Division of Geriatric Medicine
Our faculty are investigating some of the most challenging health-related issues that face our nation including:
Patient Medication Safety: A cross-national study is underway to develop computerized interventions to reduce the risk of medication-related injuries in frail elderly patients. We collaborate with investigators at Brigham and Women’s Hospital in a federally-funded Center of Excellence on Patient Safety. We are part of a national consortium of health maintenance organizations who are testing strategies to encourage safe medication use across all patient populations. In another study we are examining the use of antipsychotic medication in long-term care facilities (see a recent Wall Street Journal article citing the research of Becky Briesacher, PhD http://online.wsj.com/article/SB119811286789841083.html?mod=todays_us_nonsub_page_one ).
The new Medicare Part D drug benefit is the most significant change to the program since its inception in 1965. Rigorous research is required to monitor the program change, especially for nursing home residents who account for 4% of the Medicare population but 28% of the health care spending. The Robert Wood Johnson Foundation recently awarded an 18-month Health Care Financing and Organization grant to UMMS faculty Becky Briesacher, Jerry Gurwitz and Terry Field to study the impact of Part D on nursing home residents. The study will: 1) measure the rates of enrollment into Medicare Part D for nursing home residents from 2005 to 2007; 2) assess the impact of Medicare Part D on overall prescription drug utilization patterns; 3) identify the major drug classes most affected by the program, including an examination of benzodiazepines and their exclusion from Part D coverage; and 4) determine the impact of Medicare Part D on overall rates of hospitalizations and falls, as indicators of quality care. The objective of the project is to better inform state and federal policymakers about how the Medicare Part D improved or potentially harmed the quality of care for this frail and vulnerable population.
Affordability of Medication Expenditures: We are examining the out-of-pocket medication spending of older Medicaid recipients after paying for basic household expenses. Together with investigators at Harvard Medical School, we received funding from the Kaiser Family Foundation to examine data from the Health and Retirement Study (HRS), a longitudinal survey of adults aged 51 and older and sponsored by the National Institute on Aging. We found that even though Medicaid enrollees have health and drug coverage they spend relatively large amounts of their personal resources on medicines and other health care costs. Medicaid recipients reporting poor health status paid over 53% of the household’s available income on medications and other medical costs after food, rent and transportation expenses. The policy implications of our findings relate directly to discussions of how much can older adults afford for medications and how will this change with the new Medicare drug benefit in 2006.
Hypertension: We are examining the factors that make it especially difficult to treat blood pressure in the primary care setting. Strategies that may improve the understanding and comprehension of information by patients are being developed and evaluated.
Heart Disease: Heart failure is one of the leading causes of hospitalization, disability, and death in the United States. Major population-based studies examining the prevalence and treatment of this very common condition are being led by our faculty. In addition, we are developing ways to maximize patient understanding of instruction on how to manage warfarin.
Systematic Reviews: Division faculty are preparing systematic reviews of research evidence to determine best practices for a number of serious health conditions.
Patient Trust: Faculty are exploring the older patient-healthcare provider relationship to understand the role that patients' trust plays in health behaviors, healthcare utilization, delay in seeking care, and health outcomes.
Cancer: Faculty are examining variation in breast cancer treatment patterns and end-of-life care for cancer patients, and identifying racial disparities in care. In addition, we are collaborating with Investigators at the UMass Memorial Breast Center to explore whether patient trust enhances adherence and outcomes among patients in the high risk clinic.
Bone and Joint Disease: Our faculty have conducted research that demonstrated the benefits of exercise (aerobic or resistence) in decreasing knee pain, disability, and physical performance in older disabled adults. Faculty continue to develop innovative strategies to provide optimal medical care to patients affected by this condition. We are focusing on the underuse of potentially beneficial treatments for osteoporosis among those patients most likely to be afflicted by this very prevalent condition.
Interested in participating in or supporting our research?
Please call us at (508) 856-3085.