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The UCSF OAIC

The UCSF OAIC. Kenneth Covinsky, MD, MPH UCSF Division of Geriatrics SFVAMC Section of Geriatrics and Palliative Medicine. Theme. Characteristics and Outcomes of Late Life Disability: A Focus on Vulnerable Populations. Disability Theme. Traditional

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The UCSF OAIC

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  1. The UCSF OAIC Kenneth Covinsky, MD, MPH UCSF Division of Geriatrics SFVAMC Section of Geriatrics and Palliative Medicine

  2. Theme • Characteristics and Outcomes of Late Life Disability: A Focus on Vulnerable Populations

  3. Disability Theme • Traditional • Research that examines factors that lead to “loss of independence” • Research that informs how we can reduce risk of functional decline • But…. • What is the “I” in OAIC? • ADL Disability is not a terminal outcome

  4. Outcome of ADL Disability • The “I” should include broad spectrum of elders • We know very little about how to improve quality of life in complex elders with disability • Geriatric science has the tools to improve the independence and quality of life of disabled elders • The quality of health care for complex elders with disability is poor • Geriatric science has the tools to improve care and health outcomes for these patients • Bringing together Geriatrics and Palliative Medicine

  5. Example: “Successful Aging” • RCDC Scholar Alex Smith • Qualitative Study: In Depth Interviews of Disabled Elders at On Lok • ¾ think they aged successfully • Most think their quality of life is good • Key factors: • Adaptation (personal, medical, society) • Maintaining valued activities • Being useful to others • Dignity, Sense of control • Symptom management • Rowe and Kahn have served field well. But we need to move forward?

  6. Vulnerable Populations • Bringing together medical and social views of vulnerability • Medical: Comorbidity, functional and cognitive impairment • Social: Poverty, Social isolation, adverse circumstance • Interaction of medical and social vulnerability informs • Determinants of disability and its outcomes • Interventions

  7. Examples: Early Development in Vulnerable Populations • Brie Williams: RCDC Scholar • Older Prisoners: Prevalence and Impact of Functional Impairment (Physical/Cognitive) • Margot Kushel: External Project • The aging homeless

  8. Organization of UCSF OAIC • Principles • We view our resources as venture capital • We make investments in PEOPLE who do projects • Our job is to identify the people who will be leaders and innovators in aging research • Provide the project support that will catalyze their development • Provide mentorship, intellectual+ operational support • People principle proving a great mechanism of making our center a true Center • Operation discussions focus on people

  9. Core Structure • 2 resource cores • Data, Measures, and Accrual (DMAC) (Steinman) • Research Design and Analysis (RDAC) (Boscardin) • 2 Developmental Cores • RCDC (Walter/Yaffe) • PESC (Ritchie/Williams) • LAC

  10. Core 1: Data, Measures, Accrual • Data Set Expertise • HRS, CMS, VA • Measures • Use of measures of functioning, disability, quality of life (Geriatric spins) • Accrual • Assistance identifying older and vulnerable subjects

  11. DMAC Examples • External Project: Peripheral Neuropathy in older Cancer Patients (RO1: Miaskowski) • Add measures of physical function • Development Project • Abstraction of functional measures from electronic data (natural language processing)

  12. Core 2: Research Design and Analysis • Analysis • Proposal Development • Analytic Services • Examples • External Project: Fang (R01): Predicting complications of anticoagulant therapy • Development Project: Algorithms to calculate optimism in prediction models (open source software)

  13. Core 3: RCDC • Support early career faculty at key points of career vulnerability • RCDC Scholars: New faculty provided financial support and mentorship that will lead to K-award • RCDC advanced scholars: K funded faculty provided project support and mentorship that will lead to RO1 • Substantial $ support (30-60K/yr X 2 years), mentorship, seminars, nudging

  14. RCDC Scholar: Ryan Greysen • Hospital Medicine: Readmissions and Transitions • Central hypothesis: Real issues leading to readmission are not the typical disease measures • Functional and Cognitive Impairment, social support, caregiver stress • K23 (10!!!) • HRS readmission study • Qualitative studies: Patients/Caregivers post DC

  15. Example: Sei Lee (Advanced Scholar) • Improve diabetes management, outcomes, care of frail elders • Current Beeson Scholar who will transition to R01 • Plan: Longitudinal Study of Nursing Home Residents • RCDC support: Pilot data collection –subject assembly, measures

  16. Core 4: PESC (Ritchie) • Support for preliminary data/developmental work that will lead to a R01 • Targets: More advanced than RCDC scholars • Open to those not established in aging • Substantial awards (30K X 2 years)

  17. PESC Examples • Surgical Outcomes in Nursing Home Patients (Finlayson) • Pilot: Assemble cohorts of nursing home patients who have surgery using merged MDS-Medicare Data • R01: Outcomes of Surgery vs Conservative therapies in cholecystitis • Improving decision making, advance care planning in elders with multimorbidity (Sudore: www.prepareforyourcare.org) • Funded with VA IIR, RO1 • Pilot: Translation of materials into Spanish • Outcome: PCORI grant

  18. Thank You

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