Challenges and opportunities in advancing models of care for older adults: an assessment of the National Institute on Aging research portfolio.
OBJECTIVE
To identify existing projects supported by the National Institute on Aging (NIA) that may relate to the recommendations for models of care (MOCs) presented in the 2008 Institute of Medicine Report, Retooling for an Aging America: Building the Healthcare Workforce.


METHODS
Cross-sectional analysis of NIA's grant portfolio.


METHODS
NIA.


METHODS
NIA grantees.


METHODS
NIA's grant portfolio was queried for the period 1999 to 2008 using a variety of search terms related to MOCs. Inclusion criteria were adherence to guiding principles for MOCs (comprehensive care, efficient care, older person as an active partner) or focus on innovative feature(s) of MOCs (interdisciplinary care, care management, chronic disease self-management, pharmaceutical management, preventive home visits, proactive rehabilitation, transitional care). Exclusion criteria were lack of focus on an intervention and focus on informal caregivers. Expert NIA staff reviewed and validated projects.


RESULTS
One hundred thirty-five grants were identified. These grants represent fewer than 1% of the approximate number of grants NIA has funded over this same period of time (∼24,000 grants). Forty-four percent focused on components of comprehensive care and 34% on active involvement of older adults. Approximately half specifically focused on innovative features of MOCs, ranging from chronic disease self-management (32%) and proactive rehabilitation (26%) to preventive home visits (1%) and transitional care (1%). The majority of projects were investigator-initiated grants (46%).


CONCLUSIONS
NIA has supported the development of many interventions that include components of MOCs related to recommendations from the IOM report. The challenge for the future will be determining which of the many components of comprehensive care systems are most effective for which subsets of the elderly population and assessing opportunities for enhanced collaboration between public and private aging research stakeholders.
National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA. ligginsc@mail.nih.gov
Charlene
C
Liggins
Lisa
L
Pryor
Marie A
MA
Bernard
D000368:Aged; D000369:Aged, 80 and over; D035843:Biomedical Research / Q000639:trends*; D003191:Comprehensive Health Care / Q000458:organization & administration* / Q000592:standards; D003430:Cross-Sectional Studies; D005381:Financing, Organized; D016330:Frail Elderly; D015577:Geriatric Assessment; D005853:Geriatrics; D019983:Guideline Adherence; D006801:Humans; D054561:National Institute on Aging (U.S.); D017063:Outcome Assessment, Health Care; D014481:United States