Dartmouth Health to lead $44 million national research study of care decisions among older adults with serious illness

Dartmouth Health (DH), the most rural academic health system in the country, has been selected by the National Institute on Aging to serve as the lead site for a $44 million study, one of the largest studies ever conducted on how older Americans with serious illness make decisions about their medical care. DH will serve as the study’s rural anchor for the Advancing Ethical Goals in Society (AEGIS) trial, which will enroll more than 12,000 older patients.

"Every patient deserves the right care, at the right time, and on their own terms, whether they live two blocks or two hours from the nearest hospital," said Joanne M. Conroy, MD, CEO and president of Dartmouth Health. "This trial will prove what we believe at Dartmouth Health: rural does not mean lesser. We meet people where they are at and bring them state-of-the-art care. All patients deserve the innovative, world-class healthcare, whether it’s in rural Vermont and New Hampshire or in our cities."

Every day, thousands of older Americans and their families confront difficult decisions about serious illness. Research indicates that, in rural settings, patients face a widened and persistent gap in accessing the care they want and deserve. AEGIS will study shared decision-making, in which patients and families act as equal partners in their medical choices. The trial will test whether decision-aid tools that help patients and families understand their options, communicate what matters most to them, and navigate an increasingly complex healthcare system leading to care delivery that honors their wishes.
"Shared decision-making is a simple but profound idea: that doctors and patients can be true partners in care. The insight that these partnerships create better outcomes grew out of the late Jack Wennberg’s pioneering work here at Dartmouth," said Jennifer Hunt, MD, MEd, dean of Dartmouth’s Geisel School of Medicine and chief academic officer at Dartmouth Hitchcock Medical Center. "That spirit of patient-centered innovation is one of the things that drew me to Geisel, and our work with Dartmouth Health on AEGIS shows how our deep institutional partnership can be a catalyst for transforming rural health." 
Wennberg’s research revealed that the care patients receive often depends more on where they live than on what they prefer. Over 20 years ago, Wennberg and Angelo E. Volandes, MD, MPH, who now serves as Dartmouth Health's interim chief research officer and senior associate dean for clinical and translational research at the Geisel School of Medicine, discussed a medical dilemma: medicine had no standardized way for doctors and patients to talk about medical decisions. 

"Getting the right care should not depend on your zip code," said Volandes, who has spent two decades studying how patients with serious illness make medical decisions. "AEGIS puts Dartmouth Health and Geisel at the center of a national effort to make sure older patients and families, wherever they live, understand their choices and are respected when it matters most."

The AEGIS Trial is led by multiple principal investigators: Volandes and Michael Paasche-Orlow, MD, of Tufts Medical Center, which serves as the administrative site. Other Dartmouth Health investigators include:

•    Ellen Flaherty, PhD, MSN, APRN, vice president of Dartmouth Health’s Geriatric Center of Excellence; 
•    Nathan E. Goldstein, MD, chair of the department of medicine; 
•    Lori E. Henault, deputy director of research operations;  
•    Amber E. Barnato, MD, MS, MPH, Department chair and Director of The Dartmouth Institute for Health Policy and Clinical Practice at Geisel. 

Other institutions include:
•    Northwell Health, 
•    Dana-Farber Cancer Institute, 
•    Mayo Clinic, 
•    Emory University, 
•    University of California San Francisco, 
•    Wake Forest University
•    University of Colorado.

"We talk about rural health as a deficit. We need to reframe it as a design challenge," Volandes added. "If a tool helps a family in New Hampshire’s rural Coos County make the decision that is right for them, it will work anywhere in America."

AEGIS is the latest in a series of major awards supporting Dartmouth Health’s major rural health initiative and portfolio: Dartmouth Health at Home. This announcement follows the recently announced  $11.8 million NIH grant to fund a collaborative multidisciplinary research program with Dartmouth Geisel College of Medicine, to be known as the Center for Aging with Serious Illness, focused on addressing the needs of people aging with serious illness; and a $10 million gift from philanthropist Kenneth R. French to establish the Vickie French Hospital at Home program in honor of his late wife.

Of the $44 million total, Dartmouth Health will receive $13.2 million to lead the trial's rural sites, with an additional $623,000 supporting investigators at the Geisel School of Medicine at Dartmouth.

Funding acknowledgment: Research reported in this release is supported by the National Institute on Aging of the National Institutes of Health under award number: 1U19AG090271-01A1.