Applying Community-Engaged Intervention Mapping Methods to Improve Transitional Care in Aphasia Rehabilitation

PROJECT SUMMARY/ABSTRACT This K23 career development award will position the candidate to become an independent clinical researcher with expertise developing and testing transitional interventions in aphasia rehabilitation to improve care delivery and long-term outcomes for individuals with communication disabilities. BACKGROUND. Aphasia is a debilitating, chronic impairment in language expression and/or comprehension with devastating impacts on societal participation, psychosocial well-being and overall health and quality of life. Inadequate discharge coordination and fragmented rehabilitation care further contribute to poor outcomes for people with aphasia. Current healthcare processes are structured to provide rehabilitation care around acute episodes of injury, rather than delivery coordinated services for individuals with chronic conditions. There is an urgent need to improve care delivery to support people with aphasia as they transition along the rehabilitation continuum. Transitional care interventions that include patient-family education, communication and coordination across health professionals and actions for care continuity have been shown to improve care quality and outcomes in the management of chronic medical conditions. The objective of the current proposal is to develop and test a transitional care intervention to improve communication and quality of life outcomes for people with aphasia. SPECIFIC AIMS. Guided by the Intervention Mapping Framework and community-engaged research methods, the proposed studies will (1) evaluate current practices, needs and barriers and facilitators in transitional care in aphasia rehabilitation, (2) develop/refine and (3) test the feasibility, acceptability, and preliminary efficacy the aphasia-specific transitional care intervention. TRAINING. The candidate will achieve short-term goals through a research-rich institutional environment and a comprehensive training plan in (1) the synthesis of advanced qualitative and multi-methods research, (2) development and adaptation of complex interventions, and (3) clinical and implementation measurement for trial design. In addition to mentorship meetings and experiential training through the research plan, the candidate will complete targeted coursework, present at local and national conferences and publish in peer-reviewed journals. MENTORSHIP. The candidate will be supported by an exceptional, interprofessional mentoring team: Leora Cherney, PhD, CCC-SLP (co-primary mentor), Janet Prvu Bettger, ScD (co-primary mentor), Jeffrey Schneider, MD (co-mentor) and Ruth Palan Lopez, PhD (co-mentor). IMPACT. In line with NIDCD’s funding priorities, this work will yield a robust, clinically feasible transitional care intervention for aphasia care and inform a future R01 proposal to conduct a fully powered efficacy trial. Through this K23 award, the candidate will develop the necessary skills and training to successfully transition as a leader and independent investigator focused on translational and health systems research to improve outcomes for people with aphasia and other communication disabilities.