The National Institute of Nursing Research (NINR) has awarded a $2.7 million grant to fund a new exploratory center, entitled “Center for Improving Palliative Care for Vulnerable Adults with MCC (CIPC),” at Columbia University School of Nursing. The award by the NINR, part of the National Institutes of Health, will finance five innovative CIPC pilot projects researching the palliative needs of vulnerable adult populations living with multiple chronic conditions (MCC).
The prevalence of MCCs in older adults represents one of the nation’s most formidable healthcare challenges. Medicare beneficiaries with MCCs account for 93 percent of programmatic spending, while one-third of recipients with four or more chronic conditions account for 75 percent of spending.[i] Known in the research as “super-utilizers,” elderly patients with MCCs are more likely to have greater complications, longer hospital stays, and experience end-of-life crises that lead to high healthcare resource use without clinically significant increases in quality of life or survival.[ii]
“As the country grows older demographically, more and more people are faced with the increased possibility of developing multiple chronic conditions, which can include diabetes and arthritis, among many others, that require long-term management and pain control,” said Patricia Stone, PhD, Centennial Professor of Health Policy at Columbia University School of Nursing and Co-Principal Investigator (PI) at CIPC. “Accordingly, improving palliative care across clinical settings could not be more important, and research is the first step in finding out how to do so in an evidence-based, scientifically rigorous manner.” Stone’s colleague, Jingjing Shang, PhD, associate professor of nursing, will serve as CIPC’s other Co-PI.
Conducted in partnership with the Visiting Nurse Service of New York (VNSNY), the CIPC will generate knowledge using interdisciplinary research teams to determine how to best provide vulnerable populations with palliative care. Columbia Nursing researcher Max Topaz, Elizabeth Standish Gill Associate Professor of Nursing, will serve as VNSNY’s site PI. Factors that influence someone’s health vulnerability include race/ethnicity, acculturation, socioeconomic status, age, living location/situation (e.g., at home, in assisted living) and sexual identity. The CIPC research teams will examine the impact of these factors, as having MCCs alone does not fully explain the pattern of high healthcare utilization and yet poor outcomes observed among vulnerable adults.
The CIPC’s first two pilot projects include: the “NH-Resident Engagement in Antibiotic Care and Health Symptoms” study and the “Aged Immigrant Chinese-Americans with ESRD: Self-Care Strategies for Healthy Living” study. The first project, headed by Eileen Carter, PhD, assistant professor of nursing, will explore the risks and benefits associated with antibiotic use from the perspectives of nursing home residents and/or their families. The goal of the research will be to develop cooperative decision-making tools that support end-of-life preferences regarding antibiotic treatment while improving palliative care for this vulnerable population. Led by Carolyn Sun, PhD, associate research scientist, the second study will explore the symptoms experienced and amelioration strategies used by Chinese-Americans with end-stage renal disease in order to develop culturally appropriate, evidence-based care strategies.
Additional CIPC research contributors include: Suzanne Bakken, PhD; Walter Bockting, PhD; Bevin Cohen, PhD; Maureen George, PhD; Tonda Hughes, PhD; Elaine Larson, PhD; Jacqueline Merrill, PhD; Lusine Poghosyan, PhD; and Rebecca Schnall, PhD. CIPC will also be supported by palliative care faculty including: Karol DiBello, DNP; Penny Buschman, MS; Marlene McHugh, DNP; Debra Miller-Saultz, DNP; and Mary Ellen Tresgallo, DNP.
To learn more about CIPC, visit: http://nursing.columbia.edu/research/center-improving-palliative-care-vulnerable-adults-mcc-cipc
[i] Wolff, J. L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 162(20), 2269-2276.
[ii] Harris, L. J., Graetz, I., Podila, P. S., Wan, J., Waters, T. M., & Bailey, J. E. (2016). Characteristics of hospital and emergency care super-utilizers with multiple chronic conditions. The Journal of Emergency Medicine, 50(4), e203-e214.