We want to understand what patients with MCCs actually need as they face the end of life, and to find methods that meet those needs while reducing burdensome treatments and transitions.
Jingjing Shang, PhD, RN, Co-Principal Investigator
The Center for Improving Palliative Care for Vulnerable Adults with MCC (CIPC) is an interdisciplinary collaboration supported by a five-year National Institute of Nursing Research (NINR) grant (P20NR018072-01), which is building infrastructure and interdisciplinary research teams led by nurse scientists, to address knowledge gaps in key palliative care areas. CIPC is a partnership between Columbia University School of Nursing and the Visiting Nurse Service of New York.
Multiple chronic conditions (MCC)—defined as two or more co-occurring chronic conditions— represent one of the nation's most daunting health care challenges. Patients with MCCs represent 93 percent of Medicare spending, with 75 percent going to the one-third of beneficiaries who have four or more chronic conditions. Elderly patients with MCCs are likely to have more complications and longer hospital stays than other patients their age and to experience end-of-life crises that lead to high use of health care resources without significant increases in their quality of life or survival.
Vulnerable adult populations with MCC are at higher risk of receiving inappropriate and/or burdensome services (procedures, treatments, and hospitalizations) that are inconsistent with their preferences. Medical complexity alone does not explain these differences; the issues vary on many characteristics including race/ethnicity, acculturation, and living location.
Furthermore, there are knowledge gaps in key palliative care areas including how best to support symptom management, communication, and care coordination; these knowledge gaps must be addressed to provide effective innovative interdisciplinary care models in multiple health care settings for vulnerable adult patients with MCC to ensure they receive appropriate care that is consistent with their preference.
The specific aims of CIPC are to:
- Develop a sustainable infrastructure that supports interdisciplinary researchers to develop into transdisciplinary teams that conduct biobehavioral, palliative care research across health care settings for vulnerable adults with MCC.
- Develop new programs of biobehavioral, palliative care research for vulnerable adults with MCC led by nurse scientists.
- Enhance the knowledge and skills of participating investigators on transdisciplinary, biobehavioral, palliative care research methods across health care settings for vulnerable adults with MCC and disseminate new knowledge to relevant stakeholders.
- Evaluate the center’s inputs, outputs, and outcomes on an ongoing and annual basis and refine processes as needed.
- Administrative Core
- Pilot Core
- Enrichment Core
CIPC will use its outstanding institutional resources and proposed research activities to improve palliative care for vulnerable adults with MCC.