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Managing multiple chronic conditions, studying social determinants of health, and providing community-driven care are the pillars of the PROMOTE research center at the Johns Hopkins School of Nursing (JHSON). Funded through a National Institutes of Health P30 grant, the center is advancing the science by supporting patients with multiple chronic conditions and providing an opportunity for researchers to drive culture change and develop sustainable health care initiatives through innovative research design.

The Center (Promoting Resilience in Persons with Multiple Chronic Conditions) is founded on leading a unique shift in the current paradigm of disease-specific models of care to person-centered, community-focused methods that address various factors affecting health including functional limitations, family caregivers’ perspectives, poverty, housing, access to food, or traumatic life events.

Center Director
Sarah L. Szanton, PhD, ANP, FAAN,
Professor, Director, Center for Innovative Care in Aging

Staff Members
Alicia Cooke, MS, Senior Program Coordinator 

Executive Committee from Johns Hopkins School of Nursing

Publications

 

  • External Advisory Committee (EAC)

    Cynthia Boyd, MD, MPH, Chair
    Johns Hopkins School of Medicine and School of Public Health; Center on Aging in Health, Center for
    Area of Expertise: Transformative Geriatric Research, multiple chronic conditions, particularly patient centered care and treatment burden.

    Kurt Stange, MD, PhD, Co-chair
    Case Western Reserve University School of Medicine, past President North American Primary Care Research Group
    Area of Expertise: multiple chronic conditions and implementation science

    Susan Dorsey, PhD, RN, FAAN
    University of Maryland School of Nursing, Department of Pain and Translational Symptom Science
    Area of Expertise: physiology of pain and co-morbid conditions

    Roland Thorpe, PhD
    Johns Hopkins School of Medicine and School of Public Health; Center on Aging in Health
    Area of Expertise: health disparities research, particularly place based context on health, and discrimination

    Jeremy Walston, MD
    Johns Hopkins School of Medicine and School of Nursing; Center on Aging in Health; Older Americans Independence
    Area of Expertise: clinical geriatrics, frailty and physiologic resilience in the context of multiple chronic conditions

    Jennifer Wolff, PhD
    Johns Hopkins School of Medicine and School of Public Health; Center on Aging in Health
    Area of Expertise: integrating family caregivers into treatment, decision making and communication amongst people with multiple chronic conditions.

  • Translation Advisory Committee

    Ahrin Mishnan
    Executive Director of Foundation
    Rita and Alex Hillman Foundation

    Helen Montag
    Senior Director of Business Development and Corporate Partnerships
    Johns Hopkins Technology Transfer          

    Ahnand Parekh, MD
    Medical Director
    Bipartisan Policy Center     

    Karen Bandeen-Roche, PhD
    Johns Hopkins School of Public Health and School of Nursing; Center on Aging in Health; Older Americans Independence
    Area of Expertise: applying biostatistics to multiple biological systems

    Elise Singer, MD, MBA   
    National Medical Director
    VillageMD

    Dan Soliman
    Director of Housing Impact Area
    AARP Foundation

  • Pilot Projects

    PI: Yvonne Commodore-Mensah, PhD, MHS, RN

    Project title: A Virtual Cardiometabolic Health Program tailored to African Immigrants: The Afro-DPP Program
    Relevance to PROMOTE Center: The proposed study will address the cardiometabolic health of community-dwelling African immigrants who have multiple cardiometabolic risk factors including hypertension, prediabetes, and overweight/obesity

    Description of the Pilot

    • Target population: African immigrants who have multiple cardiometabolic risk factors including hypertension, prediabetes, and overweight/obesity
    • Problem addressed: Poor cardiometabolic health in African immigrants and lack of culturally tailored health promotion programs
    • Purpose: To examine whether a virtual, culturally-tailored, lifestyle intervention with remote monitoring of blood pressure and body composition (The Afro-DPP program) would reduce blood pressure and body weight compared to remote monitoring of blood pressure and body composition alone among African immigrants 
    • Phases: 1) Stakeholder engagement and intervention refinement with members of the African immigrant community. 2)Pilot test the intervention among 60 African immigrants residing in the Baltimore-Washington, D.C. area.
    • Intervention: A virtual cardiometabolic health program including support from a Certified Lifestyle Coach and self-monitoring of blood pressure and measures of body composition for 6 months
    • Risk: Low risk for participants
    • Future work: R-level funding

    PI: Binu Koirala, PhD, MGS, RN

    Project title: Living with multimorbidity: Symptom management across illness trajectory
    Relevance to PROMOTE Center: The proposed study seeks to support vulnerable patients and family and promote innovation, multi-disciplinary, personalized intervention to reduce symptom burden

    Description of the Pilot

    • Target population: Adults aged 55 years and above, living with multimorbidity, admitted at or eligible to admitted to the intermediate care unit (IMCU)
    • Problem addressed: Symptom burden
    • Purpose: To assess symptom trajectory and symptom burden and to develop an effective, and financially sustainable approach to meet the health needs of critically ill adults and families with multimorbidity.
    • Phases: 1) Describe the symptom trajectory and burden from the perspectives of patients, family caregivers, and health professionals and collectively develop a symptom management toolkit; and 2) Refine and pilot test the nurse-driven symptom management toolkit/intervention to decrease the symptom burden and increase the quality of life of critically ill adults with multimorbidity
    • Intervention: A nurse led pre-discharge symptom management intervention augmented by telephone support, engaging caregivers.
    • Risk: Low risk for participants
    • Future work: R level funding

     

    PI: Martha Abshire, PhD, RN

    Project title: CAREGIVER-SUPPORT Caregiver Support in the Context of Multiple Chronic Conditions
    Relevance to PROMOTE Center: will promote resilience by addressing caregiving needs in a vulnerable, older adult population of carers for people with advanced heart failure and other chronic conditions.

    Description of the Pilot

    • Target population: caregivers of older adult with advanced heart failure and other co-morbidities.
    • Problem addressed: understanding dynamic and contextual factors of family caregiving including
      • resources,
      • needs and
      • social support
    • Purpose:   improve quality of life in family caregivers of patients with multiple chronic conditions.
    • Phases: 1) a mixed methods study to understand caregiver burden, fatigue, social support and quality of life 2) a pilot intervention, developed using co-design that will focus on caregiver purpose in life, goal-setting to reduce caregiver burden and walking meetings to address strategies to achieve goals.
    • Intervention:   a resilience-building intervention delivered in the home developed suing co-design, which will incorporate end users as key stakeholders in the design, development, execution and evaluation
    • Risk: Both phases are low risk for participants. 
    • Future work: R level funding
       

    PI: Kelly Gleason, RN, PhD

    Project title: The Impact of Chronic Conditions on Patient-Reported Diagnostic Error
    Relevance to PROMOTE Center: Will promote understanding of the barriers individuals with chronic conditions face in receiving an accurate diagnosis

    Description of the Pilot
     
    • Target population: Emergency department patients with chronic conditions.
    • Problem addressed:  Diagnostic errors, an urgent public health issue, are largely unmeasured and unmonitored. How chronic conditions impact diagnostic process is poorly understood.
    • Purpose:  Develop and implement a patient-centered measure of diagnostic error, Leverage Patient’s Experience to improve Diagnosis (LEAPED).
    • Phases:
      1) Deploy and determine patient uptake of LEAPED
      2) Explore how chronic conditions, pain, and fatigue impact the diagnostic process through qualitative interviews.
    • Intervention: Seek patient feedback on their understood diagnoses and health status following emergency department discharge through the electronic health record (EHR)-facing patient portal.
    • Risk: Both phases are low risk for participants. 
    • Future work: K level funding

     

    PI: Junxin Li, PhD, RN

    Project title: A Personalized Behavioral Intervention for Older Adults with Musculoskeletal Pain and Sleep Complaints
    Relevance to PROMOTE Center: Will optimize wellness and achieve active and healthy lives of community-dwelling older adults with chronic musculoskeletal pain and sleep complaints.

    Description of the Pilot

    • Target population: community-dwelling older adults with chronic musculoskeletal pain and sleep complaints
    • Problem addressed:  older adults’ pain, sleep and mood 
    • Purpose: To promote physical and psychological wellness of community-dwelling older adults with chronic musculoskeletal pain and sleep complaints.
    • Intervention:  a personalized behavioral intervention includes individually tailored exercise training, circadian based activity guidelines with real time self-monitoring, interactive prompts, phone consultation, and financial incentives.  The intervention delivery is facilitated by multiple mobile health technology.
    • Phase: Pilot test the feasibility and preliminary efficacy of the proposed intervention for pain, sleep, and mood in 20 older adults with chronic pain and sleep complaints.
    • Risk: Low risk for participants.
    • Future work: R level funding


    PI: Nada Lukkahatai, PhD, MSN, RN

    Project title: Assessment of a Tailored Home-Based Exercise Program on Symptoms, Well-Being, and Resilience Among Cancer Survivors with Multiple Chronic Conditions
    Relevance to PROMOTE Center: will promote resilience by using Tailored Home-Based Exercise Program in Cancer Survivors with Multiple Chronic Conditions.

    Description of the Pilot

    • Target population: Cancer survivors other co-morbidities.
    • Problem addressed: The feasibility of the Tailored Home-Based Exercise program on
      • resilience
      • well-being
      • symptoms
    • Purpose:   improve quality of life in cancer survivor with multiple chronic conditions.
    • Phases: 1) Intervention trial phase (open-label phase) to understand the cancer survivors’ perception and acceptability of the Tailored Home-Based Exercise Program. The program is designed to tailored the type of exercise based on the purpose in life and goal setting.

    2) a pilot testing of the intervention phase to examine the effectiveness of the program on Symptoms (e.g., pain fatigue), well-being and resilience.

    • Intervention: a Tailored Home-Based Exercise Program, which will incorporate end users as key stakeholders in the design, development, execution and evaluation
    • Risk: Both phases are low risk for participants. 
    • Future work: R level funding

     

    PI: Mona Bahouth, MD, PhD

    Diversity Supplement: Dehydration at the time of hospitalization for stroke in patients with baseline dementia
    Relevance to PROMOTE Center: will promote physiologic resilience by understanding the relationship between dehydration and cognitive impairment in patients with stroke and multiple comorbid conditions.

    Description of the Pilot

    • Target population: Hospitalized stroke patients with cognitive impairment and multiple comorbid conditions
    • Problem addressed: Physiological abnormality and outcomes after stroke
      • Well-being
    • Purpose: To explore the relationship between dehydration and brain health in hospitalized stroke patients with multiple chronic conditions including cognitive impairment.
    • Aims: 1) To measure functional outcomes and differences in brain region shape in dehydrated vs non-dehydrated stroke patients with dementia using shape diffeomorphometry computational anatomy methods. 2) To explore formal and informal caregivers’ perceptions of barriers to adequate hydration for stroke patients with dementia using qualitative methods.
    • Risk: Both aims are low risk for participants.
    • Future work: R level funding

     

    PI: Melissa Hladek, PhD, MSN, RN 

    Diversity Supplement: Associations Between Coping Self-Efficacy and Physiologic Stress Indices in Adults with Multiple Chronic Conditions  
    Relevance to PROMOTE Center:  will deepen our understanding of the association between coping self-efficacy and physiologic stress response networks among people living with multiple chronic conditions.

    Description of the Pilot 

    • Target population:  Adults with at least two chronic conditions 
    • Problem addressed: Understanding how self-efficacy affects the stress response networks and chronic disease progression.
    • Purpose: To cross-sectionally evaluate the associations between coping self-efficacy and physiologic stress indices common to multiple chronic conditions in community-dwelling adults with multiple chronic conditions.
    • Aims:  1) To examine associations between coping self-efficacy and blood-based physiologic stress indices (IL-6, TNFαR1, BDNF) within PROMOTE P30 pilots (Li & Lukkahatai) in an adult population with multiple chronic conditions.  2) To evaluate associations between coping self-efficacy and heart rate variability (HRV), another physiologic stress indicator, within 3 PROMOTE P30 pilots (Li, Lukkahatai, Abshire). 3) To evaluate self-efficacy as a moderator of health behaviors on the physiologic stress indices in an adult population with chronic disease. 
    • Intervention: A cross-sectional supplemental study nested within 3 PROMOTE P30 center pilot studies
    • Risk: Low risk for participants
    • Future work: R level funding 
  • Events

    The PROMOTE Debrief: Maximizing Research Impact
    Tuesday, March 9, 2021 • 12:30 - 3:00 PM EST

    Join the PROMOTE Center for an online forum on designing research for the real world. Program includes a keynote address, What the Real World Needs from Research by Dr. Elise Singer, National Medical Director for VillageMD. Breakout sessions will provide participants with the opportunity to further explore the challenges in moving scientific advances into the real-world.
    Register online here or email bfitzek@jhu.edu with questions.