change in functional status that can create challenges with regard to the optimal delivery of palliative care. To improve the quality of care for these two populations, new models are needed to deliver community-based palliative care tailored to patient’s illness trajectory and changing needs. TIER-PALLIATIVE CARE (TIER-PC) is an innovative and adaptive model of delivering palliative care that provides the right level of care to the right patients at the right time. TIER-PC increases the number and intensity of disciplines added to the patient’s care team as their symptoms worsen and function declines. In Tier 1, patients who are able to care for themselves and no/mild symptoms receive a community health worker (CHW) trained to elicit illness understanding in a culturally competent way. In Tier 2, for patients with poorer function and mild symptoms, a social worker (SW), trained in serious illness communication, joins the CHW to further elicit patients’ goals and prognostic understanding while communicating symptom needs to their primary clinician. In Tier 3, as function decreases and symptoms increase, an advance practice nurse (APN) joins the CHW+SW to manage complex symptoms. Finally, in Tier 4, for those older adults with the poorest function and most complex symptoms, a physician joins the team to assure that the most complex needs (e.g., end-of-life treatment preferences and multifaceted symptom control) are met. The CHW follows patients longitudinally across all tiers and re-allocates them to the appropriate tier based on their evolving needs. We will adapt an existing model and refine TIER-PC (SA1), and evaluate the efficacy of TIER-PC in a single-site, two-arm randomized controlled trial (RCT) of TIER-PC vs. usual care in a population of community-based older adults with advanced cancer or HF (SA2). We will enroll and randomize 40 older adults to receive TIER-PC or a CHW-delivered augmented control and follow patients for 6 months. Patients with either advanced cancer or HF will receive regular assessments by the TIER-PC team to: address their specific symptom and psychosocial needs; improve illness/prognostic understanding; prescribe medications; and address goals of care. As a result of this work, we will have pilot data (symptom control; QoL) for an R01 efficacy trial. Our model has the potential to improve care for older adults with cancer or HF and match demand to the limited specialty-trained palliative care workforce.
 
DEVELOPMENT PROJECTS (0 Development Projects Listed)
  No development projects.
RESEARCH (0 Projects Listed)
PUBLICATIONS
2022
  1. Impact of Comorbid Dementia on Patterns of Hospice Use.
    Aldridge MD, Hunt L, Husain M, Li L, Kelley A
    J Palliat Med, 2022 Mar, 25(3): 396-404
    https://doi.org/10.1089/jpm.2021.0055 | PMID: 34665050 | PMCID: PMC8968839
    Citations: 1 | AltScore: 23.25
  2. The Experience of Homebound Older Adults During the COVID-19 Pandemic.
    Ankuda CK, Kotwal A, Reckrey J, Harrison KL, Ornstein KA
    J Gen Intern Med, 2022 Feb 15, 37(5): 1177-1182
    https://doi.org/10.1007/s11606-021-07361-9 | PMID: 35167063 | PMCID: PMC8853401
    Citations: | AltScore: 5.5
  3. Improving the Approach to Defining, Classifying, Reporting and Monitoring Adverse Events in Seriously Ill Older Adults: Recommendations from a Multi-stakeholder Convening.
    Baim-Lance A, Ferreira KB, Cohen HJ, Ellenberg SS, Kuchel GA, Ritchie C, Sachs GA, Kitzman D, Morrison RS, Siu A
    J Gen Intern Med, 2022 May 17
    https://doi.org/10.1007/s11606-022-07646-7 | PMID: 35581446
    Citations: | AltScore: NA
  4. Prognostic disclosure in oncology - current communication models: a scoping review.
    Bloom JR, Marshall DC, Rodriguez-Russo C, Martin E, Jones JA, Dharmarajan KV
    BMJ Support Palliat Care, 2022 Jun, 12(2): 167-177
    https://doi.org/10.1136/bmjspcare-2021-003313 | PMID: 35144938 | PMCID: PMC9119949
    Citations: | AltScore: 4.5
  5. Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015.
    Cobert J, Jeon SY, Boscardin J, Chapman AC, Ferrante LE, Lee S, Smith AK
    Chest, 2022 Jan 11, 161(6): 1555-1565
    pii: S0012-3692(22)00020-4. https://doi.org/10.1016/j.chest.2021.12.658 | PMID: 35026299 | PMCID: PMC9248079
    Citations: 1 | AltScore: 30.04
  6. Access to Palliative Care Consultation for Hospitalized Adults with COVID-19 in an Urban Health System: Were There Disparities at the Peak of the Pandemic?
    Frydman JL, Aldridge M, Moreno J, Singer J, Zeng L, Chai E, Morrison RS, Gelfman LP
    J Palliat Med, 2022 Jan, 25(1): 124-129
    https://doi.org/10.1089/jpm.2021.0313 | PMID: 34637349 | PMCID: PMC8721492
    Citations: | AltScore: 6.25
  7. Telemedicine Utilization in the Ambulatory Palliative Care Setting: Are There Disparities?
    Frydman JL, Berkalieva A, Liu B, Scarborough BM, Mazumdar M, Smith CB
    J Pain Symptom Manage, 2022 Mar, 63(3): 423-429
    https://doi.org/10.1016/j.jpainsymman.2021.09.019 | PMID: 34644615 | PMCID: PMC8854351
    Citations: 1 | AltScore: 3.1
  8. The Digital Divide: Do Older Adults with Serious Illness Access Telemedicine?
    Frydman JL, Gelfman LP, Goldstein NE, Kelley AS, Ankuda CK
    J Gen Intern Med, 2022 Mar, 37(4): 984-986
    https://doi.org/10.1007/s11606-021-06629-4 | PMID: 33559064 | PMCID: PMC7870026
    Citations: 4 | AltScore: 9
  9. Telemedicine Uptake Among Older Adults During the COVID-19 Pandemic.
    Frydman JL, Li W, Gelfman LP, Liu B
    Ann Intern Med, 2022 Jan, 175(1): 145-148
    https://doi.org/10.7326/M21-2972 | PMID: 34748380 | PMCID: PMC8845076
    Citations: 1 | AltScore: 46.054
  10. Attitudes toward deprescribing among older adults with dementia in the United States.
    Growdon ME, Espejo E, Jing B, Boscardin WJ, Zullo AR, Yaffe K, Boockvar KS, Steinman MA
    J Am Geriatr Soc, 2022 Mar 10, 70(6): 1764-1773
    https://doi.org/10.1111/jgs.17730 | PMID: 35266141 | PMCID: PMC9177826
    Citations: | AltScore: 110.25
  11. Life expectancy for community-dwelling persons with dementia and severe disability.
    Harrison KL, Ritchie CS, Hunt LJ, Patel K, Boscardin WJ, Yaffe K, Smith AK
    J Am Geriatr Soc, 2022 Mar 31, 70(6): 1807-1815
    https://doi.org/10.1111/jgs.17767 | PMID: 35357694 | PMCID: PMC9177709
    Citations: | AltScore: 35.25
  12. Incidence of potentially disruptive medical and social events in older adults with and without dementia.
    Hunt LJ, Morrison RS, Gan S, Espejo E, Ornstein KA, Boscardin WJ, Smith AK
    J Am Geriatr Soc, 2022 Feb 5, 70(5): 1461-1470
    https://doi.org/10.1111/jgs.17682 | PMID: 35122662 | PMCID: PMC9106866
    Citations: | AltScore: 27.25
  13. Improving Patient Activation among Older Veterans: Results from a Social Worker-Led Care Transitions Intervention.
    Koufacos NS, May J, Judon KM, Franzosa E, Dixon BE, Schubert CC, Schwartzkopf AL, Guerrero VM, Traylor M, Boockvar KS
    J Gerontol Soc Work, 2022 Jan, 65(1): 63-77
    https://doi.org/10.1080/01634372.2021.1932003 | PMID: 34053407 | PMCID: PMC8982469
    Citations: | AltScore: NA
  14. Development and Validation of a Functionally Relevant Comorbid Health Index in Adults Admitted to Inpatient Rehabilitation for Traumatic Brain Injury.
    Kumar RG, Zhong X, Whiteneck GG, Mazumdar M, Hammond FM, Egorova N, Lercher K, Dams-O'Connor K
    J Neurotrauma, 2022 Jan, 39(1-2): 67-75
    https://doi.org/10.1089/neu.2021.0180 | PMID: 34779252 | PMCID: PMC8917887
    Citations: | AltScore: 2.85
  15. A national profile of health-focused caregiving activities prior to a new cancer diagnosis.
    Liu B, Kent EE, Dionne-Odom JN, Alpert N, Ornstein KA
    J Geriatr Oncol, 2022 May, 13(4): 454-461
    https://doi.org/10.1016/j.jgo.2021.11.010 | PMID: 34801426 | PMCID: PMC9058151
    Citations: 1 | AltScore: 4.7
  16. Examining variation in state spending on medicaid long-term services and supports for older adults.
    Mellgard G, Ankuda C, Rahman OK, Kelley A
    Home Health Care Serv Q, 2022 Jan-Mar, 41(1): 54-64
    https://doi.org/10.1080/01621424.2021.2004286 | PMID: 34812119 | PMCID: PMC8960329
    Citations: | AltScore: NA
  17. Impact of radiotherapy on daily function among older adults living with advanced cancer (RT impact on function in advanced cancer).
    Nehlsen A, Agarwal P, Mazumdar M, Dutta P, Goldstein NE, Dharmarajan KV
    J Geriatr Oncol, 2022 Jan, 13(1): 46-52
    https://doi.org/10.1016/j.jgo.2021.07.007 | PMID: 34362714 | PMCID: PMC9044675
    Citations: | AltScore: 1.25
  18. The Safety and Efficacy of Radiation Therapy with Concurrent Dexamethasone, Cyclophosphamide, Etoposide, and Cisplatin-Based Systemic Therapy for Multiple Myeloma.
    Nehlsen AD, Sindhu KK, Moshier E, Richter J, Richard S, Chari A, Sanchez L, Parekh S, Cho HJ, Jagannath S, Dharmarajan K
    Clin Lymphoma Myeloma Leuk, 2022 Mar, 22(3): 192-197
    https://doi.org/10.1016/j.clml.2021.09.015 | PMID: 34736880 | PMCID: PMC9040190
    Citations: | AltScore: 4.6
  19. Polypharmacy in older adults with cancer undergoing radiotherapy: A review.
    Novak J, Goldberg A, Dharmarajan K, Amini A, Maggiore RJ, Presley CJ, Nightingale G
    J Geriatr Oncol, 2022 Feb 25, 13(6): 778-783
    pii: S1879-4068(22)00035-2. https://doi.org/10.1016/j.jgo.2022.02.007 | PMID: 35227626 | PMCID: PMC9283217
    Citations: | AltScore: 6.35
  20. Home, but Not Homebound: A Prospective Analysis of Persons Living With Dementia.
    Reckrey JM, Leff B, Kumar RG, Yee C, Garrido MM, Ornstein KA
    J Am Med Dir Assoc, 2022 Jan 19
    pii: S1525-8610(21)01103-8. https://doi.org/10.1016/j.jamda.2021.12.029 | PMID: 35063398 | PMCID: PMC9294063
    Citations: | AltScore: 1.6
  21. Caring Together: Trajectories of Paid and Family Caregiving Support to Those Living in the Community with Dementia.
    Reckrey JM, Li L, Zhan S, Wolff J, Yee C, Ornstein KA
    J Gerontol B Psychol Sci Soc Sci, 2022 Jan 16, 77(Supplement_1): S11-S20
    pii: gbac006. https://doi.org/10.1093/geronb/gbac006 | PMID: 35034123 | PMCID: PMC9122661
    Citations: 1 | AltScore: 3.85
  22. Cost of home hospitalization versus inpatient hospitalization inclusive of a 30-day post-acute period.
    Saenger PM, Ornstein KA, Garrido MM, Lubetsky S, Bollens-Lund E, DeCherrie LV, Leff B, Siu AL, Federman AD
    J Am Geriatr Soc, 2022 May, 70(5): 1374-1383
    https://doi.org/10.1111/jgs.17706 | PMID: 35212391 | PMCID: PMC9307069
    Citations: | AltScore: 9.4
  23. Health equity in Hospital at Home: Outcomes for economically disadvantaged and non-disadvantaged patients.
    Siu AL, Zhao D, Bollens-Lund E, Lubetsky S, Schiller G, Saenger P, Ornstein KA, Federman AD, DeCherrie LV, Leff B
    J Am Geriatr Soc, 2022 Apr 1, 70(7): 2153-2156
    https://doi.org/10.1111/jgs.17759 | PMID: 35363372 | PMCID: PMC9283257
    Citations: | AltScore: 30.5
  24. Evaluation of Family Characteristics and Multiple Hospitalizations at the End of Life: Evidence from the Utah Population Database.
    Tay DL, Ornstein KA, Meeks H, Utz RL, Smith KR, Stephens C, Hashibe M, Ellington L
    J Palliat Med, 2022 Mar, 25(3): 376-387
    https://doi.org/10.1089/jpm.2021.0071 | PMID: 34448596 | PMCID: PMC8968848
    Citations: | AltScore: 4.35
  25. Examination of the Measurement Equivalence of the Functional Assessment in Acute Care MCAT (FAMCAT) Mobility Item Bank Using Differential Item Functioning Analyses.
    Teresi JA, Ocepek-Welikson K, Ramirez M, Kleinman M, Wang C, Weiss DJ, Cheville A
    Arch Phys Med Rehabil, 2022 May, 103(5S): S84-S107.e38
    https://doi.org/10.1016/j.apmr.2021.03.044 | PMID: 34146534
    Citations: 1 | AltScore: 2.75
  26. Guidelines for Designing and Evaluating Feasibility Pilot Studies.
    Teresi JA, Yu X, Stewart AL, Hays RD
    Med Care, 2022 Jan 1, 60(1): 95-103
    https://doi.org/10.1097/MLR.0000000000001664 | PMID: 34812790 | PMCID: PMC8849521
    Citations: | AltScore: 2.1
 
2021
  1. Service Availability in Assisted Living and Other Community-Based Residential Settings at the End of Life.
    Aldridge MD, Ornstein KA, McKendrick K, Reckrey J
    J Palliat Med, 2021 Apr 7, 24(11): 1682-1688
    https://doi.org/10.1089/jpm.2020.0625 | PMID: 33826855 | PMCID: PMC8823677
    Citations: 3 | AltScore: 4.45
  2. Intensification of Diabetes Medications at Hospital Discharge and Clinical Outcomes in Older Adults in the Veterans Administration Health System.
    Anderson TS, Lee AK, Jing B, Lee S, Herzig SJ, Boscardin WJ, Fung K, Rizzo A, Steinman MA
    JAMA Netw Open, 2021 Oct 1, 4(10): e2128998
    https://doi.org/10.1001/jamanetworkopen.2021.28998 | PMID: 34673963 | PMCID: PMC8531994
    Citations: 1 | AltScore: 197.98
  3. Patterns of Material Hardship and Food Insecurity Among Older Adults During the COVID-19 Pandemic.
    Ankuda CK, Fogel J, Kelley AS, Byhoff E
    J Gen Intern Med, 2021 Nov, 36(11): 3639-3641
    https://doi.org/10.1007/s11606-021-06905-3 | PMID: 34027606 | PMCID: PMC8141363
    Citations: 1 | AltScore: 6.2
  4. Population-Based Screening for Functional Disability in Older Adults.
    Ankuda CK, Freedman VA, Covinsky KE, Kelley AS
    Innov Aging, 2021, 5(1): igaa065
    https://doi.org/10.1093/geroni/igaa065 | PMID: 33506111 | PMCID: PMC7817111
    Citations: 1 | AltScore: 1
  5. Opening the black box: Evaluating the care of people with serious illness in Medicare Advantage.
    Ankuda CK, Hunt LJ
    J Am Geriatr Soc, 2021 Oct, 69(10): 2795-2798
    https://doi.org/10.1111/jgs.17344 | PMID: 34192344 | PMCID: PMC8497412
    Citations: | AltScore: 25.05
  6. The dynamics of being homebound over time: A prospective study of Medicare beneficiaries, 2012-2018.
    Ankuda CK, Husain M, Bollens-Lund E, Leff B, Ritchie CS, Liu SH, Ornstein KA
    J Am Geriatr Soc, 2021 Jun, 69(6): 1609-1616
    https://doi.org/10.1111/jgs.17086 | PMID: 33683707 | PMCID: PMC8192419
    Citations: 4 | AltScore: 29.3
  7. Association of the COVID-19 Pandemic With the Prevalence of Homebound Older Adults in the United States, 2011-2020.
    Ankuda CK, Leff B, Ritchie CS, Siu AL, Ornstein KA
    JAMA Intern Med, 2021 Dec 1, 181(12): 1658-1660
    https://doi.org/10.1001/jamainternmed.2021.4456 | PMID: 34424269 | PMCID: PMC8383159
    Citations: 5 | AltScore: 445.782
  8. The 2021 Medicare Advantage Hospice Carve-In.
    Ankuda CK, Morrison RS, Aldridge MD
    JAMA, 2021 Dec 21, 326(23): 2367-2368
    https://doi.org/10.1001/jama.2021.21161 | PMID: 34842906 | PMCID: PMC8898554
    Citations: | AltScore: 29
  9. Outcomes of Hospital at Home for Older Adults with and without High Levels of Social Support.
    Augustine MR, Siu AL, Boockvar KS, DeCherrie LV, Leff BA, Federman AD
    Home Healthc Now, 2021 Sep-Oct 01, 39(5): 261-270
    https://doi.org/10.1097/NHH.0000000000000980 | PMID: 34473114 | PMCID: PMC8425599
    Citations: 2 | AltScore: 0.5
  10. Co-Occurring Dehydration and Cognitive Impairment During COVID-19 in Long-Term Care Patients.
    Boockvar KS, Mak W, Burack OR, Canter BE, Reinhardt JP, Spinner R, Farber J, Weerahandi H
    J Am Med Dir Assoc, 2021 Nov, 22(11): 2270-2271
    https://doi.org/10.1016/j.jamda.2021.09.002 | PMID: 34599885 | PMCID: PMC8429357
    Citations: 1 | AltScore: NA
  11. The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review.
    Caba Y, Dharmarajan K, Gillezeau C, Ornstein KA, Mazumdar M, Alpert N, Schwartz RM, Taioli E, Liu B
    JNCI Cancer Spectr, 2021 Jun, 5(3): pkab002
    https://doi.org/10.1093/jncics/pkab002 | PMID: 34056540 | PMCID: PMC8152697
    Citations: 3 | AltScore: 6.75
  12. Palliative Care Consultation for Hospitalized Patients with Primary and Secondary Brain Tumors at a Single Academic Center.
    Crooms RC, Lin HM, Neifert S, Deiner SG, Brallier JW, Goldstein NE, Gal JS, Gelfman LP
    J Palliat Med, 2021 Sep, 24(10): 1550-1554
    https://doi.org/10.1089/jpm.2021.0088 | PMID: 34166114 | PMCID: PMC8568778
    Citations: | AltScore: 0.25
  13. A Novel Method for Identifying a Parsimonious and Accurate Predictive Model for Multiple Clinical Outcomes.
    Diaz-Ramirez LG, Lee SJ, Smith AK, Gan S, Boscardin WJ
    Comput Methods Programs Biomed, 2021 Jun, 204: 106073
    https://doi.org/10.1016/j.cmpb.2021.106073 | PMID: 33831724 | PMCID: PMC8098121
    Citations: 1 | AltScore: NA
  14. Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers.
    Dixon BE, Judon KM, Schwartzkopf AL, Guerrero VM, Koufacos NS, May J, Schubert CC, Boockvar KS
    J Am Med Inform Assoc, 2021 Nov 25, 28(12): 2593-2600
    https://doi.org/10.1093/jamia/ocab189 | PMID: 34597411 | PMCID: PMC8633605
    Citations: 1 | AltScore: 4.65
  15. We Need a Paradigm Shift Around End-of-Life Decision Making.
    Dzeng E, Morrison RS
    J Am Geriatr Soc, 2021 Feb, 69(2): 327-329
    https://doi.org/10.1111/jgs.16899 | PMID: 33170951
    Citations: | AltScore: 26.92
  16. Perceptions of event notification following discharge to improve geriatric care: qualitative interviews of care team members from a 2-site cluster randomized trial.
    Franzosa E, Traylor M, Judon KM, Guerrero Aquino V, Schwartzkopf AL, Boockvar KS, Dixon BE
    J Am Med Inform Assoc, 2021 Jul 30, 28(8): 1728-1735
    https://doi.org/10.1093/jamia/ocab074 | PMID: 33997903 | PMCID: PMC8324223
    Citations: 3 | AltScore: 63.25
  17. Virtual Geritalk: Improving Serious Illness Communication of Clinicians Who Care for Older Adults.
    Frydman JL, Gelfman LP, Lindenberger EC, Smith CB, Berns S, Kelley AS, Dow LA
    J Pain Symptom Manage, 2021 Sep, 62(3): e206-e212
    https://doi.org/10.1016/j.jpainsymman.2021.02.024 | PMID: 33631324 | PMCID: PMC8380266
    Citations: 2 | AltScore: 7.58
  18. Non-Concordance between Patient and Clinician Estimates of Prognosis in Advanced Heart Failure.
    Gelfman LP, Mather H, McKendrick K, Wong AY, Hutchinson MD, Lampert RJ, Lipman HI, Matlock DD, Swetz KM, Pinney SP, Morrison RS, Goldstein NE
    J Card Fail, 2021 Jun, 27(6): 700-705
    https://doi.org/10.1016/j.cardfail.2021.03.005 | PMID: 34088381 | PMCID: PMC8186811
    Citations: 2 | AltScore: 12.25
  19. Palliative Care as Essential to a Hospital System's Pandemic Preparedness Planning: How to Get Ready for the Next Wave.
    Gelfman LP, Morrison RS, Moreno J, Chai E
    J Palliat Med, 2021 May, 24(5): 656-658
    https://doi.org/10.1089/jpm.2020.0670 | PMID: 33373533 | PMCID: PMC8064944
    Citations: 1 | AltScore: 1.85
  20. Polypharmacy among older adults with dementia compared with those without dementia in the United States.
    Growdon ME, Gan S, Yaffe K, Steinman MA
    J Am Geriatr Soc, 2021 Jun 8, 69(9): 2464-2475
    https://doi.org/10.1111/jgs.17291 | PMID: 34101822 | PMCID: PMC8440349
    Citations: 2 | AltScore: 113.87
  21. Evaluating the Beijing Version of Montreal Cognitive Assessment for Identification of Cognitive Impairment in Monolingual Chinese American Older Adults.
    Hong Y, Zeng X, Zhu CW, Neugroschl J, Aloysi A, Sano M, Li C
    J Geriatr Psychiatry Neurol, 2021 Aug 11, 35(4): 586-593
    https://doi.org/10.1177/08919887211036182 | PMID: 34378450 | PMCID: PMC8831672
    Citations: | AltScore: 7
  22. What Affects Adoption of Specialty Palliative Care in Intensive Care Units: A Qualitative Study.
    Hua M, Fonseca LD, Morrison RS, Wunsch H, Fullilove R, White DB
    J Pain Symptom Manage, 2021 Jun 25, 62(6): 1273-1282
    pii: S0885-3924(21)00397-3. https://doi.org/10.1016/j.jpainsymman.2021.06.015 | PMID: 34182102 | PMCID: PMC8648909
    Citations: 1 | AltScore: 14.35
  23. Live discharge from hospice for people living with dementia isn't \graduating\-It's getting expelled.
    Hunt LJ, Harrison KL
    J Am Geriatr Soc, 2021 Jun, 69(6): 1457-1460
    https://doi.org/10.1111/jgs.17107 | PMID: 33855701 | PMCID: PMC8192462
    Citations: 5 | AltScore: 53.29
  24. Instead of wasting money on aducanumab, pay for programs proven to help people living with dementia.
    Hunt LJ, Harrison KL, Covinsky KE
    J Am Geriatr Soc, 2021 Dec, 69(12): 3690-3692
    https://doi.org/10.1111/jgs.17462 | PMID: 34480351 | PMCID: PMC8648993
    Citations: | AltScore: 161.35
  25. Barriers to telehealth access among homebound older adults.
    Kalicki AV, Moody KA, Franzosa E, Gliatto PM, Ornstein KA
    J Am Geriatr Soc, 2021 Apr 13, 69(9): 2404-2411
    https://doi.org/10.1111/jgs.17163 | PMID: 33848360 | PMCID: PMC8250614
    Citations: 6 | AltScore: 51.3
  26. The Serious Illness Population: Ascertainment via Electronic Health Record or Claims Data.
    Kelley AS, Hanson LC, Ast K, Ciemins EL, Dunning SC, Meskow C, Ritchie CS
    J Pain Symptom Manage, 2021 Sep, 62(3): e148-e155
    https://doi.org/10.1016/j.jpainsymman.2021.04.012 | PMID: 33933617 | PMCID: PMC8419009
    Citations: 1 | AltScore: 8.8
  27. The epidemiology of social isolation and loneliness among older adults during the last years of life.
    Kotwal AA, Cenzer IS, Waite LJ, Covinsky KE, Perissinotto CM, Boscardin WJ, Hawkley LC, Dale W, Smith AK
    J Am Geriatr Soc, 2021 Jul 11, 69(11): 3081-3091
    https://doi.org/10.1111/jgs.17366 | PMID: 34247388 | PMCID: PMC8595510
    Citations: 3 | AltScore: 132.59
  28. Use of High-risk Medications Among Lonely Older Adults: Results From a Nationally Representative Sample.
    Kotwal AA, Steinman MA, Cenzer I, Smith AK
    JAMA Intern Med, 2021 Nov 1, 181(11): 1528-1530
    https://doi.org/10.1001/jamainternmed.2021.3775 | PMID: 34309620 | PMCID: PMC8314172
    Citations: | AltScore: 296.32
  29. Association between Lifetime History of Traumatic Brain Injury, Prescription Opioid Use, and Persistent Pain: A Nationally Representative Study.
    Kumar RG, Ornstein KA, Corrigan JD, Sayko Adams R, Dams-O'Connor K
    J Neurotrauma, 2021 Aug 15, 38(16): 2284-2290
    https://doi.org/10.1089/neu.2020.7496 | PMID: 33567980 | PMCID: PMC8672103
    Citations: 1 | AltScore: 10
  30. Design Considerations for Mobile Health Applications Targeting Older Adults.
    Li C, Neugroschl J, Zhu CW, Aloysi A, Schimming CA, Cai D, Grossman H, Martin J, Sewell M, Loizos M, Zeng X, Sano M
    J Alzheimers Dis, 2021, 79(1): 1-8
    https://doi.org/10.3233/JAD-200485 | PMID: 33216024 | PMCID: PMC8837196
    Citations: 4 | AltScore: NA
  31. The 32-Item Multilingual Naming Test: Cultural and Linguistic Biases in Monolingual Chinese-Speaking Older Adults.
    Li C, Zeng X, Neugroschl J, Aloysi A, Zhu CW, Xu M, Teresi JA, Ocepek-Welikson K, Ramirez M, Joseph A, Cai D, Grossman H, Martin J, Sewell M, Loizos M, Sano M
    J Int Neuropsychol Soc, 2021 Jun 18, 28(5): 511-519
    https://doi.org/10.1017/S1355617721000746 | PMID: 34140060 | PMCID: PMC8729172
    Citations: | AltScore: 10
  32. Barriers to learning a new technology to go online among older adults during the COVID-19 pandemic.
    Li W, Ornstein KA, Li Y, Liu B
    J Am Geriatr Soc, 2021 Nov, 69(11): 3051-3057
    https://doi.org/10.1111/jgs.17433 | PMID: 34409589 | PMCID: PMC8446986
    Citations: 4 | AltScore: 3.6
  33. Trends of hospitalizations among patients with both cancer and dementia diagnoses in New York 2007-2017.
    Liu B, Ornstein KA, Alpert N, Schwartz RM, Dharmarajan KV, Kelley AS, Taioli E
    Healthc (Amst), 2021 Sep, 9(3): 100565
    https://doi.org/10.1016/j.hjdsi.2021.100565 | PMID: 34252707 | PMCID: PMC8453053
    Citations: | AltScore: 7
  34. The Influence of Increasing Levels of Provider-Patient Discussion on Quit Behavior: An Instrumental Variable Analysis of a National Survey.
    Liu B, Zhan S, Wilson KM, Mazumdar M, Li L
    Int J Environ Res Public Health, 2021 Apr 26, 18(9):
    pii: 4593. https://doi.org/10.3390/ijerph18094593 | PMID: 33926078 | PMCID: PMC8123707
    Citations: | AltScore: NA
  35. Retrospective analysis of characteristics associated with higher-value radiotherapy episodes of care for bone metastases in Medicare fee-for-service beneficiaries.
    Marshall D, Aldridge MD, Dharmarajan K
    BMJ Open, 2021 Oct 19, 11(10): e049009
    https://doi.org/10.1136/bmjopen-2021-049009 | PMID: 34667003 | PMCID: PMC8527129
    Citations: | AltScore: 1.75
  36. All you need is love: Yet another social determinant of health.
    Meier DE, Morrison RS
    J Am Geriatr Soc, 2021 Nov, 69(11): 3020-3022
    https://doi.org/10.1111/jgs.17421 | PMID: 34409585 | PMCID: PMC8595554
    Citations: 1 | AltScore: 52.75
  37. Senior Associate Editor's Response to Readers' Comments to Morrison: Advance Directives/Care Planning: Clear, Simple, and Wrong (DOI: 10.1089/jpm.2020.0272).
    Morrison RS
    J Palliat Med, 2021 Jan, 24(1): 14-15
    https://doi.org/10.1089/jpm.2020.0526 | PMID: 33095092 | PMCID: PMC9206472
    Citations: 1 | AltScore: 3.35
  38. What's Wrong With Advance Care Planning?
    Morrison RS, Meier DE, Arnold RM
    JAMA, 2021 Oct 26, 326(16): 1575-1576
    https://doi.org/10.1001/jama.2021.16430 | PMID: 34623373
    Citations: 9 | AltScore: 449.472
  39. Deprescribing Blood Pressure Treatment in Long-Term Care Residents.
    Odden MC, Lee SJ, Steinman MA, Rubinsky AD, Graham L, Jing B, Fung K, Marcum ZA, Peralta CA
    J Am Med Dir Assoc, 2021 Dec, 22(12): 2540-2546.e2
    https://doi.org/10.1016/j.jamda.2021.07.009 | PMID: 34364847 | PMCID: PMC8627463
    Citations: 2 | AltScore: 34.5
  40. Engagement in Meaningful Activities Among Older Adults With Disability, Dementia, and Depression.
    Oh A, Gan S, Boscardin WJ, Allison TA, Barnes DE, Covinsky KE, Smith AK
    JAMA Intern Med, 2021 Apr 1, 181(4): 560-562
    https://doi.org/10.1001/jamainternmed.2020.7492 | PMID: 33492334 | PMCID: PMC7835951
    Citations: 1 | AltScore: 83.19
  41. Medicare-funded home-based clinical care for community-dwelling persons with dementia: An essential healthcare delivery mechanism.
    Ornstein KA, Ankuda CK, Leff B, Rajagopalan S, Siu AL, Harrison KL, Oh A, Reckrey JM, Ritchie CS
    J Am Geriatr Soc, 2021 Dec 22, 70(4): 1127-1135
    https://doi.org/10.1111/jgs.17621 | PMID: 34936087 | PMCID: PMC8986555
    Citations: 1 | AltScore: 12.5
  42. Prospective assessment of dementia on transitions in homeboundness using multistate Markov models.
    Ornstein KA, Liu SH, Husain M, Ankuda CK, Bollens-Lund E, Kelley AS, Garrido MM
    J Am Geriatr Soc, 2021 Dec 23, 70(4): 1117-1126
    https://doi.org/10.1111/jgs.17631 | PMID: 34951008 | PMCID: PMC8986556
    Citations: | AltScore: 11.85
  43. Expanding the Palliative Care Workforce during the COVID-19 Pandemic: An Evaluation of Core Palliative Care Skills in Health Social Workers.
    Pelleg A, Chai E, Morrison RS, Farquhar DW, Berglund K, Gelfman LP
    J Palliat Med, 2021 Nov, 24(11): 1705-1709
    https://doi.org/10.1089/jpm.2021.0027 | PMID: 34191595 | PMCID: PMC8823669
    Citations: | AltScore: 5.35
  44. A national profile of kinlessness at the end of life among older adults: Findings from the Health and Retirement Study.
    Plick NP, Ankuda CK, Mair CA, Husain M, Ornstein KA
    J Am Geriatr Soc, 2021 Apr 21, 69(8): 2143-2151
    https://doi.org/10.1111/jgs.17171 | PMID: 33880751 | PMCID: PMC8373783
    Citations: 1 | AltScore: 28.35
  45. Prevalence of Memory-Related Diagnoses Among U.S. Older Adults With Early Symptoms of Cognitive Impairment.
    Qian Y, Chen X, Tang D, Kelley AS, Li J
    J Gerontol A Biol Sci Med Sci, 2021 Sep 13, 76(10): 1846-1853
    https://doi.org/10.1093/gerona/glab043 | PMID: 33575783 | PMCID: PMC8436977
    Citations: | AltScore: 15.05
  46. Paid Caregivers in the Community-based Dementia Care Team: Do Family Caregivers Benefit?
    Reckrey JM, Boerner K, Franzosa E, Bollens-Lund E, Ornstein KA
    Clin Ther, 2021 Jun, 43(6): 930-941
    https://doi.org/10.1016/j.clinthera.2021.03.022 | PMID: 33972126 | PMCID: PMC8440352
    Citations: 4 | AltScore: NA
  47. Family Caregiving for Those With and Without Dementia in the Last 10 Years of Life.
    Reckrey JM, Bollens-Lund E, Husain M, Ornstein KA, Kelley AS
    JAMA Intern Med, 2021 Feb 1, 181(2): 278-279
    https://doi.org/10.1001/jamainternmed.2020.4012 | PMID: 33252607 | PMCID: PMC7851727
    Citations: 4 | AltScore: 18.4
  48. Barriers to implementation of STRIDE, a national study to prevent fall-related injuries.
    Reckrey JM, Gazarian P, Reuben DB, Latham NK, McMahon SK, Siu AL, Ko FC
    J Am Geriatr Soc, 2021 Feb 13, 69(5): 1334-1342
    https://doi.org/10.1111/jgs.17056 | PMID: 33580718 | PMCID: PMC8177692
    Citations: 3 | AltScore: 10.35
  49. Receipt of Hospice Aide Visits Among Medicare Beneficiaries Receiving Home Hospice Care.
    Reckrey JM, Ornstein KA, McKendrick K, Tsui E, Morrison RS, Aldridge M
    J Pain Symptom Manage, 2021 Dec 22, 63(4): 503-511
    pii: S0885-3924(21)00678-3. https://doi.org/10.1016/j.jpainsymman.2021.12.019 | PMID: 34954065 | PMCID: PMC8930441
    Citations: | AltScore: 40
  50. RESEARCHRacial and Socioeconomic Disparities in Access to Telehealth.
    Rivera V, Aldridge MD, Ornstein K, Moody KA, Chun A
    J Am Geriatr Soc, 2021 Jan, 69(1): 44-45
    https://doi.org/10.1111/jgs.16904 | PMID: 33075143 | PMCID: PMC8726710
    Citations: 9 | AltScore: 25.4
  51. Challenges in Measuring Applied Cognition: Measurement Properties and Equivalence of the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT) Applied Cognition Item Bank.
    Teresi JA, Ocepek-Welikson K, Kleinman M, Cheville A, Ramirez M
    Arch Phys Med Rehabil, 2021 Feb 5, 103(5S): S118-S139
    pii: S0003-9993(21)00136-2. https://doi.org/10.1016/j.apmr.2020.12.029 | PMID: 33556349 | PMCID: PMC8344387
    Citations: 1 | AltScore: 1.5
  52. Differential Item Functioning Analyses of the Patient-Reported Outcomes Measurement Information System (PROMIS?) Measures: Methods, Challenges, Advances, and Future Directions.
    Teresi JA, Wang C, Kleinman M, Jones RN, Weiss DJ
    Psychometrika, 2021 Sep, 86(3): 674-711
    https://doi.org/10.1007/s11336-021-09775-0 | PMID: 34251615 | PMCID: PMC8889890
    Citations: | AltScore: 1.25
  53. Depression and anxiety symptoms are related to pain and frailty but not cognition or delirium in older surgical patients.
    Wang S, Cardieri B, Mo Lin H, Liu X, Sano M, Deiner SG
    Brain Behav, 2021 Jun, 11(6): e02164
    https://doi.org/10.1002/brb3.2164 | PMID: 33949810 | PMCID: PMC8213643
    Citations: 2 | AltScore: 3
  54. Discharge processes in a skilled nursing facility affected by COVID-19.
    Weerahandi H, Mak W, Burack OR, Canter BE, Reinhardt JP, Boockvar KS
    J Am Geriatr Soc, 2021 Sep, 69(9): 2437-2439
    https://doi.org/10.1111/jgs.17228 | PMID: 33955557 | PMCID: PMC8242513
    Citations: 2 | AltScore: NA


EXTERNAL ADVISORY BOARD MEMBERS

Christine Ritchie
UCSF
Serving since 2011 (11 years)

Jay Magaziner
University of Maryland
Serving since 2011 (11 years)

Vincent Mor
Brown University
Serving since 2011 (11 years)

Ken Langa
University of Michigan
Serving since 2017 (5 years)


RECOGNITION AND AWARDS (2021-2022)
Carolina Crooms (2021)
  • Received a 2022 Exceptional Scholar Award from the Icahn School of Medicine at Mount Sinai for her project focusing on palliative care for older adults with high-grade gliomas. June 2022.
Fred Ko (2021)
  • Fred C. Ko, MD named among the New York Times Super Geriatrics Doctors. May 2021
  • Named among Castle Connolly’s Top Doctors in Geriatrics
  • named Fellow of the National Initiative on Gender, Culture and Leadership in Medicine (C-Change) Mentoring & Leadership Institute, Brandeis University. 2021-2022.
Julia L. Frydman (2021)
  • Appointed Assistant Professor for the Brookdale Department of Geriatrics and Palliative Medicine. Dr. Frydman will join our faculty as a Clinical Investigator. September 2021.
Laura Gelfman (2021)
  • Recipient of the AAHPM 2021 Early Career Investigator Award. February 2021.
  • Recipient of the 2020 Sojourns Scholar Leadership Program Grant from the Cambia Health Foundation. January 2021.
  • Selected as a 2020 Sojourns Scholar Leader from Cambia Health Foundation and the Sojourns Scholar Leadership Program’s National Advisory Board. December 2020.
Maria Loizos (2021)
  • Received the 2020 Faculty Idea Prize for “SMART-PC: An accessible, palliative care mHealth tool for patients with serious illness” from Mount Sinai Innovation. December 2020.
Stephanie Chow (2021)
  • Awardee of an Office of Wellbeing and Resilience grant to Enhance Team-Based Care in Primary Care Geriatrics Practices through Patient Coordinators. November 2020.

MINORITY RESEARCH

General Brief Description of Minority Activities:
Not defined.


No minority trainee information specified.

No minority grant information specified.