Symptom perception, behavior, and outcomes in older asthmatics
R01HL131418 (Wisnivesky/Federman/Feldman)                   5/1/16-4/30/21
The objective of the study is significant for its potential to greatly advance understanding of the mechanisms related to worse outcomes in older adults, and it will provide actionable data for new interventions to improve self-management.
Specific Aims: 1) Prospectively assess the association between symptom perception and asthma morbidity among older adults.; 2) Examine the association between symptom perception and asthma SMB among older adults and identify the pathways linking them; 3) Determine the influence of cognition on symptom perception among older adults with asthma.; 4) Pilot test an intervention designed to correct under-perception of asthma symptoms in older adults.

Obesity and Asthma: Unveiling Metabolic and Behavioral Pathways
R01HL129198-01A1 (Wisnivesky/Federman/Holguin)          5/1/16-4/30/21
The goal of this study is to evaluate the relative contributions of novel biological and behavioral pathways that may explain the association between obesity and worse asthma outcomes.
Specific Aims: 1) Compare the longitudinal relationship between L-arginine/ADMA balance and morbidity (lung function, asthma control, acute resource utilization, and quality of life) between obese adults with late onset asthma vs. (1) obese adults with early onset asthma and non-obese asthmatics with early (2) or late (3) onset disease; 2) Evaluate the interrelationship between obesity- and asthma-related illness beliefs, and the impact of cognitive function, on patients’ management of these conditions over time; 3) Develop and pilot test three theory-based modules that integrate counseling for asthma and obesity to promote better SMB, including self-monitoring, adherence to asthma medications, and lifestyle changes for weight loss.

Self-management Behaviors among COPD Patients with Multi-morbidity
R01HL126508 (Wisnivesky/Federman)                                  7/1/15-6/30/20
In this project, we will use qualitative and quantitative interviews of adults with chronic obstructive pulmonary disease and comorbid hypertension and/or diabetes to examine the interplay of cognitive and emotional illness
representation and medication beliefs for these conditions and their impact on self­management behaviors. We will use the data to develop and pilot test patient counseling modules to improve self­management in these patients.
Specific Aims: 1) Examine the interactive effects of COPD-, HTN-, and DM-related cognitive and emotional illness representations and medication beliefs on patients’ self-management of these conditions over time; 2) Assess the association of major depression with COPD SMB over time and evaluate the pathways, via cognitive and emotional illness representations and medication beliefs, mediating this relationship; 3) Guided by findings from Aims 1-2 and the SRM, develop and pilot test education and counseling modules for COPD patients with MM to promote adherence to SMB.

Development of an EMR- integrated enhanced after visit summary
R21HS023844 (Federman)                                                         7/1/15-6/30/17
The objective of this study is to develop and pilot test an electronic medical record (EMR)-integrated enhanced after visit summary (eAVS) designed to increase clinical efficiency, improve patients’ understanding and retention of key clinical information, and advance the patient-centered application of the EMR.
Specific Aims: 1) Develop and refine a patient-centered eAVS that 1) facilitates clinicians in preparing and reviewing essential information for patients (e.g. medication changes, self-care instructions); 2) routinely provides patients and caregivers with print and electronic (via EHR web portal) essential information from their clinic visit that is comprehensible and usable; 2) Pilot test the eAVS to assess patients’ and providers’ experience with the tool and determine its preliminary impact on patients’ understanding and adherence to medication regimens and scheduled appointments.

EHR-based Universal Medication Schedule to Improve Adherence to Complex Regimens
1R01NR015444-01A1 (Wolf/Federman)                                      9/26/16-7/31/21
We will leverage increasingly available technologies to impart a Universal Medication Schedule (UMS) in primary care to help patients living with diabetes safely use and adhere to complex drug regimens.
Specific Aims: 1) Test the effectiveness of the UMS, and UMS + SMS text reminder strategies compared to usual care;
2) Determine if the effects of these UMS strategies vary by patients’ literacy skills and language; 3) Evaluate the fidelity of the two strategies and explore patient, staff, physician, and health system factors influencing the interventions; 4) Assess the costs required to deliver either intervention from a health system perspective.

LitCog III: Health Literacy and Cognitive Function among Older Adults
R01AG030611 (Wolf)                                                                    6/1/16-2/29/19
This study seeks to elucidate potentially modifiable, causal mechanisms linking cognitive decline to worse health that will aid in the design of effective, health system-led, health literacy & self-management interventions.
Specific Aims: 1) Evaluate longitudinal associations between cognitive function and health among older adults; 1b) identify psychosocial factors that influence these associations; 2) assess whether poorer cognitive function and decline leads to excess healthcare resource use and costs; 3) describe the explicit challenges LitCog subjects face when self-managing complex chronic conditions, and explore the acceptability of potential solutions.

Bundled Payment for Mobile Acute Care Team Services
C1CMS331334 (Siu)                                                                      9/1/14-8/31/17
Centers for Medicare & Medicaid Services – CMS Innovation Center
The Icahn School of Medicine at Mount Sinai project will test Mobile Acute Care Team (MACT) Services, which will utilize the expertise of multiple providers and services already in existence in most parts of the United States but will transform their roles to address acute care needs in an outpatient setting. MACT is based on the hospital-at-home model, which has proven successful in a variety of settings. MACT will treat patients requiring hospital admission for selected conditions at home. The core MACT team will involve physicians, nurse practitioners, registered nurses, social work, community paramedics, care coaches, physical therapy, occupational therapy and speech therapy, and home health aides. The core MACT team will provide essential ancillary services such as community-based radiology, lab services (including point of care testing), nursing services, durable medical equipment, pharmacy and infusion services, telemedicine, and interdisciplinary post-acute care services for 30 days after admission. After 30 days, the team will ensure a safe transition back to community providers and provide referrals to appropriate services.
Role: Evaluation Lead