Added Value of Primary Care-Senior Center Linkages for Health and Functioning

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DESCRIPTION (provided by applicant): The prevalence of diabetes and its complications has increased among older adults, and new models of care are needed to combat this trend among vulnerable populations. According to the Chronic Care Model (CCM), optimal chronic illness care requires linkages with community-based resources. Research based upon the CCM suggests that self-management support for older adults with diabetes may be bolstered by linkages between primary care providers and senior centers, but studies of such linkages are rare. This proposal describes an exploratory grant to demonstrate the added value of primary care's linkage with multipurpose senior centers in maintaining the health and functioning of older adults with diabetes, as well as to identify facilitators and barriers to creating and maintaining linkages between primary care clinics and community-based multipurpose senior centers. Our initial inquiry will capitalize on a unique, existing public-private partnership that has linked an innovative primary care network to two community-based, multipurpose Senior Centers that serve over 9,000 vulnerable seniors living in majority Hispanic, low-income neighborhoods in San Antonio, TX. In collaboration with these partners, an interdisciplinary team of researchers proposes to accomplish the following specific aims for the R21: 1) Among newly registered members of multipurpose senior centers who have type 2 diabetes, determine if being a patient of primary clinics with established linkages to the Senior Centers is associated with frequency and type of services used and clinically relevant improvements over a 9-month follow-up period. 2) Using qualitative methods, identify: a) Senior Center services that primary care providers, administrators, and staff are aware of and value most; b) specific ways, formal and informal, in which members' primary care clinics are linked to the senior centers; and c) barriers and facilitators (e.g., tools, resources, and interactions) to creating and maintaining primary care-senior center linkages. To address Aim 1, we propose to recruit and consent 360 older adults ¿ 65 years with type 2 diabetes as they become new members of the two multipurpose Senior Centers over a 9-month enrollment period. At baseline (i.e., time of registration as a new senior center member) and 9-months follow-up, we will assess patient activation and functioning using self-report and performance-based measures. At 9-months follow-up, we will ascertain frequency of visits and type of services used from Senior Center activity logs. We will also obtain electronic medical record data for those Senior Center members who are patients of the primary care clinics with established links to the senior centers. To address Aim 2, we will use key informant interviews to identify: a) Senior Center services that primary care providers, administrators, and staff are aware of and value most; b) specific ways, formal and informal, in which members' primary care clinics are linked to the Senior Centers; and c) barriers and facilitators (e.g., tools, resources, and interactions) to creating and maintaining primary care-senior center linkages.