August 13, 2018

New Funding: Family medicine faculty will lead research and clinical pilot program to address aging with long-term disabilities

A $4.3 million grant will help establish a Rehabilitation Research and Training Center at the U-M and Michigan Medicine. Disability researchers Michael McKee and Elham Mahmoudi will establish new research and a model clinic in this large-scale effort.


Michael M. McKee, MD, MPHElham Mahmoudi, Ph.D., M.B.A.
Michael M. McKee, MD, MPH and Elham Mahmoudi, Ph.D, M.B.A., M.A.

Michael M. McKee, M.D., M.P.H. and Elham Mahmoudi, Ph.D., M.B.A., M.S., assistant professors and disability health researchers, will join an interdisciplinary team of researchers and clinicians at the University of Michigan and Michigan Medicine, as the group establishes a national Rehabilitation Research and Training Center (RRTC) program at U-M. The program will focus on improving the aging experience of individuals with long-term physical disabilities.

RRTC programs conduct research, offer training and disseminate information around rehabilitation topic areas determined by the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR). There are 23 active programs operating across the United States

Supported by $4.3 million in NIDILRR funding over the next five years, the U-M RRTC will generate research around the interactions between personal and environmental factors associated with better health outcomes for people with physical disabilities.

Known as the Investigating Disability Factors and Promoting Environmental Access for Healthy Living RRTC — or IDEAL, for short —the U-M center will also use the research it generates to develop evidence-based interventions to help this patient population live better.

Nationally, 1 in 5 adults lives with a disability.*

But knowing what it’s like for those 53 million people to age — and how their unique needs may change over time — isn’t always clear to the professionals that provide care.

“When we work in a health care system, we interact with patients with disabilities, but we don’t always understand what it’s like to live with a physical disability,” says Michelle Meade, Ph.D., associate professor of physical medicine and rehabilitation and lead investigator of the IDEAL RRTC program.

“For example, managing other health conditions, such as diabetes or the aftereffects of a stroke, while dealing with a spinal cord injury or cerebral palsy adds another level of complexity.”

“People think that people living with physical disabilities should have a low quality of life because they have a disability,” says Meade. “But there are many things that can be done to ensure positive outcomes and prove that people can live meaningful lives with physical disabilities.” 

Meade serves as director of the center and is joined by co-principal investigators Philippa Clarke, Ph.D., professor of epidemiology at the University of Michigan School of Public Health and research professor at the U-M Institute for Social Research, and Robyn Rontal, J.D., MHSA, policy analytics director for the Center for Healthcare Research and Transformation in Ann Arbor. 

IDEAL RRTC core contributor photos
IDEAL RRTC core contributors

Goals and research plans

The IDEAL RRTC has four main objectives: 

  • Identify environmental factors, including the practices, programs and policies, that are associated with healthy aging for individuals with long-term physical disabilities from diverse backgrounds — particularly those from low-income and racial/ethnic minority communities.
  • Develop interventions to modify environmental factors to enhance the health, functioning and participation of individuals aging with long-term physical disabilities.
  • Serve as a national resource center to improve outcomes for people aging with long-term physical disabilities, their families and other stakeholders by providing information, training and technical assistance to a variety of groups — including individuals with disabilities, disability and rehabilitation researchers, clinicians and service providers, and policymakers.
  • Engage key stakeholder groups, particularly disability- and aging-related organizations, to bridge programs and practices for older adults and people with disabilities and maximize the relevance and usability of the new knowledge generated by the RRTC. 

Taking stock of environmental factors associated with good health is a key objective.

Says Meade: “An individual with a physical disability living in an area with accessible buses, good health care and government policies that promote accessibility to resources may have more opportunities than an individual living in an environment with low resources and health care over an hour away.” 

Which is why the research portion of the center’s work will be critical. 

“We’re going to examine and identify key gaps in existing literature and, using national insurance claims databases, look at the trajectories for existing individuals,” Meade says. “We’ll look at factors such as gender, age, hospitalizations, geography, current health care policies and so on.”

Next, the center will conduct participatory research.

“We’ll then reach out and do community-based participatory research collaborating with physical disability organizations in the Flint and Detroit communities, looking for individuals who have been thriving and those who have not, and talking with them about their challenges and what has helped them most,” Meade says. “Pairing this information with the information from the claims databases will help us map between environmental factors and what makes positive outcomes. 

The center will then take these knowledge discoveries to create interventions.  

“One example is our family medicine team is going to then look at this data and explore how we could set up a clinic to be most responsive for this group of individuals,” Meade says.

Another example: Clive D’Souza, Ph.D., an assistant professor of industrial and operations engineering, and a co-investigator and project director in the center, will focus on transportation access and aim to inform the deployment of autonomous vehicles for individuals with physical disabilities.

Says Meade: “The center is truly leveraging what’s best about U-M: partnering with our colleagues and communities to make a difference.”

The center will act as a national resource center for stakeholders, policymakers and disability organizations.

“For example, how do we make sure health care providers in rural Nebraska have the information they need to make the appropriate treatment and projections for their patients with physical disabilities,” Meade says. “The center will create a resource for them to turn to for more information.

Defining the experiences of aging with disabilities

Health economist Elham Mahmoudi will serve as co-project director in two RRTC studies that explore the interactions between personal and environmental factors that promote or inhibit healthy aging of individuals with long-term physical disabilities. Mahmoudi and collaborator Mark Peterson, PhD, MS, associate professor of physical medicine & rehabilitation, will analyze existing national longitudinal databases, including claims data from Optum, Medicare, Medicaid, and Social Security Administration data, with the following research aims:

  • Determine the longitudinal trends of co-morbid conditions common among individuals diagnosed with a physical disability stratified by type of insurance (public vs. private) and socioeconomic status.
  • Identify the independent and joint contributions of medical factors and social and environmental factors on adverse health events, healthcare use, and costs.
  • Quantify how changes in medical and social factors predict or mediate adverse health events and healthcare costs among individuals with specific diagnoses of physical disabilities
  • Examine interstate variation in health coverage, particularly as related to Medicaid home and community-based services, on access to and utilization of healthcare among adults with long-term physical disability.
  • Examine interstate variation in health coverage, and particularly in Medicaid home and community-based services, on adverse health events and health outcomes among adults with disability. 

Testing Discoveries with a Model Clinic

Disability health clinician-scholar Michael McKee will lead the effort to develop, pilot, and evaluate a model primary care clinic for adults with long-term disabilities. This model clinic will put into practice some of the findings from the RRTC research studies and provide a novel, accessible, and integrated health program for people with physical disabilities. The pilot clinic parallels successful efforts from McKee and Philip Zazove, M.D., professor and the George A. Dean Chair of Family Medicine, to establish the Deaf Health Clinic, which provides tailored primary care services to Deaf patients. 

The model clinic will be housed within Briarwood Family Medicine. The aims of this project are:

  • To measure the effectiveness of a pilot model clinic designed for persons with physical disabilities to promote the use of recommended preventive services and promotion of healthy behavior and healthy living. 
  • To assess the effectiveness of improved social support through care managers designed for persons with physical disabilities on reducing adverse health events and improving healthy aging. 

Growth potential 

IDEAL RRCT collage of institutional partner logos
IDEAL RRTC Institutional Support and Partnerships

The IDEAL RRTC will launch in October with their website; research projects are set to begin within the following six months.

“After the first year, we hope to begin publishing results from some of the studies,” Meade says. “The rollout plan for the center allows us to have projects going on with two or three studies within each project.

“A key piece will be how we present our findings so that people can understand and use it — especially the policy briefs that will be developed by Ms. Rontal and the team at the Center for Healthcare Research and Transformation to highlight the connections between state and national policies and health outcomes.” 

The IDEAL RRTC is led by center director Michelle Meade, Ph.D. She is joined by co-principal investigators Philippa Clarke, Ph.D., and Robyn Rontal, J.D., MHSA. Co-investigators for the center include Clive D’Souza, Ph.D.; Elham Mahmoudi, Ph.D.; Michael McKee, M.D., MPH; Shan Parker, Ph.D.; Mark Peterson, Ph.D.; Amy Pienta, Ph.D.; Melissa Riba, M.A.; and Rie Suzuki, Ph.D.

Read the original press release from Kylie Urban at Michigan Medicine.

Browse the latest disability health research from the University of Michigan Department of Family Medicine.