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ARRA Investments in Research on Health Services and Aging


Public Health Burden
Health Services studies in the context of aging research help policy makers and medical practitioners determine the most efficient, and often the most cost effective, means to provide comprehensive and continuous care as the needs of older adults become more complex. Studies encompass a wide range of topics and methodologies including analyses of public health programs, interventions, and policies.

Understanding Costs
Costs related to both medical care and medications for older adults can be significant personal and systemic burdens. Evaluations of current and new programs are needed to assess the full cost of care and to ensure that interventions are accessible and efficient in meeting the demands of this population. ARRA-funded projects in this area include:
  • An analysis of the effect of prescription drug coverage on outcomes of care for elderly patients with coronary heart disease.1
  • An evaluation of the outcomes of the recently announced decision that the Centers for Medicare & Medicaid Services (CMS) will no longer reimburse hospitals for caring for injuries resulting from accidental falls during the hospitalizations of older patients.  This study will be conducted to determine whether elimination of payment for such injuries is associated with changes in the frequency of reported falls and changes in fall prevention strategies.2
  • An assessment of the costs and outcomes of care across the full continuum of health care for older adults with dementia and Alzheimer’s disease.  Findings will be used to help inform new treatment models.3
Increasing Utilization
In the current health care debate, the provision and utilization of health care insurance and resulting outcomes are being contested. Very little is known concerning the impact of these potential policies on those who are uninsured.
  • Investigators on one ARRA-funded project will evaluate a health insurance lottery currently under way in Oregon for low income residents 50 to 64 years of age to determine its impact on health care utilization, outcomes, and overall well-being.4
Improving the Quality of Care
Quality of health care can be an important factor in determining patient outcomes. In most systems, quality is closely linked with both costs and utilization of services. ARRA-funded projects that support efforts to assess aspects of quality in our current health care system include:
  • An examination of the quality of hospitals as perceived through Medicare patients and their clinical experiences and a comparison of such perceptions with alternative measures of clinical quality.5
  • An analysis of Medicare data to describe the role of hospitalists (physicians who devote all of their time to the care of hospitalized patients) to determine differences in patients outcomes compared to other types of clinicians.6
  • An analysis of patient outcome measures and rates of hospitalization to determine if differences exist in the quality of care provided by for-profit versus non-profit nursing homes.7
Addressing Disparities
Racial, geographic, and socio-economic disparities in accessing affordable quality care can result in postponement of necessary treatments and inequalities in health outcomes. ARRA-funded grants that support efforts to refine how both policy makers and practitioners address such disparities include:
  • Determining the impact of the Medicare Part D drug benefit across racial and ethnic groups for accessing and using antihypertensive medications. Findings will inform other initiatives in providing coverage to other vulnerable populations.8
  • Developing, applying, and improving methods that enhance public health agencies, policy-makers, and researchers’ ability to track disparities in the effective delivery of interventions to improve population health.9
Preparing the Next Generation of Researchers
Sustaining a comprehensive knowledge base in this field is an important investment in ensuring that the most current information and emerging methodologies are readily available to inform decision making.  ARRA-funded projects critical in training and developing the next generation of health services researchers include:
  • Recruiting and training doctoral-level students in health services research to prepare them for careers as independent scientists.10
  • Recruiting new faculty members to enhance the capacity for transdisciplinary research on aging that examines how social context and the health care system interact to impact health outcomes for older adults.11
  • Facilitating learning opportunities for health services researchers to increase their knowledge of the relationship between cost-related medication non-adherence and patient outcomes.12



  1. 1RC1AG036158-01 -- Effect of Prescription Drug Benefits On Cardiovascular Outcomes in the Elderly -- Amal Trivedi (RI)
  2. 1R01AG033005-01A1 -- CMS Nonpayment for Nosocomial Injury and Risk of Falls in Hospitals -- Ronald Shorr (FL)
  3. 1R01AG031222-01A2 -- Modeling Alzheimer Disease Costs and Transitions -- Christopher Callahan (IN)
  4. 1RC2AG036631-01 -- The Effect of Health Insurance on Utilization and Outcomes: The Oregon Lottery -- Katherine Baicker (MA)
  5. 1R03AG031990-01A1 -- Quality and Costs in Hospitals: What Can We Learn From Medicare Patients? -- John Romley (CA)
  6. 1R01AG033134-01A1 -- Care of the Elder Hospitalized Patient: The Role of Hospitalists -- James Goodwin (TX)
  7. 1R01AG034179-01 -- Selection and the Quality Impact of Nursing Home Ownership -- David Grabowski (MA)
  8. 1R01AG034056-01 -- Racial Disparities in Older Adults: Impact of Medicare Part D -- Joseph Hanlon (PA)
  9. 1RC1AG035616-01 -- Tracking Disparities in the Effective Delivery of Health Services -- Christopher Murray (WA)
  10. 2T32AG023482-06 -- Aging Health and Health Services Research Training -- Vincent Mor (RI)
  11. 1P30AG036459-01 -- New Faculty Recruitment for Interdisciplinary Research on Aging -- David Meltzer (IL)
  12. 3K01AG031836-02S1 -- Cost-Related Underuse of Medication and the Health of Older Adults -- Becky Briesacher (MA)


 
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