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Home-based Primary Care for Homebound Seniors: a Randomized Controlled Trial

Award Number: R01AG052557
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 06/15/2016
PERIOD OF PERFORMANCE END DATE: 05/31/2022

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Home-based Primary Care for Homebound Seniors: a Randomized Controlled Trial - DESCRIPTION (provided by applicant): The objective of this study is to evaluate the impact of home-based primary care (HBPC) on outcomes for homebound older adults, including hospitalization and emergency department (ED) visits, quality of life and symptom control, costs of care, and burden of care for their informal caregivers. We will also conduct a mixed methods dissemination and implementation evaluation of HBPC. Over one million seniors in the U.S. have functional limitations that prevent them from receiving office-based primary care (OBPC). As a result, homebound adults typically experience poor disease control, high rates of hospitalization, and large healthcare expenditures resulting for hospitalizations and ED use. Few modes of healthcare delivery designed specifically for the homebound have been studied, but observational data suggest that HBPC could improve outcomes and reduce spending for these highly vulnerable patients. We propose a pragmatic randomized controlled trial of HBPC vs. OBPC for homebound older adults, with 3 Specific Aims: to compare the impact of HBPC and OBPC 1) on hospitalization and ED visit rates, symptom control and quality of life, and satisfaction with care among homebound elders; 2) on caregiving burden among informal caregivers (e.g., family and friends); and 3) on healthcare expenditures for the homebound. We hypothesize that patients in HBPC and their caregivers will have better outcomes compared to OBPC patients. We will recruit 350 homebound adults ≥ 65 years in New York City from outpatient clinical and community- based settings. HBPC will be delivered through Mount Sinai Visiting Doctors or the Chelsea Village House Calls Program. Patients randomized to OBPC will continue to receive care from their usual outpatient primary care provider or will be assigned one within the Mount Sinai healthcare system. We will conduct interviews in English and Spanish at baseline and quarterly thereafter up to 1 year. Medicare and Medicaid claims data will be used to determine healthcare utilization and costs. The study embraces the concepts of a pragmatic trial design to facilitate the translation of study findings for practical clinical, systms, and health policy applications. The study team includes experts in aging related health services research, health economics, health policy, randomized clinical trials, and the medical and nursing care of homebound older adults. The proposed study would be the largest prospective study of homebound older adults and the only randomized trial of HBPC for the homebound. It would fill important knowledge gaps in our understanding of the effects of HBPC for the homebound. The study is consistent with the Institute of Medicine's call for expanded research on comprehensive models of chronic care, including the multidisciplinary management of chronic diseases and the medical home concept.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = -$83 )
2023	2020	ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI	1 GUSTAVE L LEVY PL	NEW YORK	NY	10029	NEW YORK	USA	Aging Research	000	5	10/28/2022	NON-COMPETING CONTINUATION	-$83
														Subtotal = -$83

Issue Date FY: 2020 ( Subtotal = $689,404 )
2020	2020	ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI	ONE GUSTAVE L LEVY PL	NEW YORK	NY	10029	NEW YORK	USA	Aging Research	000	5	6/5/2020	NON-COMPETING CONTINUATION	$689,404
														Subtotal = $689,404

Issue Date FY: 2019 ( Subtotal = $690,015 )
2019	2019	ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI	ONE GUSTAVE L LEVY PL	NEW YORK	NY	10029	NEW YORK	USA	Aging Research	000	4	6/11/2019	NON-COMPETING CONTINUATION	$690,015
														Subtotal = $690,015

Issue Date FY: 2018 ( Subtotal = $689,189 )
2018	2018	ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI	ONE GUSTAVE L LEVY PL	NEW YORK	NY	10029	NEW YORK	USA	Aging Research	000	3	6/1/2018	NON-COMPETING CONTINUATION	$689,189
														Subtotal = $689,189

Issue Date FY: 2017 ( Subtotal = $696,699 )
2017	2017	ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI	ONE GUSTAVE L LEVY PL	NEW YORK	NY	10029	NEW YORK	USA	Aging Research	000	2	7/5/2017	NON-COMPETING CONTINUATION	$696,699
														Subtotal = $696,699

Issue Date FY: 2016 ( Subtotal = $721,497 )
2016	2016	ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI	1 GUSTAVE L LEVY PL, BOX 3500	NEW YORK-NEW YORK	NY	10029		USA	Aging Research	000	1	6/14/2016	NEW	$721,497
														Subtotal = $721,497

Grand Total All Awards = $3,486,721

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Home-based Primary Care for Homebound Seniors: a Randomized Controlled Trial

Award Number: R01AG052557

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 06/15/2016

PERIOD OF PERFORMANCE END DATE: 05/31/2022

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