Centers of Excellence in Geriatric Medicine and Training

Developing the Faculty to Teach Tomorrow’s Doctors about Older Persons’ Health Needs A Brief History of Geriatrics Why Are Centers of Excellence Needed? Preparing Tomorrow’s Leaders in Geriatric MedicineCenters of Excellence Focus on Research and Training Centers of Excellence: Support for Basic Science Research Centers of Excellence: Support for Clinical Research Centers of Excellence: Support for Health Services and Outcomes Research Centers of Excellence: Support for Clinician Education Centers of Excellence: Infusing Aging into Clinical Speciaties The Hartford Foundation’s Continued Commitment to Geriatric Medicine

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Centers of Excellence: Support for Health Services and Outcomes Research

A third research career path in geriatrics relates to the task of translating newly acquired medical knowledge into the practice of caring for patients. For example, if a new treatment strategy for delirium is identified by clinical researchers, it will only have an impact on patient care if a system is in place to support this practice at the bedside or in the clinic.

Academic geriatricians devoted to health services research devise strategies to effectively translate new medical knowledge into care practices. They also focus on quality of life issues, such as types of care that improve functional status or prevent functional decline, thereby helping patients to live independently or without pain.

Strategies for providing more effective geriatric care have numerous benefits for both patients and health care institutions, including improved patient safety, better clinical outcomes, enhanced patient satisfaction, and strengthened financial position for health care institutions along with reduced liability.

Geriatric academicians engaged in this type of research face similar obstacles as those in basic science and clinical research. And again, the Hartford Centers of Excellence provide the essential resources to fill the gaps in support for talented physician scientists interested in researching new models to improve health care delivery to the elderly.

Why are African-Americans Less Likely to Use Hospice Services

Even though African-Americans have higher rates of mortality from cancer and heart disease than Caucasians (the two leading diagnoses among hospice patients), African-Americans are less likely to use hospice services. This statistic intrigued Kimberly S. Johnson, MD, Associate, Division of Geriatrics, Duke University, Durham, North Carolina. When she arrived at Duke University as a resident, she was already interested in end-of-life care, but she hadn’t yet considered a career in academic medicine.



Kimberly S. Johnson, MD, Duke University, Durham, NC. Dr. Johnson’s research seeks to identify strategies that will increase use of hospice—considered the “gold standard” for end-of-life care—by African-Americans.

“I grew up in a small town in Mississippi, attended medical school at Johns Hopkins University, and knew that one day I was going to practice geriatric medicine,” says Dr. Johnson. “But my idea was to go back and practice in my home town. Physicians in practice were my role models, not people in academics.” During her residency at Duke, Dr. Johnson encountered Dr. Harvey Cohen, director of the Duke Center for Aging and Center of Excellence, and other geriatricians on the wards, who inspired her to change career goals. “I decided there was absolutely no other place for me than an academic medical center,” she says.

Her interest in research also grew out of interactions with patients and families, where she noted cultural differences in preferences for treatment at the end of life. The reasons for lower rates of hospice use among African-Americans are not well defined. Speculative explanations include mistrust of the health care system, issues related to spiritual beliefs and acceptance of death, less access to health care in general, and not being informed about hospice care.

Dr. Johnson’s research involves analyzing local and national databases of hospice users to look for racial differences. She’s also undertaking a study to interview community-dwelling elders about their attitudes and beliefs that might affect future hospice use.

“Currently, hospice is considered the gold standard for end-of-life care,” says Dr. Johnson. She hopes to identify strategies for intervention to increase its use by African-Americans. Specifically, she is looking at hospice organizations that have successfully attracted higher numbers of African-Americans to determine best practices that might be applied in other hospice organizations. Strategies may include more ethnically diverse staff and volunteers and better education and outreach programs.

"Without the Centers of Excellence experience, I probably wouldn't have thought of these research questions," says Dr. Johnson. "Having appropriate mentorship, and being surrounded by people who are accomplished clinical investigators, has been a major help to me."