Current Projects

Improving Access to Neurology Care to Advance Pharmacologic Treatment for Older Adults with ADRD

Revised Abstract Text

Project Summary

Alzheimer’s Disease and Related Dementias (AD/ADRD) affect 6.9 million adults in the U.S. and pose major public health challenges. Despite advances in understanding and treating ADRD, many older adults experience delays in diagnosis, limited access to neurologic specialty care, and reduced use of medications to manage the disease. Novel medications for AD, such as newly approved anti-amyloid monoclonal antibody (mAb) therapies, represent a significant turning point in treatment as the first disease-modifying therapies for this condition. While the effectiveness of these therapies is modest and associated with potential adverse effects, they are expected to be the first in a series of future therapies targeting the biological underpinnings of AD/ADRD. Importantly, only patients with early mild cognitive impairment or early-stage AD are eligible for current mAb therapies, underscoring the importance of early detection and timely referral to specialists.

Given the importance of specialist evaluation in determining eligibility and initiation of new ADRD therapies, improving access to neurology care is essential. Understanding barriers to successful referrals and improving knowledge of ADRD among patients, care partners, and primary care providers (PCPs) may help optimize treatment pathways. The overall objective of this proposal is to prepare for a clinical trial of a patient navigation intervention designed to enhance access to neurology care and support the appropriate use of current and future ADRD therapies. Our interdisciplinary research team will examine patient-, provider-, and system-level factors that influence specialist referrals and prescribing practices in ADRD care.

The specific aims are to: (1) Quantify the magnitude and relative contribution of patient, provider, health system, and structural factors associated with differences in neurology visits and initiation of ADRD therapies across six regional hospitals in California; (2) Identify barriers to and facilitators of successful neurology referrals for ADRD from primary care through qualitative interviews with patients, care partners, and PCPs; (3) Collaborate with advisory groups to develop, refine, and assess the feasibility and acceptability of a patient navigation intervention to improve access to neurology care for older adults with ADRD.

Completion of these aims will support the design and implementation of a multi-site clinical trial focused on improving referrals to neurology specialists and enhancing access to current and future ADRD therapies.

Revised Public Health Relevance Statement

Project Narrative

Alzheimer’s Disease and related dementias (AD/ADRD) are increasingly common, costly, and burdensome, affecting nearly 7 million older adults in the U.S. Although effective management of ADRD increasingly depends on timely access to neurology specialists, many patients do not complete referrals or receive necessary care. Few studies have examined the full range of factors influencing access to neurology services or developed interventions to improve care pathways. This study aims to understand multilevel barriers and facilitators of access to neurology care and to develop an evidence-based patient navigation intervention to support timely specialist evaluation and improve access to current and emerging ADRD therapies.

NIH/NIA K01AG076865; Developing and Testing a Population Health Approach to Deprescribing and Optimizing Medications in Older Adults

PI: Michelle S Keller, PhD
The goal of this study is to develop and validate a polypharmacy risk prediction model, use this model to create a population health polypharmacy registry, and use the registry to enroll patients in a polypharmacy pharmacist-led deprescribing clinic.

NIH/NHGRI R01HG011066, iAGREE: A Multi-Center, Networked Patient Consent Study

PI: Lucila Ohno-Machado, PhD
The goal of this study is to develop and evaluate a technological solution that honors patient preferences for sharing their electronic health records in a way that meets institutional requirements for adoption.

NIH/NIDDK R01DK129810, Improving the Patient Experience of Hemodialysis Vascular Access Decision Making

PI: Karen Woo, MD, PhD
Major Goals: To develop a prognostic model for short-and long-term outcomes of vascular access operations, and to identify best practices for promoting shared decision-making during the physician-patient encounter.

NIH/NIDDK R01DK132422: Comparing Surgical and Endovascular Arteriovenous Fistula

9/2022 to 8/2025

PI: Karen Woo, MD, PhD
Major Goals: To compare procedural outcomes of surgical vs. endovascular creation of arteriovenous fistula, and thus acquire the data needed to inform design and execution of a full-scale randomized trial that will compare the outcomes of surgical vs. endovascular creation of arteriovenous fistula.

American Heart Association, Diverse Clinical Trial Participation Using Data-Driven and Evidence-Based Participant Recruitment and Retention Science (FIND-AD)

PIs: Doris Molina-Henry, PhD and Mireille Jacobson, PhD
Project Goals/Aims: This project is aimed at identifying recruitment strategies for Alzheimer’s Disease studies that are effective, feasible, and sustainable and that can inform and advance the field of recruitment science, in turn accelerating participation of diverse groups into clinical trials.