Search the Health Library
Get the facts on diseases, conditions, tests and procedures.
I Want To...
Find a Doctor
Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians.
I Want To...
Find Research Faculty
Enter the last name, specialty or keyword for your search below.
Health Service Delivery for People with Complex Care Needs
As the U.S. population ages, the number of Americans who have chronic health conditions will greatly increase. These demographic and epidemiologic dynamics will strain the capacity and the sustainability of the acute care-oriented U.S. health care system, which now provides chronic care ineffectively and inefficiently. New health service delivery systems will need to be developed, evaluated, and disseminated into widespread practice in order to deliver high-quality, cost-effective care for older adults.
In recent work that includes partnerships with other health care institutions and agencies, researchers from the Center for Transformative Geriatric Research have explored the development of geriatrics health service delivery at all levels of the health system, from the patient and their family or caregivers to providers, hospital and health system. Using a wide array of qualitative and quantitative research techniques, investigators are finding new and better ways to care for older adults.
Current Research Studies
Hopkins investigators have been at the forefront of developing, evaluating, and disseminating into practice new models of geriatric health service delivery to care for an aging population. Current research studies are focused on:
- Clinical interventions to improve transitions of older adults across the continuum of care
- Community-based long-term care
- Program of All-inclusive Care for the Elderly (PACE)
- Hospital at Home
- Home-based primary care
- Home-based palliative care
- Skilled home health care, assisted living, and long-term care
- Guided care
- Models of multidisiplinary care for people with dementia
- Assisted living facilities
Director of Transitional Care Research
Associate Medical Director; Clinical Chief, Ventilator Rehabilitation Unit, Johns Hopkins Bayview Medical Center
Associate Medical Director, The Johns Hopkins Bayview Medical Center, Division of Geriatric Medicine and Gerontology
Director, Center on Aging and Health-East
Director, Program in Geriatric Health Services Research
Co-Director, Elder House Call Program
Co-director, Medicine Clerkship
Medical Director, Business Development and Strategic Alliances
Program Director, Fellowship Training Program in Geriatric Medicine and Gerontology
Medical Director, Program for All-Inclusive Care of the Elderly (PACE)
Assistant Professor of Pathology
Joint Appointment in Psychiatry and Behavioral Sciences
Co-Director, Johns Hopkins Memory and Alzheimer's Treatment Center
Assistant Professor of Oncology
Associate Professor of Neurology
- Susannah Cafardi
- Ayse Gurses, PhD
- Nicole Werner, PhD
- Sara Szanton, RN, PhD
- Albert Wu, MD, MPH
- Kitty Chan, PhD
- Qilu Y, PhD (Westat)
- Armstrong Institute for Patient Safety and Quality
- Johns Hopkins Home Care Group
- Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management
- Johns Hopkins School of Nursing, Center for Innovative Care in Aging
- Johns Hopkins School of Nursing, Department of Community and Public Health
- National PACE Association Research Committee
- University of Maryland Department of Pharmaceutical Health Services Research