The rising number of older patients with complex, often chronic conditions (e.g., cardiac disease, dementia, renal failure) presents challenges in service delivery and social organization that are best tackled by interdisciplinary teams of health professionals who can integrate a variety of concepts, methods, and practices.1 Researchers recognize that the tenets of interdisciplinary research are necessary for advancing the science of aging and for creating new knowledge to provide better care for older Americans.2 In broad terms, interdisciplinary research crosses traditional boundaries between academic disciplines and involves researchers working jointly, but from their own discipline's perspective, to address a common problem.3 In the geriatric context, interdisciplinary research reflects collaboration across two or more relevant disciplines within or across institutions and depends on new partnerships that expand geriatric research foci and methods beyond traditional boundaries. Indeed, early steps toward interdisciplinary research, across a broad range of topics and themes (e.g., depression, diabetes), have demonstrated the capacity of this type of research to enhance the effectiveness of interventions, thereby improving health outcomes and the quality of life of individuals.4,5 Thus, because the increased development of high-quality geriatric health care services requires integrating skills, building new partnerships, and, in general, expanding research activities beyond the traditional boundaries of individual disciplines, the RAND/John A. Hartford Foundation initiative, “Building Interdisciplinary Geriatric Health Care Research Centers,” sought to establish interdisciplinary geriatric research centers that would not only focus on the development of innovative clinical and health services interventions for older adults but also provide interdisciplinary education and training opportunities for new and established investigators.
Although addressing the health care issues of older adults requires interdisciplinary collaboration, current incentive and reward structures, conceptual and financial barriers, career development issues, and cultural differences can discourage interdisciplinary research efforts and collaboration.6,7 Despite such barriers, fostering interdisciplinary research is possible through a variety of means, including requiring interdisciplinary collaboration as a funding condition, creating research training programs that emphasize the involvement of other disciplines, and establishing joint centers.8
This article provides scientists and leaders involved (or interested) in interdisciplinary research with a model that has effectively promoted interdisciplinary research as well as with some key lessons learned from two phases of the Building Interdisciplinary Geriatric Health Care Research Centers initiative.
Initiative Background and Implementation
The initiative began in 2002 (before the National Institutes of Health [NIH] initiated its Clinical and Translational Science Award [CTSA] program, which supports the establishment of cross-institutional, cross-disciplinary centers).
In the context of this initiative, we have defined interdisciplinary geriatric research as two or more investigators holding different professional degrees who are actively engaged in the design, implementation, and analysis of clinical or health services research related to older adults. The overarching goal of the initiative was to create infrastructure and incentives for leaders and researchers in geriatrics that would allow them to work around barriers and build interdisciplinary research centers. Rather than being centered in one academic department or disciplinary unit, the interdisciplinary geriatric research centers would reflect true collaboration across two or more core health care disciplines (i.e., medicine, nursing, or social work) and at least one related discipline (pharmacy, psychology, rehabilitation, nutrition, sociology, etc.) within or across institutions. With this organizational structure, the centers would be able to build new partnerships that expand geriatric research foci and methods beyond traditional boundaries, to attract subsequent extramural peer-reviewed funding for the design and study of highly innovative clinical and health services interventions, and to serve as models for better understanding of how to expand interdisciplinary health care research, especially in geriatrics.
Phase 1 of the initiative (January 1, 2003, through June 30, 2005) funded centers at five institutions: Duke University (Durham, North Carolina), Boston University (Boston, Massachusetts), the University of California, Los Angeles (Los Angeles, California), University of Pennsylvania (Philadelphia, Pennsylvania), and Yale University (New Haven, Connecticut). Eligible institutions included those with ongoing geriatric research activity in a minimum of two of the core geriatric disciplines (medicine, nursing, or social work). Each institution received $200,000 across two and a half years and was required to provide matching funds totaling at least one-half of this amount. As part of its grant proposal, each center conducted a needs assessment that identified key areas of strength, described specific barriers, and suggested specific opportunities to advance interdisciplinary geriatric research. The centers used the results of the needs assessment to develop their plans for building an interdisciplinary geriatric health care research center; the plans included the proposed organizational structure of the center and the types of interdisciplinary research and training activities that the grant would support. The funded centers undertook a range of unique activities, including pilot projects, which provide opportunities for researchers of different levels and from different disciplines, especially those not typically involved in geriatric research, to work together for the enhancement of geriatric health care research. Some Phase 1 pilot projects included “Affective Responses to Prevention Among Nursing Home Residents With Dementia” at Duke and “Preferences for Depression Treatment Among Older Primary Care Patients” at the University of Pennsylvania. These projects and other Phase 1 centers' activities led to a number of grant submissions and awards, to peer-reviewed publications and conference presentations, and to career advancements for some individuals. Although definitively attributing all of these results directly to the initiative is impossible, the centers' systematic reporting, according to established criteria, suggests a reasonable connection.9
The results and lessons learned from the initiative's first phase offered useful insights regarding barriers to developing interdisciplinary centers and teams; strategies for overcoming these barriers; and the ideal composition and function of interdisciplinary research centers, which we applied during the second phase. In particular, we learned from Phase 1 that creating and sustaining interdisciplinary research teams of the future requires (1) developing both formal and informal structures that bring people together, give them a sense of belonging, and hold them together around an agenda of interdisciplinary geriatric research, (2) assertively expanding and maintaining strong interdisciplinary links, particularly those that involve investigators from disciplines with strong potential for collaboration that are not currently as well represented in interdisciplinary geriatric research, and (3) mentoring and supporting the education, training, and development of junior investigators engaged in interdisciplinary work.
We designed Phase 2 of the initiative (January 1, 2007, through June 30, 2009) to foster the successes in these three areas. For this phase, the basic eligibility and program requirements remained the same (institutional matching funds equal to at least one-half of the requested amount, involvement of at least two core disciplines, and the existence of interdisciplinary pilot projects), but, based on the lessons learned from Phase 1 of the initiative, we modified some of the requirements and added others. The modifications and additions were meant to ensure that applicants demonstrated a substantial amount of existing geriatric research activity, included co-principal investigators from at least two of the core geriatric disciplines as well as investigators from one related discipline, and articulated a clear focus on interdisciplinary training and mentoring. As with the first phase, the applicants conducted a required needs assessment that identified strengths and demonstrated a clear understanding of gaps.
For Phase 2, we selected seven centers from institutions across the country to establish interdisciplinary geriatric research centers: Cornell University (New York, New York); New York University (NYU; New York, New York); University of California, San Francisco (UCSF; San Francisco, California); University of Massachusetts (Boston, Massachusetts); University of Missouri, Columbia (Columbia, Missouri); University of North Carolina (UNC; Chapel Hill, North Carolina); and University of Washington (Seattle, Washington).
RAND Coordinating Center involvement
During both phases, the RAND Coordinating Center provided technical assistance in the form of coordination and communication activities (e.g., bimonthly conference calls with center directors), dissemination efforts (e.g., presentations on interdisciplinary mentoring and research at scientific meetings), and center development work (e.g., site visits and ongoing consultation). The Coordinating Center focused especially on career development and mentoring via Career Development Institutes (CDIs). The Coordinating Center hosted and facilitated three CDIs during the second phase of the initiative. The CDIs brought together junior and senior investigators across all the centers, provided skill-building workshops in grantsmanship, offered career development and mentoring, and coordinated opportunities for networking and developing collaborative projects. Overall, the Coordinating Center's technical assistance focused less on specific research projects and more on building infrastructure that would enable the centers to support pilot research and team-building and to subsequently secure new research funding.
The Coordinating Center also conducted an evaluation of the centers (the evaluation of the Building Interdisciplinary Geriatric Health Care Research Centers initiative was approved by the institutional review board of the RAND Corporation). The multifaceted evaluation assessed the centers' processes and outcomes, reviewed the RAND Coordinating Center's role in enhancing the success of the centers, and studied factors affecting the development of and pathways to interdisciplinary research careers in geriatrics. Center directors completed semiannual progress reports that detailed their center's activities, collaborative efforts, products, and progress toward goals and objectives. The reports also described the role of the Coordinating Center at the center. Following each of the three CDIs, RAND conducted brief surveys through which participants rated the usefulness of different sessions and wrote in suggestions for follow-up activities. RAND also surveyed the junior faculty involved in the initiative about their individual involvement with a center, about their center's infrastructure, and about their personal interdisciplinary education and training. Finally, RAND conducted interviews with the directors of each funded center to gather information on the directors' efforts to promote interdisciplinary research. The structured interviews included questions on each center's goals; interdisciplinary infrastructure, activities, and collaboration; interdisciplinary research pilot projects; interdisciplinary education and training; and sustainability. To complete our evaluation of the overall initiative, we asked each of the Phase 1 center directors to provide a brief update (two years out) of their center's progress and status in these same areas.
Organization of interdisciplinary research centers
The Phase 2 interdisciplinary research centers organized their activities into three areas of focus: infrastructure, collaborative research projects, and career development.
All seven of the centers developed an infrastructure designed to establish their roles as a resource for researchers and as the focal point for interdisciplinary geriatric research activities at the institution. Either two or three center directors from the fields of medicine, nursing, or social work led the centers. A few centers focused their efforts on a particular area, such as community-based participatory research or palliative care. All of the centers used steering committees to open the decision-making process to a wide group of researchers from the core disciplines and to help engage key institutional leaders, including vice chancellors and deans. These steering committee meetings provided an opportunity to network across disciplines and to discuss and share information about new opportunities for partnerships and research.
The centers all sponsored a variety of activities to support interdisciplinary research projects in geriatrics. They implemented regular research or work-in-progress seminars to provide researchers with opportunities to receive feedback on their work. For example, the center at the University of Massachusetts organized a quarterly interdisciplinary seminar series and held monthly research-in-progress seminars. The centers' activities, including conferences, symposia, and retreats, worked to increase awareness of geriatrics and gerontology and to build relationships across disciplines. The center at UNC, for example, hosted a campus-wide aging research retreat to create a strategic plan to foster and focus interdisciplinary research capacity and activity among senior and junior investigators at the university. And the UCSF center developed a Wiki site to facilitate communication and collaboration among faculty and to share ideas, proposals, manuscripts, and other interdisciplinary products. Through these and other similar events, the centers were able to disseminate updates on center progress, information on collaborative opportunities, and results of research to a broad audience of investigators.
In addition to infrastructure and interdisciplinary research, the centers focused on the education and training of graduate students, postdoctoral fellows, and junior faculty. The primary career development activities included mentoring and career development seminars. For example, the University of Washington integrated mentoring into the interdisciplinary geriatric research seminar series and conducted group and individual consulting sessions, during which junior researchers could ask senior researchers for advice and feedback on their projects. Through their mentoring efforts, the centers provided more structure for mentoring activities, expanded the pool (and increased the engagement) of interdisciplinary mentors, and integrated mentoring into other center activities. Several centers supported career development training sessions as part of their efforts to educate and train graduate students and junior faculty to conceptualize projects and develop fundable proposals. At NYU, junior faculty involved with the center attended a weekly faculty development seminar series that focused on developing research proposals. Together, the centers' education and training activities helped create an environment supportive of junior faculty career development.
Outcomes from the interdisciplinary research centers
To be able to better attribute the work of the centers to the success of collaborating faculty, RAND asked that for Phase 2 a member of the core center team or a close collaborator not only report products but also categorize the center's role and degree of influence in developing and completing the products as high, medium, or low. The team member or collaborator selected high if the center played an integral role in bringing together the investigators and in shaping the development and direction of the product; medium if the center played a role in bringing together the investigators and shaping the product, but the product may have happened in some form even without the center; and low if the center played some role, but the product would have happened without the center. The evaluation results presented here, particularly those regarding grants, publications, presentations, and career advancements, focus on the seven centers funded in Phase 2; however, we have drawn the lessons learned from our experiences with all the centers in both phases of the initiative.
The centers' focus on infrastructure, support of interdisciplinary research, and education/career development during Phase 2 of the initiative led to many new collaborations and pilot projects, to grant submissions and awards, to manuscript acceptances and conference presentations, and to career advances for junior faculty.
Collaborations and pilot projects.
Together, the seven centers involved a total of 131 new faculty members representing a diverse set of disciplines, including sociology, occupational therapy, rehabilitation medicine, psychology, psychiatry, public health, engineering, policy analysis and management, cardiology, pathology, dentistry, and emergency medicine. The centers averaged 18 new collaborators per center. The pilot projects that each center supported numbered from two to seven. The projects covered a range of topics and themes. For example, the University of Missouri, Columbia's pilot projects included a study on technology and range of motion, a fall-prevention study, an end-of-life intervention study, and new electronic health resources for patients with diabetes.
Researchers involved with the seven Phase 2 centers submitted a total of 342 new grants during the two-year initiative. Overall, the centers rated the role of the center as high for 103 (30%) of these submissions. Researchers involved with the seven centers received 151 new grants during Phase 2 (from January 1, 2008, through December 31, 2009). The centers varied widely in both the number of grants awarded and the center's role in the awarded grants. The awards ranged from NIH grants to national or local foundation grants. The total amount awarded through these 151 grants was $73,700,000. Across the seven centers, the median grant award total was $4,660,000. The centers reported that $10,000 of this resulted from grants which the center played a high role in developing. Overall, the centers' involvement was high in 38 (25%) of the grants awarded.
Manuscripts and presentations.
Across the seven centers, 883 manuscripts were accepted for publication during the grant period. The journals that accepted articles for publication demonstrate the range of disciplines represented by the researchers involved with the centers (nursing, social work, gerontology, informatics, etc.).
The centers included any manuscript accepted for publication if a member of the center's core team either authored it or collaborated closely with the authors and if it directly related to the center's educational or research agenda. Centers rated their involvement with the publication as high for 124 (14%) of the manuscripts. The publications accepted during the first year of the initiative most likely would have been submitted prior to the start of the center's activities. Nonetheless, the volume of manuscripts listed and the range of disciplines involved suggest that center researchers had worked to form relationships and disseminate findings across disciplines.
Overall, researchers involved with the centers gave 516 presentations at academic and research conferences during the grant period. The conferences, including the Gerontological Society of America Annual Meeting, the American Geriatrics Society Annual Meeting, and meetings on cancer research, occupational therapy, nursing administration, and internal medicine, involved a range of disciplines. A number of the conference presentations related directly to the pilot projects sponsored by the centers. Other presentations brought research findings to a wide audience of researchers and practitioners. Overall, the centers rated their involvement as high for one-fifth of the conference presentations (103 presentations).
A total of 42 senior and junior faculty members from across the centers achieved significant career advancements (i.e., their rank rose from assistant to associate professor). The centers rated their involvement as high for almost one-fifth (8; 19%) of these advancements.
Our assessment of the infrastructure, collaborative research, and career development activities at the five first-phase centers and the seven second-phase centers helped us identify factors that influenced the development, effectiveness, and sustainability of the centers. Overall, we learned from the second-phase centers that building interdisciplinary research capabilities takes time, attention, and support. The external funding provided by the grant and the work of the RAND Coordinating Center helped to bring together individuals with common interests and to build on existing institutional efforts in geriatric research. Yet, each center's progress was closely tied to how it integrated the initiative's interdisciplinary model into its own interdisciplinary research efforts. All of the centers engaged top-level institutional leaders to help raise the profile of the centers and to recognize the efforts of the collaborators through campus-wide events or strategic planning processes. By involving institutional leaders, the center directors also worked toward linking the centers to other broader institutional priorities and garnering support and resources for the center's work. By drawing on infrastructure already in place, the centers built capacity and identified other opportunities for interdisciplinary research and collaboration. Finally, the centers began working beyond the individual institutions to develop a broader national consortium across CTSA institutions that focus on interdisciplinary geriatric education.
We have highlighted facilitating factors that were evident across more than one center, that made some centers more effective than others, and that offered particularly clear implications for future efforts in developing interdisciplinary research centers. In Table 1, we describe the factors and summarize their implications for ongoing and future efforts to develop interdisciplinary research centers.
The centers all successfully established infrastructure and supported activities that gave the center an identity as a nexus of activity for interdisciplinary research and collaboration on aging. The center infrastructure and interdisciplinary activities provided a structure for collaboration that helped to build a shared culture and to create opportunities for reciprocal learning. The infrastructure of the most successful centers included
- Strong interdisciplinary leadership, including deans, chairs, and institutional administrators
- Clear structure and organization for interdisciplinary research activities
- Tangible benefits (feedback, advice, networking) for those participating in activities
- Wide array of interdisciplinary activities (including online forums, in-person meetings)
- Effective communication to a broad audience
The existence and development of pilot projects enabled the centers to directly support interdisciplinary research projects. Many of the centers also integrated mentoring into the pilot projects to provide focused support and to monitor the project's progress. Factors that related to the collaborative research projects facilitating interdisciplinary research at the centers were (1) clearly defined requirements for interdisciplinary involvement and (2) institutional support, including funding, for innovative interdisciplinary research projects that have future potential.
Education and training
The centers focused on the education and training of graduate students and junior faculty. Across the seven centers, certain aspects of their education and training activities seemed to influence the development and sustainability of the centers. These factors comprised the ability to provide formal, structured mentoring activities and the integration of career development into a range of interdisciplinary activities.
About two years after their grants ended, the Phase 1 centers reported that they had continued at least the primary activities begun through the initiative—but in different forms and with other sources of support. The University of Pennsylvania, for example, has transformed the RAND/Hartford center activities into a new interdisciplinary center with a different name. For their collaborative research efforts, the Phase 1 centers report that they have completed nearly all of the pilot projects funded through the centers, many of which have led to grants. Further, the Phase 1 centers' updates state that the involved institutions have become more focused on interdisciplinary research and mentoring, which has, in turn, made sustaining the career development components of the centers easier. Although the Phase 1 centers have continued the interdisciplinary mentoring activities, they have done so in more informal ways.
The sustainability efforts of the Phase 2 centers have focused on developing and strengthening links and collaborations with other interdisciplinary efforts within the institution. To sustain the infrastructure, the centers report plans to continue select activities, including some courses, seminar series, interdisciplinary work groups, and newsletters. The centers report, for the collaborative research component, strategies to develop more, fundable interdisciplinary research proposals based on their pilot projects and, for the career development component, continued activities, such as formal interdisciplinary research mentoring and work-in-progress seminars.
Initiative evaluation and future research
Our evaluation of the RAND/Hartford Building Interdisciplinary Geriatric Health Care Research Centers initiative focused on the number of tangible products produced during the initiative, but other outcome measures may be better. Future evaluation should work toward developing other metrics for measuring success. For example, looking at how centers leveraged resources to make new connections and then measuring the number and results of those new connections could reveal valuable information. Including a more formal process evaluation component to help understand the broader effect of the efforts would also be helpful. Finally, collecting more qualitative data on the relationships developed and experiences individuals had through collaborations could provide a richer understanding of how a center's activities translate into successful outcomes.
As institutions look to establish interdisciplinary geriatric research centers (or interdisciplinary centers of any type), the results of this initiative can inform decisions about effective strategies for building relationships and developing collaborative partnerships across disciplines. To make these centers sustainable, directors need to consider, as they plan for development, what center elements they can market to which potential funders. By linking centers to existing transinstitutional entities (that may not be specifically focused on geriatric research), such as CTSAs, new centers can build on institutional strengths. As more interdisciplinary geriatric health care research centers take root, the field will move closer to the goal of increasing the effectiveness of clinical interventions and health services interventions for the elderly, thereby improving the health outcomes and the quality of life for this population.
Focusing on older adults requires an interdisciplinary team to address the complexity of multiple interacting chronic conditions and to devote time for extensive interaction. The centers selected for Phase 2 of the RAND/Hartford Building Interdisciplinary Geriatric Health Care Research Centers initiative represented a reasonable balance across disciplines, content focus, and strategies. The centers had a threshold of existing activity and then used the results of the needs assessment conducted during the proposal phase to plan activities to build on this base. The centers successfully developed infrastructure and activities to draw together a wide range of interdisciplinary collaborators and to provide multiple opportunities for them to work together.
The authors thank the John A. Hartford Foundation for its generous support of this initiative, especially Amy Berman, James O'Sullivan, and Corrine Rieder, as well as members of the initiative's National Advisory Panel, for their valuable guidance throughout the selection, implementation, and evaluation processes. Finally, they acknowledge the five Phase 1 centers and their directors (Rebecca A. Silliman, Elizabeth Clipp, Kenneth Schmader, David B. Reuben, Mary D. Naylor, and Terri R. Fried) and the seven Phase 2 centers and their directors (M. Carrington Reid, Christopher Murtaugh, Elaine Wethington, Terry Fulmer, Scott Sherman, C. Seth Landefeld, Margaret Wallhagen, Jerry Gurwitz, Kathleen Miller, Jan Mutchler, Marilyn Rantz, Steven Zweig, Jan Busby-Whitehead, Mary Palmer, Sheryl Zimmerman, Barbara Cochrane, and Elizabeth Phelan) for their achievements in supporting and developing interdisciplinary research and researchers.
This initiative was funded by the John A. Hartford Foundation.
The evaluation of the RAND/Hartford Building Interdisciplinary Geriatric Health Care Research Centers initiative was approved by the institutional review board of the RAND Corporation.