Projects
Current Projects
Improving Medical Care of Assisted Living Residents with Dementia – The overall goal of this project is to increase adherence to evidence-based disease guidelines for Alzheimer’s Disease and related dementia care by: 1) improving diagnosis, assessment, and staging of dementia; 2) reducing problems with medication use (including underprescribing of effective medications and use of potentially inappropriate medications); and 3) improving the assessment, detection and treatment of critical elements of dementia quality of life (behavioral symptoms, pain, depression, and mobility problems). The study is utilizing the resources of an existing cohort of 293 assisted living ( AL) facilities and 40 nursing homes where Sheps Center researchers have conducted numerous studies over the past six years that document the need for improved medical services.
Principal Investigator: Philip D. Sloane, M.D., M.P.H.
Funding Source: Alzheimer’s Association
Total Project Period: 03/05 – 02/10
Improving Decision-Making About Feeding Options for Dementia Patients – This study is a cluster randomized controlled trial of a previously piloted decision aid to improve decisions about feeding options for patients with advanced dementia. It aims to test: 1) whether a decision aid on feeding options in dementia effectively informs surrogate decision-makers in the intervention group; 2) whether the decision aid improves 1 and 3 month decision-making outcomes for surrogate decision-makers in the intervention group; and 3) the impact of the decision aid on 1 and 3 month clinical treatment decisions.
Principal Investigator: Laura C. Hanson, M.D., M.P.H.
Primary Funding Source: National Institute on Aging, NIH
Total Project Period: 9/28/06 – 6/30/10
Employment of Adults with Disabilities under the North Carolina Medicaid Infrastructure Grant (MIG) – . This study will provide assistance to the North Carolina Medicaid Infrastructure Grant-2 (MIG2), through on-going collaboration with consumer, employer and state agency stakeholders; collection of primary data on working adults with emotional, cognitive and physical limitations and their employers; and analysis of primary and secondary data to meet the informational needs of MIG2. The goal is to assist the MIG2 effort to develop a comprehensive and lasting employment infrastructure in North Carolina that coordinates disparate state service delivery systems in order to maximize employment for people with disabilities, increase the state's labor force through the inclusion of people with disabilities, and protect and enhance workers' healthcare, other benefits, and needed employment supports.
Principal Investigator: Kathleen C. Thomas, M.P.H., Ph.D.
Funding Source: North Carolina Division of Vocational Rehabilitation
Total Project Period: 07/07 –12/09
Physician Care in Assisted Living ( AL) Facilities – Currently, there is no systematic information regarding physician care to AL facility residents, and how it is coordinated with AL services. Obtaining this information is the first step to improving the quality of medical care for millions of our nation’s elderly. Therefore, the aims of this project are to: 1) describe the care that 240 physicians provide to 480 AL facility residents in 120 stratified AL facilities across four states, as well as the physician and practice characteristics and perspectives related to this care; 2) describe the 120 AL facility managers’ (or healthcare liaisons’) reports of the care physicians provide to AL facility residents, as well as the medical support services provided by the AL facility and his/her own perspectives regarding this medical care; 3) examine how physician and practice characteristics are associated with the care they provide to AL facility residents; and 4) examine how AL facility characteristics are associated with the care physicians provide to AL facility residents. Findings will have great promise to clarify the current role and future promise of physician services in AL.
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: National Institute on Aging, NIH (subcontract with University of Maryland Baltimore County)
Total Project Period: 07/07 – 12/09
Stigma in the Cultural Context of Residential Settings for the Elderly – Different forms of community housing and residential long-term care now exist for older adults, including active adult communities, assisted living facilities, nursing homes, and continuing care retirement communities. These settings differ in at least two important ways: 1) they do not similarly intend to address the health and psychosocial needs of the residents who live there and 2) they are not similarly acceptable to prospective clientele. Anecdotal data indicate that the more services a setting offers, the more its residents are stigmatized. Unfortunately, this stigma may act to delay an individual's willingness to seek and accept necessary services. Therefore, the aims of this project are to determine: 1) how older adults define stigmatizing traits in themselves and others in their everyday routines; 2) how older adults act and react to stigmatizing traits in themselves and others in their everyday routines; 3) how stigmatizing interpersonal and inter-group traits influence social dynamics and personal behaviors (such as masking, hiding, enabling) to avoid stigma; 4) how stigma is defined or operates differently in various levels of care and environmental configurations (such as those with single vs. graded levels of care in one campus); and 5) how the quality of settings and care might be improved with attention to the personal and social dynamics of stigma.
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: National Institute on Aging, NIH (subcontract with University of Maryland Baltimore County)
Total Project Period: 07/07 – 06/12
Development of an Assisted Living Consensus Instrument - Phase I - Currently, there are almost 40,000 assisted living residences providing care to as many as one million older adults across the United States. The services provided by these settings differ, but this type of descriptive information is not readily available to help consumers make decisions as they seek services and compare settings. This project will work with a group of key stakeholders to develop a voluntary instrument for assisted living providers to complete to describe their characteristics and services so as to better inform prospective consumers. Topics to be included are services and costs of care; staffing, staff training, and staff turnover; move in/move out criteria and residents' rights, house rules, and life safety; and dementia services.
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: Abt Associates Inc.
Total Project Period: 05/27/08 - 04/26/10
Blue-White Light Therapy for Circadian Sleep Disorders in Alzheimer's Disease - Disturbed night-time sleep is common in older persons with Alzheimer's disease and related dementias (ADRD), leading to significant negative effects on the daytime function of the affected person and on the well-being of caregivers. Sedating drugs, the conventional treatment for disturbed sleep, have limited effectiveness and pose increased risk in this population. Disturbed sleep in ADRD is virtually always accompanied by marked disturbances of the circadian system, and research has established that controlled bright-dark light cycles will synchronize that system to the 24-hour solar day.
Principal Investigator: Phillip D. Sloane, M.D., M.P.H.
Funding Source: National Center for Complementary & Alternative Medicine
Total Project Period: 07/1/08 - 06/30/10
Rotavirus Gastroenteritis in a Long-Term Care Population – This project is an epidemiologic assessment of the incidence and characteristics of rotavirus in nursing home residents. Rotavirus is one of several viruses that cause gastroenteritis, or an inflamation of the intestines. People with gastroenteritis typically have fever, vomiting, and diarrhea, which can last anywhere between 3 and 9 days. Long periods of gastroenteritis may lead to dehydration, which can lead to hospitalization. Dehydration can also cause other medical emergencies, such as electrolyte imbalances. Gastroenteritis can be risky in older adults, especially for those that live in institutional settings. In order to learn more about the etiology of rotavirus as a cause of gastroenteritis in older adults, we will enroll nursing home residents in the local area, and follow them to monitor for an episode of the disease. One-hundred and fifty nursing home residents aged 65 and older (or their guardian in cases of cognitive impairment) will be enrolled in th study. These enrolled residents will then have blood drawn and other baseline measures completed. Residents will then be observed for one year. If during that year the resident has an episode of gastroenteritis, blood and stool samples will be collected. Based on other study sites, we estimate that 41 residents will experience an episode of gastroenteritis and undergo the additional blood draw and stool collection. Once the one-year surveillance period is over, follow-up data (such as current health status) will be collected.
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding: Source: Merck and Co., Inc
Total Project Period: 11/14/08-2/28/10
Recently Completed Projects
Implementing a Program to Prevent Injurious Falls in Assisted Living – Using a model of quality improvement and adapting evidence-based interventions that have been used in nursing home and community settings, a multi-component intervention of medication review, assessment, environmental modification, and exercise were developed to reduce risk factors for falls and fall and fracture rates among residents of assisted living facilities. Two pairs of matched assisted living facilities were randomly selected, one of each is receiving the multi-component intervention program and the other an educational intervention. Over the course of one year of implementation they will be evaluated to determine: 1) the degree to which the facility changes its practices in accordance with the multi-component intervention; the degree to which residents accept and adhere to the intervention; and facility- and resident-level facilitators for and obstacles to implementation and maintenance of the intervention; 2) the change in resident risk factors, and in facility fall and fracture rates; and 3) the relationship of implementation and adherence to change in risk factors and fall and fracture rates. [This is the first project funded at UNC funded under the Accelerating Change and Transforming Organizations and Networks (ACTION) Task Order Agreement to RTI from AHRQ.]
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: Agency for Healthcare Research and Quality (subcontract with the Research Triangle Institute)
Total Project Period: 09/15/06 – 09/30/09
Social Work Involvement in the End of Life in Long-Term Care – The purpose of this study is to better understand issues related to the quality of dying considered important by social workers practicing in long-term care settings, and to learn about the role of these social workers and others filling similar roles in the end-of-life experience. Three focus groups will be conducted with social workers or other long-term care staff who fulfill a similar role. The results will inform the substance of a survey sent to approximately 200 social workers or other long-term care staff who work in settings that provided data for the National Institute of Aging project “End of Life Care in Residential Care and Nursing Homes.”
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: Hartford Foundation (subcontract with Florida State University)
Total Project Period: 09/07 – 08/09
A Family Staff Partnership to Improve Long-Term Care Quality – Virtually all practitioners, policy-makers, researchers and the general public recognize a need to improve the quality of care in nursing homes and other residential long-term care settings. In large part, quality concerns exist because there is an insufficient and inconsistent workforce to care for long-term care residents. Fortunately, there is a likely remedy to worker burden, already in place and waiting to be mobilized: residents’ families. Therefore, the aim of this project is to conduct a six-month randomized clinical trial of a family-staff partnership program in 24 nursing homes and residential care/assisted living facilities. Families (N = 960) will be involved in resident-focused activities and relations between family and staff (544 nursing assistants and personal care aides) will be facilitated. Results have implications for the workforce crisis in long-term care, and can benefit all individuals who live in, work in, and care about those living and working in, nursing homes and residential care/assisted living facilities.
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: Agency for Healthcare Research and Quality
Total Project Period: 09/15/06 – 06/30/09
Measuring the Quality of Dying in Residential Long-term Care – Long-term care (LTC) settings have become a significant site for end-of-life (EOL) care. Although, the information available on EOL in LTC has been growing, one important omission in the research is lack of definitive outcome measures to assess the quality of dying in LTC. This project will evaluate six quality of dying measures that have been used in—but not necessarily developed for—LTC populations, one developed by this research team for an earlier study. They will be administered to family caregivers in 300 nursing homes and decedents in 150 residential care/assisted living facilities, to determine: 1) the domains of study, convergent validity, internal consistency reliability, ease of use, and perceived relevance of each; 2) what combination of items from the measures results in a composite instrument with the best psychometric properties overall, and in different settings; and 3) whether the measure can separate quality of care from quality of dying. Thus, the project will develop one or two comprehensive, yet parsimonious, valid and reliable measures to assess the quality of dying and the quality of EOL care in LTC. A similar study planned for the Netherlands will permit examination of the culturally-bound components of care and outcomes, which will be useful for international comparisons to improve EOL care in LTC.
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: National Palliative Care Research Center
Total Project Period: 07/07 – 06/09
Improving the Integration of Evidenced-Based Clinical and Community Services to Support Healthy Behaviors – This is a randomized trial within a primary care practice-based research network (PBRN) evaluating two different interventions compared to usual practice to improve linkages with community resources addressing tobacco use, unhealthy diets, and physical inactivity. The first intervention uses an evidence-based quality improvement learning collaborative and the second uses a more informal practice strategy in which practices will receive written material (brochures, fax referral forms, and “information” prescription pads) to facilitate referral to community resources that address the selected unhealthy behaviors. Quantitative and qualitative analyses will be used to understand the impact of the interventions at the practice, provider, patient, and community resource level. The main outcome measure is the probability that a patient with an unhealthy behavior is referred to a community resource. [This is the first Primary Care-Practice Based Research Network (PBRN) project.]
Principal Investigator: Philip D. Sloane, M.D., M.P.H.
Funding Source: Agency for HealthCare Policy and Research (AHRQ)
Total Project Period: 07/07 – 12/08
Understanding the Direct and Indirect Costs of Quality Measurement Data Collection and Reporting in Primary Care Practice –. The purpose of this study is to estimate both direct and indirect costs incurred by primary care practices related to being required to collect and report quality performance measurement data. A diverse sample of eight practices will participate in the study. Direct and indirect costs of the following scenarios will be estimated: 1) total costs absorbed by practices who are reporting 1-2 measures; 2) costs involved with reporting a small group of measures (2-8 measures); and 3) costs of reporting 2-8 (or more) measures to several different stakeholders. Cost estimates will be generated for practices that use Health Information Technologies (HIT, e.g. electronic health records, registries) and for those that do not. In addition, the project seeks to determine: 1) what factors influence primary care practices to collect and report quality measures; 2) the actual strategies used by practices to implement and maintain reporting, and to improve the cost-efficiency of this reporting; and 3) the justification of these costs. [This is the second Primary Care-Practice Based Research Network (PBRN) project.]
Principal Investigator: Philip D. Sloane, M.D., M.P.H.
Funding Source: Agency for HealthCare Policy and Research (AHRQ)
Total Project Period: 09/07 – 10/08
Implementing a Program to Prevent Injurious Falls in Assisted Living – Using a model of quality improvement and adapting evidence-based interventions that have been used in nursing home and community settings, a multi-component intervention of medication review, assessment, environmental modification, and exercise will be developed to reduce risk factors for falls and fall and fracture rates among residents of assisted living facilities. Two pairs of matched assisted living facilities will be randomly selected; one of each will receive the multi-component intervention program and the other an educational intervention. Over the course of one year of implementation they will be evaluated to determine: 1) the degree to which the facility changes its practices in accordance with the multi-component intervention; the degree to which residents accept and adhere to the intervention; and facility- and resident-level facilitators for and obstacles to implementation and maintenance of the intervention; 2) the change in resident risk factors, and in facility fall and fracture rates; and 3) the relationship of implementation and adherence to change in risk factors and fall and fracture rates. [This is the first project funded at UNC funded under the Accelerating Change and Transforming Organizations and Networks (ACTION) Task Order Agreement to RTI from AHRQ.]
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: Agency for Healthcare Research and Quality (subcontract with the Research Triangle Institute)
Total Project Period: 09/15/06 – 09/14/08
A National Assisted Living Community-based Participatory Research Partnership – The goal of this project is to develop a practice/policy-research partnership, through which new knowledge can be generated and existing knowledge translated, to truly improve the quality of care and quality of life in assisted living. Members of the Center for Excellence in Assisted Living (CEAL) and the Collaborative Studies of Long-Term Care (CS–LTC) will establish a partnership with an organizational structure and established modes of communication, to work together toward two aims: 1) the development of a sustainable model of national community-based participatory research (CBPR) in assisted living and 2) the collection of pilot data for and development of a research project related to medication management in assisted living. The project will develop a partnership focused on improving the quality of assisted living, and also serve as a beta test of this model.
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: Agency for Healthcare Research and Quality
Total Project Period: 09/06 – 08/08
Social Work Involvement in the End of Life in Long-Term Care – The purpose of this study is to better understand issues related to the quality of dying considered important by social workers practicing in long-term care settings, and to learn about the role of these social workers and others filling similar roles in the end-of-life experience. Three focus groups will be conducted with social workers or other long-term care staff who fulfill a similar role. The results will inform the substance of a survey sent to approximately 200 social workers or other long-term care staff who work in settings that provided data for the National Institute of Aging project “End of Life Care in Residential Care and Nursing Homes.”
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: Hartford Foundation (subcontract with Florida State University)
Total Project Period: 09/07 – 08/08
Evaluating the Alzheimer’s Association’s Training Program for Direct Care Staff – Based in part on the work of a previously funded Sheps Center project, the Alzheimer’s Association embarked on a campaign to improve the quality of care and quality of lives for people with Alzheimer’s disease and dementia in residential care/assisted living (RC/AL) facilities and nursing homes (NHs). Practice recommendations for direct care staff related to care for food and fluid intake, pain management, and activity involvement, have been developed based on research as well as input from Association chapters, industry and care experts. Chapter affiliates of the Alzheimer’s Association were trained to provide classroom instruction on these practices to care staff in RC/AL facilities and NHs in the summer, 2005. This project is a collaborative effort to evaluate: 1) the training provided by the affiliate to the direct care staff and supervisors; 2) the extent to which the practice recommendations are being implemented; and 3) the characteristics related to training outcomes in North Carolina, South Carolina, and Virginia. The supplement allows Kentucky to be included in the evaluation.
Principal Investigator: Sheryl Zimmerman, Ph.D.
Funding Source: Alzheimer’s Association
Total Project Period: 11/05 – 10/08
Supplemental Funding Source: Commonwealth of Kentucky
Total Project Period: 05/07 - 06/08
Preventative Oral Health and Adults With Developmental Disabilities – This project is adding a preventive oral hygiene component to the primary health care project described earlier in this section. Personnel from the Sheps Center and the Department of Dental Ecology are training five dental hygienists from the North Carolina Oral Health Section of the State Department of Health and Human Services in issues unique to working with adults with developmental disabilities. These dental hygienists will train, free of charge except for expenses, local non-medical case managers, nurse care managers, residential care workers, and family members in how to work together with adults with developmental disabilities to help them develop good oral health practices. In addition, written training and technical assistance materials will be developed to promote and improve oral hygiene for adults with developmental disabilities. These materials will be shared with other North Carolina communities via a project website, managed by the North Carolina Council of Community MH/DD/SAS Programs.
Principal Investigator: Kathryn Moss, Ph.D.
Funding Source: Duke Endowment
Total Project Period: 01/06 – 12/07
Older Adults and Drug Decisions: Collaboration and Outcomes – This project is studying the outcomes of an intervention designed to prompt physicians, at the time of a clinic visit, to address adults’ (60 years of age or older) priorities regarding arthritis and its therapy using a longitudinal quasi-experimental design with a study and control group.
Principal Investigator: Betsy L. Sleath, Ph.D.
Funding Source: National Institute on Aging, NIH (subcontract with University of Wisconsin)
Total Project Period: 09/15/02 – 08/31/07
