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Today, there are enormous opportunities to accelerate science designed to improve outcomes among chronically ill adults and their family caregivers and reduce total healthcare costs. 

Transitions in Health and Healthcare 

Addressing the healthcare needs of adults with chronic illness risks and conditions in a person and family-centered, safe, effective, efficient, equitable and timely manner will be a major issue confronting all societies in the foreseeable future. Research that focuses on transitions in health provides an opportunity to explore the dynamic interplay between the chronically ill person and a multitude of physical, psychological, social and behavioral domains across the health continuum. The research initiatives at the NewCourtland Center emphasize the generation and use of knowledge related to all major transitions in health and health care among adults and across the continuum (early identification and intervention related to chronic illness risks to palliative and end of life care). The science generated by the Center emphasizes the unique contributions of nurses in solving these high priority health challenges.

Transitions in health and healthcare are processes central to the nursing discipline. Understanding the nature and trajectory of health transitions is essential for nurses, who want to play a major role in health promotion, prevention of health problems. This understanding also provides effective management of people from all age and health ranges, as well as their caregivers. Carefully designed interventions during transitions present opportunities for maximal effect, thus producing optimal results.  


Improving Self-Care of Informal Caregivers of Adults with Heart Failure (R01NR018196), PI: Barbara Riegel

A Training and Fidelity Model to Move and Scale Evidence-Based Dementia Care and Caregiver Support Programs into Practice: The Case for COPE in PACE Service Settings (R01AG061945), PI: Nancy Hodgson; Laura Gitlin

Connect-Home: Testing the Efficacy of Transitional Care for Patients and Their Caregivers During Transitions from Skilled Nursing Facilities to Home (R01NR017636, Toles), PI: Mary Naylor

A Problem Solving Intervention for Hospice Caregivers (R01NR012213), PI: George Demiris

Safety Outcomes of Obese Nursing Home Residents in US Nursing Homes (R01HS025703, Felix), PI: Christine Bradway

Palliative Care Research Cooperative (PCRC) Group: Refinement and Expansion (U2CNR014637, Kutner, Ritchie, Pollak), PI: Salimah Meghani


The Role of Palliative Care Interventions to Reduce Circardian Rhythm Disorders in Persons with Dementia (R01NR015226), PI: Nancy Hodgson

Information Needs of Homecare Nurses During Admission and Care Planning (R01HS024537, Sockolow), PI: Kathryn Bowles

Sources and Solutions of Persistent Disparities in Cancer Pain (American Cancer Society, 128779-PEP-15-186-01), PI: Salimah Meghani

Retention in Cancer Clinical Trials: Modeling Patients’ Risk Benefit Assessments (R01NR014865), PI: Connie Ulrich

Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health In Care Transitions by Evaluating the Value of Evidence) (TC-1403-14-19, Williams), PI: Mary Naylor

Sepsis Survivors’ Post-Acute Outcomes: Impact of Early Home Health and MD Visits (R01NR016014, Murtaugh), PI: Kathryn Bowles