"Factors Influencing Inner City Older Adults' Non-Urgent ED Visits"

PI: Deborah D'Avolio (PI)

Funding Source:  Frank Morgan Jones

Funding Source:  Frank Morgan Jones

Period: June 1, 2007 to June 30, 2008

Project Summary:

The study will examine factors, which lead vulnerable older adults to the Emergency Department (ED) for non-urgent care.  The research aims are to describe the socio-demographic and illness characteristics of older adults seeking non-urgent care in the ED; identify the health care needs of older adults and factors associated with use and outcomes of the ED visit; and, examine the relationships between health services access, emergency services utilization, and perceived health to overall quality of life.

"Reducing HIV Transmission Behaviors Among HIV Seropositive African American Men Fifty Years and Older"

"The lived experiences of Korean immigrant caregivers after nursing home placement of their elderly non-English speaking (NELS) relatives with dementia"
 

PI: Eun-Hi Kong (doctoral candidate)
Period: March 1, 2005 through March 1, 2006
Funding Source: Frank Morgan Jones

Project Summary: The study evaluates the described experiences of Korean immigrant caregivers who place non-English language speaking elderly relatives with dementia in American nursing homes. Symbolic interactionism and cultural models are two theoretical frameworks which will be used to guide this project.

"The Relationship of Sleep, Breathing, and neurobehavior in COPD

PI: Judith Reishstein (post-doctoral fellow)
Period: March 1, 2005 through February 28, 2006
Funding Source: Frank Morgan Jones

Project Summary: The study will test the hypothesis that neurobehavioral deficits in individuals with Chronic Obstructive Pulmonary Disease (COPD) are determined by the interaction of sleep quality and hypoxemia, controlling for the influence of age, gender, education level, and disease severity. . Subjects will undergo in-home overnight pulse oximetry and actigraphy, maintain a sleep diary, and complete in-laboratory neurobehavior testing to document neurobehavioral performance deficits in other sleep disorders. Data from the pilot study will be used to determine the feasibility of measuring sleep-related parameters in the home, and to estimate effect sizes.

"Knowledge Discovery Modeling to Support Clinical Decision Making in Predicting Hospital Acquired Pressure Ulcers"

PI: Tae Young Kim (doctoral student)
Period: January 1, 2005 to August 31, 2005
Funding Source: Frank Morgan Jones

Project Summary: The purpose of the project is to explore the multidimensional relationships between pressure ulcer formation and risk factor depending on the subjects' characteristics and to obtain a better understanding of contributing factors that are highly correlated with pressure ulcer development in hospitalized adults. The project will identify the best set of predictive risk factors and explore the applicability of various predictive models to identify at-risk patients admitted.

"Non-pharmacological intervention for agitation in dementia: Meta-Analysis" (Pilot I)

PI: Eun-Hi Kong (doctoral student)
Period: November 1, 2004 to October 30, 2005
Funding Source: Frank Morgan Jones

Project Summary: The purpose of this project is to complete a systematic meta-analysis review of the literature related to non-pharmacological interventions for agitation in dementia. A comprehensive evaluation of research evidence based on "best practices" methodology will be used to ascertain
the strength of evidence used to support specific protocols examined, to resolve uncertainty when original research disagrees, and to identify gaps in knowledge where further study is needed.

"Non-pharmacological intervention for agitation in dementia: Meta-Analysis" (Pilot II)

PI: Eun-Hi Kong (doctoral student)
Period: November 1, 2004 to October 30, 2005
Funding Source: Frank Morgan Jones

Project Summary: The focus of the research will be an examination of the special needs and difficulties of Korean immigrant caregivers after nursing home placement of their elderly Non-English language speaking relatives with dementia. Descriptive methodology will be used to examine the lived
experiences of Korean immigrant caregivers, and the extent to which culturally competent care is provided in long term care settings.

"The Impact of the Prospective Payment System on Psychiatric Home Health Care for Depressed Older Adults"

PI: Yu Ru Lin (doctoral student)
Period: September 1, 2004 to December 30, 2004
Funding Source: Frank Morgan Jones

Project Summary:This descriptive comparative study focuses on an examination of the Prospective Payment System (PPS) reimbursement methodology as it affects access to quality of psychiatric home health care services for vulnerable older adults with depression as defined by the International Statistical Classification of Diseases. Pre- and post- depressed older client receiving psychiatric home health care will be examined to determine if there are any differences for these individuals related to physical functioning levels and service utilization. Project results provide an opportunity to gain additional knowledge related to how a home care reimbursement system may affect the provision and quality of psychiatric home care services.

"Effects of Writing and Sharing of Caregiving Narratives on the Job Satisfaction of Direct Care Workers in Nursing Homes"

PI: L. Evans and Eun-Hi Kong
Period: August 1, 2004 - April 1, 2005
Funding Source: University of Pennsylvania Division of Geriatric Medicine, Academic Long Term Care Network

Project Summary: This project will explore non-pharmacological treatment for agitation in dementia.

“Designing a Framework and Exemplar for Clinical Guideline Development to Foster the Translation of Evidence-Based Practice”

PI: V. Cotter and L. Evans
Period: July 1, 2004 to December 31, 2004
Funding Source: HCGNE

Project Summary: The project will address the challenges and the gaps separating research translation to practice through testing a process model that facilitates developing and disseminating clinical practice guidelines based on Penn’s evidence-based research. A systematic peer-review process mechanism will be used to collect, evaluate and synthesize research appropriate for translation. Findings and recommendations from this study will provide insights into methods and infrastructure support most necessary to design a framework that fosters research translation.

"Symptoms and Needs for Care in the LIFE Program"

PI: David Casarett, MD, Neville Strumpf, RN, PhD, Beth Lewis, PhD, MSW
Funding Source: Hartford/Rand Interdisciplinary Geriatric Research Center

Project Summary: Virtually no studies have been conducted on the palliative care needs of PACE enrollees, thus limiting our knowledge of the impact of any physical and psychological experiences associated with life threatening illness, preferences and values concerning end-of-life. Answers to these questions will be important in guiding efforts to improve palliative care services for LIFE members and their families. The members who enroll in the LIFE program are generally physically and /or cognitively impaired, have numerous chronic illnesses and co morbidities, and may have or be at risk for one or major life-threatening illnesses. They may also have significant functional impairment and substantial needs for home care in order to continue to live independently. It is likely, therefore, that this populations has significant needs for palliative and supportive care.

The goal of this descriptive study is to define end-of-life needs, including symptom management, counseling support, and advance care planning among members who enroll in a PACE program servicing a predominantly African American urban population. The setting will be the LIving Independently for Elders (LIFE) program. This study will accrue for one year and total of 40 subjects will be recruited. Data will be collected in two interviews with members, each lasting 30-40 minutes. In the first interview, all subjects will be asked to provide basic demographic information, and clinical information about their diagnosis. A time-structured interview will be used to elicit preferences for life sustaining treatment using both closed- and open-ended questions, as well as perceived needs for pain and symptom management. We will also be consulting members' medical charts, to obtain information aba out medications and treatments members may be receiving, symptoms they may be experiencing and information about their plans for care for the future. Specifically, we will be collecting information about diagnosis, functional status, medication use, and the presence of advance directive and health care wishes.

“The Effects of Informal Caregivers on the Outcomes of Older Adults Receiving Home Health Care”

PI: Eunhee Cho (doctoral student)
Period: March 01, 2004 to February 28, 2005
Funding Source: Frank Morgan Jones Fund.

Project Summary: The purpose of this secondary analysis is to evaluate the effects of informal caregiving on the type of primary caregiver (i.e., spouse, offspring, relative, non-relative, paid helper) on the outcomes of elders receiving home health care. The project will compare changes in functional status and depression symptoms, as well as differences in the rates and timing of re-hospitalization over a 60 day period among patients who do and those who do not receive informal care in addition to home health care.

"Organizational Culture in Nursing Homes”

PI: C. Scalzi and L. Evans
Period: March 1, 2004 to February 29, 2005
Funding Source: Frank Morgan Jones Fund.

Project Summary: The project will build on a previous study that examined cultural change in nursing home settings. This project will examine organizational culture, its patterns, and its susceptibility to adaptation of a patient focused intervention. Pilot resources will also be used to support a systematic review of the literature and manuscript preparation. Findings from this pilot will support a NIH or comparable grant submission to conduct a larger scale study that employs secondary analysis to further test this cultural change intervention across multiple nursing home facilities in various geographic regions.

“A Description of Enrollment in a Program of All-Inclusive Care for the Elderly (PACE)"

PI: Anna Beeber (doctoral student)
Period: February 01, 2004 to June 1, 2005
Funding Source: Frank Morgan Jones Fund.

Project Summary: The purpose of this qualitative descriptive study is to describe enrollment in a Program of All-Inclusive Care for the Elderly (PACE) from the perspective of elders and others involved in enrollment. This project will address what is enrollment; when, how and why do elders enroll; what events contribute or lead to enrollment from the perspective of elders and families, informal caregivers and providers of health and social services. This project provides opportunities to examine why nursing home eligible elders choose the PACE program rather than institutional care.

"A comparison of Idiopathic and Secondary Diagnosis of Elder Persons with Restless Legs Syndrome (RLS)"
PI: Norma Cuellar
Period: November 1, 2003 to August 31, 2004
Funding Source: Frank Morgan Jones Fund

Project Summary:
The descriptive comparative project study will examine if differences exist between primary and idiopathic diagnosis of older adults with Restless Leg Syndrome (RLS) and the effects of this diagnosis on sleep, symptom severity, fatigue, depression and quality of life. A variety of measurement instruments will be used to generate data necessary for further examination of conventional and non-conventional RLS treatment interventions. "The Impact of the Prospective Payment System on Psychiatric Home Health Care for Depressed Older Adults" PI: Yu Ru Lin (doctoral student) Period: September 1, 2004 to December 30, 2004-11-02 Funding Source: Frank Morgan Jones Project Summary: This descriptive comparative study focuses on an examination of the Prospective Payment System (PPS) reimbursement methodology as it affects access to quality of psychiatric home health care services for vulnerable older adults with depression as defined by the International Statistical Classification of Diseases. Pre- and post- depressed older client receiving psychiatric home health care will be examined to determine if there are any differences for these individuals related to physical functioning levels and service utilization. Project results provide an opportunity to gain additional knowledge related to how a home care reimbursement system may affect the provision and quality of psychiatric home care services.

“Relationships Among Sleepiness, Cognition, Mood, and Self-Care in Persons with heart Failure”
PI: Barbara Riegel
Period: June 1, 2003 to May 31, 2004
Funding Source: Jones Morgan Fund

Project Summary:
Poor self-care is common in elders with heart failure. The project study exams the relationship between sleepiness as a contributor to poor self-care through its effects on cognition and mood. The study is to generate pilot data testing the relationships among these variables using sleepiness as a significant predictor of cognitive deficits, distressed mood and poor self-care.

“Effectiveness of Ambulatory Outpatient Rehabilitation for Cognitively Impaired Elders”
PI: Fang Yu (Doctoral Candidate)
Period: March 1, 2003 to December 31, 2003
Funding Source: Frank Morgan Jones Fund

Project Summary:
The purpose of this retrospective cohort study is to explore differences in rehabilitation interventions and outcomes between elders with cognitive impairment and those with normal cognitive function in a sample of elders admitted to a Comprehensive Outpatient Rehabilitation Facility (CORF). An electronic descriptive database will be constructed of key patient variables from the CARE program clinical records for analysis to determine rehabilitation outcomes (functional gain, rehabilitation efficiency, number of days of service and discharge destination) to determine statistical significance of rehabilitative intervention.

"Illness Narratives of Women with Long-Term Urinary Incontinence”
PI: Christine Bradway (Penn doctoral candidate)
Period: August 2, 2002 to December, 31, 2003
Funding Source: Frank Morgan Jones Fund

Project Summary:
The purpose of this study is to examine the subjective, lived experience of women who suffer from long-term urinary incontinence (UI) and to show how cultural models help define that experience. The specific aims of the study are to describe and analyze 1) what UI means, and 2) how that meaning is constructed by women with long-term UI. Individual narratives of women with long-term UI will be described and if possible, a cultural model for long-term UI will be identified. At study completion, a research report will be compiled to represent the stories told by women with long-term UI, in order to understand their experiences, and to highlight cultural themes.

“Post-Fall Assessment: Development and Validation of a Tool for Use with Older Adults in Nursing Homes”
PI: Deanna-Gray-Miceli (post-doctoral fellow)
Period: March 20, 2003 to September 15, 2003
Funding Source: Jones Morgan Fund

Project Summary:
The project study supports Phase I of a research study to validate a post-fall assessment tool using expert review by a panel of geriatric clinicians (physicians and gerontological nurse practitioners) to determine content validity (i.e., the extent to which the post-fall assessment tool covers the relevant information needed to identify the underlying etiology of the fall).

“Developing a Palliative Care Program in the Nursing Home: “A Ethnographic Study”
PI: Nancy Hodgson and Anne Power
Period: August 1, 2002 to July 31, 2003
Funding Source: Frank Morgan Jones Fund

Project Summary:
The purpose of the project is 1) to identify the circumstances and conditions that give rise to the development of a palliative care program (PCP) in one long-term care facility, 2) to explore the meaning of palliative care for members of the core health care team, 3) to learn how this process is experienced by core members of the health care team, and 4) to learn how participant’s beliefs and attitudes about end-of-life care shape the development of a palliative care program. A model for developing a PCP will be constructed based on the analysis of resident and staff data. These findings can be then used to develop larger joint projects with HCGNE with the aim of developing recommendations for initiating and implementing future sustainable palliative care programs in long term care.

“Evaluation of the Accuracy of Height Assessment in Pre-Menopausal Women”
PI: Anne McGinley CoPI: Terri Lipman
Period: July 1, 2002 to June 30, 2003
Funding Source: Frank Morgan Jones Fund

Project Summary:
The assessment of adult women height is a diagnostic standard of care for osteoporosis and to determine the need for hormonal replacement therapy. Historical research findings indicate that there exists minimal quality assurance related to the technique and precision of linear measurement. Height measurements are frequently inaccurate due to measurements obtained by untrained observers using inaccurate techniques with faulty equipment. The purpose of this study is to examine the accuracy of pre- and post- menopausal women height measurement data applying for comparison purposes a practice model previously developed for accurate growth measurement in young children. The study will use researcher clinical observations to ascertain the standards and techniques employed for linear measurement of a selected group of adult women. A portable stadiometer will then be used to record height measurements comparing for accuracy with the previously recorded measurements.

.presented at the Endocrine Society in San Diego, June 4-7, 2005.

“A Strategic Plan for Dissemination of Gerontologic Nursing Research through a Consultation Service Model”
PI: E. Sullivan-Marx
Period: March 1, 2003 to June 15, 2003
Funding Source: Frank Morgan Jones Fund

Project Summary:
The purpose of this proposal is to develop a strategic plan to expand the research and enhance the impact of the Penn Nursing Network’s Gerontological Nursing Consultation Service (PNN Consulting/GNCS). This strategic plan will provide an evaluation of the current status of business growth and resource efficiency, identify operational and organizational requirements to sustain and improve the consultation service, create a brand identify and strategy to expand the impact of the GNCS, and determine opportunities to integrate scholarship and education within the scope of the School of Nursing’s and Penn’s HCGNE mission.

"Discharge Patterns of Fallers Who Present to the Emergency Room"
PI: M. Marenberg
Period: February 1, 2003 to May 31, 2003
Funding Source: Frank Morgan Jones Fund

Project Summary:
The project is an ancillary study to Exercise & Training Model research (RO1,Strumpf) to compare the demographic and fall characteristics of those who entered the study, and those who did not using an intervention trial to determine if exercise can reduce risk factors for frail elderly who presented to the emergency room for a fall.

“Exploring the Relationships of OASIS Data to Home Care Outcomes”
PI: Kathy Bowles
Period: April 1, 2002 to April 1, 2003
Funding Source: Frank Morgan Jones Fund

Project Summary:
The purpose of the study is to explore the relationships within a set of existing data collected from patients discharged from home care to the outcomes of an episode of home care. The study has important implications for effectively meeting the needs of older adults by helping home care organizations make accurate clinical decisions and target resources to the appropriate patients. The Outcomes Assessment Information Set (Oasis) data base will be the source used to identify the specific patient functional status characteristics that are associated with the need for continued care versus discharge from service. An Oasis sample data set will be selected for exploratory analyses that include cluster analysis to determine patterns in the data or multiple regression analysis to determine predictors of re-certification for more home care, hospitalization, or discharge without further service. Data mining techniques will be applied to explore for relationships among the data not expected or found with traditional regression. This study has the potential of providing a predictive profile of the characteristics of patients that can be used to identify similar patients for re-certification or intervention to prevent re-hospitalization.

“Does an Early State Support Group Affect AD Patients’ Quality of Life Coping Strategies, Depression and Insight?”
PI: Val Cotter
Period: April, 2002 to April, 2003
Funding Source: Frank Morgan Jones Fund

Project Summary:
The purpose of the study is to investigate whether a support group intervention for persons with early stage Alzheimer’s disease (AD) affects quality of life (QOL), coping strategies, depression and insight into their health and AD. Sixteen patients and sixteen caregivers will be included in the study. A gerontology nurse practitioner and master’s prepared social worker will facilitate the 8 weekly, 90-minute semi-structured discussions using a curriculum tested in previous pilot work. The intervention model encourages group dynamics to discuss and communicate feelings regarding memory loss and focuses on techniques that enhance each person’s capabilities for lifestyle adjustments. A team of two part-time support group facilitators and one part-time research assistant will be used. Data will be collected at two time points: baseline and post-intervention (within four-weeks following the completion of the support group). Primary endpoint is patient self-reports of quality of life ratings, secondary measures of depression, and insight using 6-item appreciation of health and AD. Participants will also be asked to complete an evaluation that incorporates their reactions and overall impressions of the intervention.

“Preparing Home Care Practitioners for the Future”
PI: Karen Buhler-Wilkerson
Period: March, 2002 to February, 2003
Funding Source: Hartford
CREF: 0035

Project Summary:
The pilot will replicate nationally the 1988 Schumacher and Lindsay “Issues in Home Health Nursing Education” study. The pilot will reexamine home care curriculum content at the undergraduate level through replication of the 1988 survey methodology. 673 baccalaureate Schools of Nursing will be surveyed to determine the current status of didactic and clinical teaching related to home care. A panel of experts will review the reported findings and formulate recommendations responsive to current home care practice, policy and research curriculum needs necessary to prepare the next generation of clinicians to meet the changing needs of community-based frail elders.

“A Clinical Database to Facilitate Research with Frail Older Adults”
PI: L. Evans
Period: May 1, 2002 to September 31, 2002
Funding Source: Frank Morgan Jones Fund

Project Summary:
The purpose of this project is to prepare an integrated electronic database containing critical data elements for the EPR system that can be used by faculty and student researchers interested in studying phenomena related to care of frail elders. Selected CARE Program date elements compiled from approximately, 300 patient records will be migrated to this designed integrated database. With the completion of this initial step, a planned longer term process of preparing a meta data dictionary of clinical and research databases in gerontologic nursing is anticipated to support future research work.

"Quality Cost Model Advanced Practice Nurse (APN) Transitional Care Model for Elders"
PI: Mary Naylor
Period: September 1, 2001 through September 1, 2002
Funding Source: Hartford Pilot Funds
CREF: 0021

Project Summary:
As a next step to promote the APN Transitional Care Model and to determine its performance across a broad base of diverse and geographically dispersed integrated health systems this pilot project will design and conduct preliminary alpha testing of handheld computers to collect research data and to develop an innovative software prototype for patient "point-of-care" data collection. Testing will evaluate the software's programmed applications, data capturing routines, and data processing speed and end-user friendliness. Further storage space capacity, file transfer capabilities and ease of end-user application will be tested. The "point-of-care" software prototype will be Beta tested during the national demonstration. The software design will incorporate the use of this innovative technology for the collection of transitional care patient screening, assessment and intervention data. As part of this project a strategic plan will be developed to build partnerships with integrated health systems to secure demonstration site location research partners. The project resources will provide the necessary means for strategic recruitment positioning to secure these sites that are geographically dispersed to determine the transitional care model's capacity to replicate predictive clinical and economic outcomes.

"A program to Develop Continuing Research in Gero-Oncology: Delineation and Management of Symptoms Experienced by People with Head and Neck Cancer"
PI: Sarah Kagan
Period: January 1, 2001 through December 31, 2001
Funding Source: Frank Morgan Jones Fund

Project Summary:
The pilot will investigate the relationship of chemosensory impairment after head and neck cancer surgery to depressed mood with the outcome measure of weight maintenance. This quasi-experimental study will address the relationship of the key variables --along with age, caregiver status, stage of disease, and means of feeding--through the UCSF symptom management model, using a unidirectional hypothesis and a hierarchical regression analysis. The investigation to include will use E-mail to communicate with patients for post-operative symptom management and include investigation of symptom experience and management on sleep, sleep disturbance, body image and adjustment concerns for people with head and neck cancer. Research partners represent interdisciplinary work in cancer and gero-oncology.

"Medicare Payments to Advanced Practice Nurses Following the Balanced Budget Act 1997: A Proposal to the Frank Morgan Jones Fund/Hartford CGNE"
PI: Eileen Sullivan-Marx
Period: June 13, 2001 through December 31, 2001
Funding Source: Hartford CREF: 0031

Project Summary:
The purpose of this descriptive study is to compare Medicare claims data for services paid to nurse practitioners and clinical nurse specialists prior to and following the Balanced Budget Act of 1997 that granted direct reimbursement for Medicare services to nurse practitioners and clinical nurse specialists. Innovative models of care employing advanced practice nurses will be evaluated in light of the current payment structures for APNs. This study will provide data examining billing and payment made to APNs following a major change in health policy payment.