Integrating Geriatrics into the Specialties of Internal Medicine Diabetes, Cardiovascular Complications and Aging Meeting April 4-5, 2013 Funded by grants by The John A Hartford Foundation and NIA to ASP Kevin P. High, MD, MS Principal Investigator About AAIM The Alliance for Academic Internal Medicine (AAIM) is the consortium of five academically focused specialty organizations representing 70,000 faculty and staff at over 400 departments of internal medicine at 143 medical schools and 263 teaching hospitals in the United States and Canada. AAIM consists of the following organizations: Association of Professors of Medicine (APM) Association of Program Directors in Internal Medicine (APDIM) Association of Specialty Professors (ASP) Clerkship Directors in Internal Medicine (CDIM) Administrators of Internal Medicine (AIM) D. Craig Brater, MD, President Bergitta Smith, EVP 1
About ASP The Association of Specialty Professors (ASP) is the organization of specialty internal medicine divisions at the medical schools and community teaching hospitals in the US and Canada - founded in 1993 ASP membership is available to internal medicine divisions in all internal medicine specialties. Each division is represented by 2 faculty members, typically the division chief and fellowship training program director. In FY 2012 ASP > 1,100 members at > 110 institutions. About ASP ASP dedicates its efforts to: Promoting specialty internal medicine as a career discipline. Facilitating cooperation within the internal medicine community. Holding forums and meetings on specialty internal medicine. Publishing educational and public policy material on specialty internal medicine. Supporting new initiatives in education, biomedical research, and patient care for the benefit of specialty training programs. ASP maintains a standing geriatrics committee with representatives from each specialty of internal medicine. 2
Integrating Geriatrics Project Background The precursor to this project, led by William R. Hazzard, MD, Toward Optimal Geriatric Care: Integrating Geriatrics into the Subspecialties of Internal Medicine, Goal was to develop interest in geriatrics through a series of 12 Geriatrics Education Retreats held over a six year period beginning in 1995. Integration Grant - Introduction Funded by generous grants from the John A. Hartford Foundation since 2002 and since 2012 by a U13 from NIA Project Leadership: Kevin High, MD, Principal Investigator Jeffrey Halter, MD, Co-Principal Investigator Kenneth Schmader, MD, Co-Principal Investigator Arti Hurria, MD, Co-Investigator Project Administration Kelly Middleton Nancy Woolard Consultant William Hazzard, MD; PI of the first two JAHF grants 3
Overview of Integrating Geriatrics Project Components Three main initiatives of the Integrating Geriatrics Project. Expansion of research efforts through NIH meetings Development of special interest groups within specialty societies Professional development of T. Franklin Williams Scholars T. Franklin Williams Scholars Program Goal: The T. Franklin Williams Scholars Program aims to improve the health care of older Americans by creating a critical mass of internal medicine specialists advancing research, education, and clinical care focused on this population. 4
Evolution of the TFWS and DWJS Programs..... GEMSSTAR GEMMSTAR Program Highlights NIA RFA for RO3 - funds geriatrically-focused PROJECTS by specialists (or geriatricians doing specialty-focused research) Just-in-time requirement for a geriatricallyfocused career-development plan with matching funding/support Options for that support: Institution K12/CTSA/OAIC RCDC/VA CDA Specialty Society programs 8 societies agreed to participate in the 2011, 2012, 2013 program GEMSSTAR (continued) Participating Organization(s) Components of Participating Organizations Funding Opportunity Title Activity Code Announcement Type Related Notices Funding Opportunity Announcement (FOA) Number National Institutes of Health (NIH) National Institute on Aging (NIA) Grants for Early Medical/Surgical Specialists Transition to Aging Research (GEMSSTAR) (R03) R03 Small Grant Program Reissue of RFA-AG-12-002 None RFA-AG-13-006 10 5
NIH Workshops Strategy based on a successful pilot with the American Society of Hematology (ASH), National Cancer Institute, National Institute on Aging (NIA), AGS, and ASP in 2005 and 2006 Resulted in two national symposia and two requests for applications (RFAs) funded by NIA and the National Heart, Lung, and Blood Institute $3.3 million RFA for Thrombosis and Venous Thromboembolism in the Elderly $2.5 million RFA for Anemia in the Elderly Expanding Research Efforts through NIH Workshops Participants: Representatives of ASP and the American Geriatrics Society (AGS) National Institute on Aging (NIA) extramural program leaders Members of internal medicine specialty societies Specialty oriented NIH Institute extramural program leaders 6
Initiative 1: NIH Workshops Two-day workshops focused on specific geriatrics research questions linked to the specialty Workshops 2007 HIV in Aging 2008 (1) Chronic Kidney Disease in Seniors (2) Immunization and Aging 2009 Idiopathic Pulmonary Fibrosis 2010 Acute Kidney Injury in Older Adults 2012 Transplantation in Older Adults 13 Initiative 1: NIH Workshops Anticipated Outcomes Published manuscript on the meeting topic Symposium at the annual meeting of the relevant specialty society Potential Outcomes Federally funded initiative for research on the topic or related topics Future expansion of the integrating geriatrics effort to additional specialties 7
Publications and Funding Opportunities HIV in Aging - 2007 Publication: Effros RB, Fletcher CV, Gebo K, et al. Aging and Infectious Diseases: Workshop on HIV Infection and Aging: What is Known and Future Research Directions. Clinical Infectious Diseases. 2008 Aug 15; 47(4):542-53. Active FOAs PA-12-174 (R21), -175 (R01), -176 (R03) Funded by 13 IC s! Chronic Kidney Disease Anderson S, Halter JB, Hazzard WR, Himmelfarb J, et al. Prediction, Progression, and Outcomes of Chronic Kidney Disease in Older Adults. Journal of the American Society of Nephrology. Jun;20(6):1199-209. FOAs active PA- R01 and R21 opportunities funded by the National Institute on Aging and National Institute on Diabetes and Digestive and Kidney Diseases. 15 KM2 Publications and Funding Opportunities Immunization High KP, D Aquila RT, Fuldner RA, Gerding DN, et al. Workshop on Immunizations in Older Adults: Identifying Future Research Agendas. Journal of the American Geriatrics Society. 2010 Apr;58(4):765-76. RFA-AI-12-038 from NIAID and NIA with deadline Feb, 2013. Idiopathic Pulmonary Fibrosis Castriotta RJ, Eldadah BA, Foster WM, Halter JB, et al. Workshop on Idiopathic Pulmonary Fibrosis in Older Adults. Chest 2010;138;693-703. FOA active PA-10-179 Acute Kidney Injury Anderson S, Eldadah B, Halter JB, Hazzard WR, et al. Acute Kidney Injury in Older Adults. J Am Soc Nephrology 22: 28 38, 2011. FOAs active PA-13-141 (R01), -142 (R03), -143 (R21) 16 8
Slide 15 KM1 NEED TO REVIEW Awards total Kelly Middleton, 1/30/2013 Slide 16 KM2 NEED TO REVIEW Awards total Kelly Middleton, 1/30/2013
Publications and Funding Opportunities Transplantation in Older Adults PA-13-030 (R01), -037 (R03), -038 (R21) 17 NIH Workshop ROI from the 2006-0239 Grant Total spent on six NIH workshops: ~$465,000 Outcomes Approximately 205 attendees Six published manuscripts in five major journals (only one primarily a geriatrics journal) Twelve FOAs from NIH across at least 11 Institutes ROI Increasing with every funding cycle 18 9
NIH Workshops ROI - Total And counting...... HIV PA s have been renewed, others just reaching time of ROI (~3-4 years) 19 U13 NIH Workshop Grant A Transdisciplinary Approach to Engage Specialty Investigators in Aging Research 1U13AG040938-01 Three Workshops co-funded with JAHF 2012 Solid Organ Transplantation 2013 Diabetes and Cardiovascular Morbidities 2014 Wound Repair and Regeneration Each with jr. faculty invites/research skills workshop 20 10
NIH Workshops The proceedings of each workshop are to be published: Goal is both a Specialty AND Geriatrics/Aging journal The planning committee acts as the writing group on behalf of the meeting attendees Each meeting has a science writer present to capture the discussion 1 st draft < 6 weeks after meeting Sent to individual speakers to edit within 10 business days: need to be very sensitive to page limitations Revisions with final editing by planning committee Submission to journal within 90 days of meeting Diabetes, Cardiovascular Disease and Aging Workshop Our task in the next two days Present what is known, what is not known, prioritize what should be known in a minimal # of slides!! Very sophisticated audience don t need much background, focus on the key holes in current data Keep the geriatric and gerontologic perspective at the forefront within the science: What is the affect of aging and age on pathophysiology? Functional outcomes/assessments? Multiple co-morbidities the rule rather than exception Goals may be different in this population 11
Rules of the Game Ties/formal attire are STRONGLY discouraged Informality is the goal junior faculty go up to the most famous person in the field and ask a question Engage in LIVELY discussion!!! No applause, except....... Thank our funders JAHF Marcus Escobedo, JAHF Program Officer NIA U13 grant Sue Zieman, NIA Program Officer 12