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

描述（由申请人提供）：糖尿病及其并发症的患病率在老年人中有所增加，需要新的护理模式来应对弱势群体中的这一趋势。根据慢性护理模型（CCM），最佳慢性疾病护理需要与社区资源的联系。基于CCM的研究表明，初级保健提供者和老年中心之间的联系可能会加强老年糖尿病患者的自我管理支持，但这种联系的研究很少。该提案描述了一项探索性拨款，以证明初级保健与多功能老年中心的联系在维持糖尿病老年人的健康和功能方面的附加价值，并确定在初级保健诊所和社区多功能老年中心之间建立和维持联系的促进因素和障碍。我们的初步调查将利用一种独特的、现有的公私合作关系

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.