Expanding the CAARN to accelerate research on multiple chronic conditions with rural and African-American communities and health-care providers

项目摘要/摘要 四分之三的老年人患有多种慢性病，这些疾病会恶化健康，缩短寿命 并增加医疗费用；这一负担对非裔美国人造成了不成比例的影响。尽管 迫切需要干预措施，以帮助患有MCC的老年患者改善自我管理，现有计划 在服务不足的社区，其覆盖范围和有效性有限。我们的长期目标是增加 可用于改善老年人健康的自我管理干预措施的数量和覆盖范围 MCCS。这项建议的目标是建立一个成熟和可持续的基础设施，以促进 组建和协作研究团队，重点开发和传播有效的 针对患有MCC的非裔美国人和农村社区的老年人的新的自我管理干预措施。 为了实现这一目标，我们将扩大社区-学术老龄化研究网络(CAARN)，最初 创建于2010年，由美国国立卫生研究院资助，以促进开发、测试和/或传播行为 改善老年人健康的干预措施。到目前为止，CAARN促进了社区研究 52个县和1个部落的46名调查人员和社会服务提供者之间的伙伴关系。我们建议 扩大CAARN的基础设施，从主要以农村为重点，增加与卫生系统的伙伴关系 和非裔美国人社区，通过提供：1)来自合作组织的训练有素的研究联络员 代表卫生系统和非裔美国利益攸关方；2)培训研究人员建立信任 与非洲裔美国人社区合作；3)多学科专家，将在设计阶段提供咨询 干预措施。这些补充创建了一个成熟的、可持续的CAARN基础设施，以实现我们的目标： 目标1：促进研究，以开发和测试新的多发病自我管理方案的可行性 对于专注于激活患者自我管理并赋予他们能力的老年人 持续参与目标设定并与提供者(S)分享决策，以最大限度地提高行为 改变；目标2：证明新的自我管理方案对患有MCC的老年人的有效性 在提高生活质量方面，重点关注农村和非裔美国老年人；目标3： 促进研究，以最大限度地传播、实施和覆盖有效的多种疾病自我 管理课程，特别是在农村和非裔美国人人口中。利用社区的原则- 基于参与性研究，CAARN将吸引来自卫生系统、农村和非洲的利益相关者- 美国社区在多学科研究团队中开发、测试和研究如何最好地 传播干预措施，以减轻监控化学品的实质性负担。这应该会增加可获得性， 并减少传播针对这些问题量身定做的有效、实用干预措施的时间 并纳入卫生系统，以改善通信、临床护理和卫生公平。

Project Summary/Abstract Three out of four older adults live with multiple chronic conditions (MCCs) that worsen health, shorten life span, and increase healthcare costs; this burden disproportionally affects African Americans. Despite the critical need for interventions to help older patients with MCCs improve self-management, existing programs have limited reach and effectiveness in underserved communities. Our long term goal is to increase the number and reach of self-management interventions available to improve the health of older adults with MCCs. The objective of this proposal is to create a mature and sustainable infrastructure that facilitates the formation and collaboration of research teams focused on the development and dissemination of effective new self-management interventions for older adults from African American and rural communities with MCCs. To achieve this goal, we will expand the Community-Academic Aging Research Network (CAARN), originally created in 2010 with NIH funding to facilitate development, testing, and/or dissemination of behavioral interventions to improve the health of older adults. To date, CAARN has facilitated community-research partnerships between 46 investigators and social services providers in 52 counties and 1 tribe. We propose to expand CAARN’s infrastructure from its primarily rural focus, to increase partnerships with health systems and African American communities, by providing: 1) trained research liaisons from partnering organizations representing health systems and African-American stakeholders; 2) training for researchers on building trust with African- American communities; 3) multidisciplinary experts who will consult during the design phase of interventions. These additions create a mature, sustainable CAARN infrastructure to accomplish our aims: Aim 1: Facilitate research to develop and test the feasibility of new multi-morbidity self-management programs for older adults that focus on activating patients towards self-management and empowering them to continuously engage in goal-setting and shared decision-making with their provider(s) to maximize behavior change; Aim 2: Demonstrate the effectiveness of new self-management programs for older adults with MCCs in improving quality of life, with a concentrated focus on rural and African-American older adults; Aim 3: Facilitate research to maximize dissemination, implementation, and reach of effective multi-morbidity self- management programs, particularly in rural and African-American populations. Using principles of community- based participatory research, CAARN will engage stakeholders from health systems, rural, and African- American communities on multidisciplinary research teams to develop, test, and research how best to disseminate interventions to reduce the substantial burden of MCCs. This should increase the availability of, and decrease the time to dissemination of, effective, practical interventions that are tailored to these communities and integrated into health systems to improve communications, clinical care, and health equity.