Reaching the Most Vulnerable: A Novel Model of Care in Advanced Parkinson's Disease

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PROJECT SUMMARY/ABSTRACT As Parkinson's Disease (PD) progresses, the symptoms of this debilitating and costly condition increase in number and severity, quality of life declines, and caregiver strain rises, resulting in 100-200,000 US patients becoming homebound. This population loses access to care despite overwhelming need. Evidence supports interdisciplinary and home-based models of care in other elderly cohorts, and the use of telehealth in earlier stages of PD; however, none of these have been formally tested in advanced PD. The long-term goals of this K23 are 1) to develop the candidate into a leader in the fields of movement disorders and health services research, and 2) to develop, test, and disseminate models of care and related interventions to improve access to care, quality of care, and quality of life for patients with advanced PD and their caregivers. The aims of this project are 1) to test the efficacy of an interdisciplinary home visit program for patients with advanced PD on patient quality of life and caregiver strain when compared with usual care; 2) to compare the effects of home visits with and without caregiver peer mentoring on caregiver health; and 3) to conduct a budget impact analysis of the model. We will prospectively study 60 patient-caregiver pairs matched with subjects receiving usual care within the National Parkinson Foundation Parkinson's Outcome Project (POP); we will enroll 36 experienced past caregivers as peer mentors. The K23 candidate is an Assistant Professor of Neurology and Population Health at New York University School of Medicine, and completed a movement disorders fellowship and NINDS T32-supported Master's of Science in Clinical Epidemiology at the University of Pennsylvania. She has conducted clinical and health services research in geriatrics, neurology, and PD, identifying health literacy and medication beliefs as barriers to care. She has demonstrated the feasibility of a pilot interdisciplinary home visit program for homebound individuals with PD. The candidate is committed to a career in patient-oriented research and proposes an comprehensive five-year plan of mentorship, formal training, self-directed learning, and research. She will develop expertise and skills in: 1) Implementation and dissemination science; 2) Comparative and cost effectiveness research; and 3) Palliative care skills and research. The results of this K23 will inform future R01 applications that will test the efficacy and cost effectiveness of this model for advanced PD in other settings, and adapt this model to other chronic neurologic conditions. By identifying, testing, and disseminating effective therapies and models of care for this previously understudied population, we can minimize morbidity and unnecessary healthcare utilization. Dr. Fleisher's mentorship team includes expertise in PD, implementation and dissemination of interdisciplinary care models, telehealth, cost effectiveness, and the POP. The outstanding institutional support, and proposed training, career development, and research plans will ensure Dr. Fleisher's successful transition to an independent clinical investigator dedicated to improving the health outcomes of patients with advanced Parkinson's Disease and other neurodegenerative conditions.