MIT Roybal Center for Translational Research to Improve Health Care for the Aging
One of 15 Roybal Centers in the United States, the MIT Roybal Center for Translational Research to Improve Health Care for the Aging will support randomized evaluations of low-cost, high-impact behavioral interventions to improve health care delivery and health outcomes for older adults in the United States.
According to the National Council on Aging, over 25 million Americans over the age of sixty are economically insecure, living at below 250 percent of the Federal Poverty Line. In addition, the aging population is more likely to utilize our health care system and experiences higher rates of chronic disease and other illnesses. Low-cost, behavioral interventions have the potential to dramatically improve health outcomes and reduce costs of care for the aging population, especially for those experiencing poverty. However, too little is known about which behavioral interventions are effective for improving the health of aging individuals. The Center, in collaboration with partners, will work to build a body of evidence to inform policymakers and practitioners on which behavioral interventions work, and why. Previous projects funded by Roybal Centers include “Changing Behavior in Hospitalized Seniors with Healthy Mobility to Reduce Harms of Hospitalization,” “Structuring Incentives to Attract and Retain Wellness Program Participants,” and “Changing and Understanding Motivation to Increase Physical Activity Among Sedentary Older Adults.”
Each year, the MIT Center will run one Request For Proposals to solicit pilot proposals from the J-PAL research network on behavioral interventions to improve health outcomes for the elderly and aging individuals. Previously funded J-PAL projects on aging-related issues include “The Impact of Medicare Bundled Payments: Evidence from a Nationwide Randomized Evaluation for Lower Extremity Joint Replacement” and “Deferring Agency at End-of-Life: The Role of Information and Advance Directives.” For more information, contact Hannah Reuter, the US Health Care Delivery Initiative Manager.
The MIT Roybal Center for Translational Research to Improve Health Care for the Aging is funded by the National Institute on Aging (NIA). The Roybal Center was created with support from a five-year P30 center grant to conduct translational research on aging populations.
Request for Proposals (RFP) MIT Roybal Center for Translation Research to Improve Health Care for the Aging
The MIT Roybal Center seeks to identify, fund, and support low-cost, high impact trials of behavioral interventions for mid-life and older people that can inform policy solutions to ensure their care is efficient, effective, and equitable.
MIT Roybal Center RFP Opens — September 21, 2022
MIT Roybal Center RFP Closes — January 4, 2023
Notification of J-PAL approval — Week of February 27, 2023
Deadline to submit supplemental Roybal proposal documents for NIH review and approval — March 13, 2023
Award Letters Released — August 23, 2023
Types of proposals
The Roybal Center will accept pilot proposals only. Pilot studies may be awarded a maximum of $75,000, including the full federally-negotiated indirect cost rate of the PI’s institution. The award period for NIH pilot awards should be for one year from July-June to align with the Roybal budget period. Projects will not be able to begin enrollment or any other activities until NIH has approved the project, which will likely be in June 2022.
The following modifications are in place as of October 29, 2020 until noted otherwise.
1. All applications must follow J-PAL’s Covid-19 response guidelines in regard to in-person interactions with subjects.
2. If your proposed project will feature in-person interactions with subjects, vendors, or partners, please note that the evolving situation could result in changes to these guidelines at a future date. Therefore, please be sure to include the following in your application materials, which are listed in more detail in the “How to Apply” section:
- Budget Narrative: Include a discussion of what funds will and will not be spent in what timeframes if the proposed project is paused, modified, or dissolved because of Covid-19 related disruptions.
- Proposal Narrative: Outline aspects of the proposed project that can be completed right away vs aspects dependent on the status of the Covid response more broadly. The proposal should also include plans for conducting fieldwork, and how this will evolve should Covid-19 prevent in-person contact.
J-PAL-affiliated researchers, J-PAL post-doctoral fellows, and HCDI-invited researchers are eligible to apply for funding. Graduate students are not eligible for Roybal funding.
How do I apply?
The following documents must be sent to the Roybal RFP manager Hannah Reuter ([email protected]) by 5pm ET on Wednesday, January 5, 2022:
- Proposal narrative - for full details on what to include in the proposal narrative
- A completed Roybal RFP cover sheet
- A completed Roybal RFP budget
- A budget narrative
All of these documents can be found under the "application documents" heading.
Who will review applications?
Proposals are reviewed by two peer reviewers from J-PAL’s academic network. After peer review, the HCDI RFP Review Board reviews each proposal and makes all funding decisions. The Review Board may grant an unconditional approval, a conditional approval (pending minor revisions), a request to revise and resubmit, or a rejection. After review by the Review Board, proposals will then be sent to the NIA for final approval. PIs will need to provide additional documentation for NIA review. Requirements will vary across proposals. Regardless of funding status, all applicants to the RFP will receive redacted comments from the referees.
Please note that the MIT Roybal Center will not accept off-cycle submissions.
Experimental Evidence on the Effectiveness of Non-Experts for Improving Vaccine Demand
Researchers: Marcella Alsan, Sarah Eichmeyer
Abstract: We experimentally vary signals and senders to identify which combination will increase vaccine demand among a disadvantaged
population in the United States – Black and White men without a college education. Our main finding is that laypeople (non-expert
concordant senders) are most effective at promoting vaccination, particularly among those least willing to become vaccinated. This
finding points to a trade-off between the higher qualifications of experts on the one hand, but lower social proximity to low socio-
economic status populations on the other hand, which may undermine credibility in settings of low trust.
Leveraging the Random Assignment of Medicaid Managed Care Plans
Researchers: Matthew Notowidigdo, Craig Garthwaite
Abstract: In South Carolina, the Medicaid program is administered through Managed Care Organizations (MCOs), which offer different health care plans to Medicaid beneficiaries. These plans differ in their generosity, network coverage, and other attributes, and they are ranked by the state using a system of “star ratings.” The system of MCOs offers choices to health care consumers and allows plans to compete for consumers. In South Carolina, when consumers do not make an active plan choice, the state uses an algorithm to assign plans to consumers automatically. Starting earlier this year (in 2017), this auto-assignment is now being made using an explicitly random process. We propose to use this randomized assignment feature to study the effect of plan assignment on patient outcomes such as health care utilization and health care expenditures (both overall and by category). This prospective analysis will be complemented with a retrospective analysis that takes advantage of the state’s historical quasi-random round-robin assignment procedure to allocate households to plans. Additionally, we propose to combine the analysis of the randomly assigned population with the population that made active choices to try to distinguish between treatment and selection in accounting for which plans perform better.
Increasing the Effectiveness and Diffusion of COVID-19 Messaging for Vaccination
Researchers: Esther Duflo, Abhijit Banerjee, Arun Chandrasekhar, Benjamin Olken, Emily Breza, Marcella Alsan, Paul Goldsmith-Pinkham
Abstract: Despite widespread availability of COVID-19 vaccination in the U.S., many people remain unvaccinated. Understanding the effectiveness (or lack thereof) of popular outreach campaign strategies for the vaccine is therefore critical. In this paper, we conduct a very large scale randomized study of the impact of two outreach strategies that were central to many vaccination campaigns.
Physicians are some of the most trusted figures in the US, and during the COVID-19 pandemic, direct appeals by physicians and nurses have been used as a strategy to promote protective behavior, particularly vaccination. Another cornerstone of the vaccination strategy, particularly in the United States, has been the use of local leaders, influential people, and simply friends and family, to promote immunization in their social networks. In this project, we tested the impact of both direct communication by doctors and efforts to motivate individuals to convince their friends to be vaccinated.
Physicians and nurses recorded short videos to promote COVID-19 vaccination and address common doubts. In December 2021-January 2022, these messages were diffused as sponsored messages to Facebook users in randomly selected counties. In a second group of areas, Facebook users received a doctor-recorded video encouraging them to become an immunization ambassador for their friends. The message directed them to a site from where they could easily share any of the videos diffused in the first treatment. In a third group of areas, users were encouraged to think about their most influential friend, and to forward them the message encouraging them to become an immunization ambassador. Finally, there was a control group. In total 17,828,769 Facebook users received at least one video in the US.
Our primary outcome variable is the number of vaccinations delivered in the weeks following the intervention, obtained from administrative data (first doses, second doses and booster). We cannot reject the null of no effect on vaccination of any of the interventions and on any of the outcome variables. Early in 2022, near the peak of the Omicron wave, physicians messages were not sufficient to affect the decision to get immunized against SARS-Cov2, regardless of whether they were targeted to those not yet vaccinated or to those who were convinced of the benefits of vaccination and were tasked to convince others.
Bridging the Gap between Pregnancy and Primary Care
Researchers: Jessica Cohen, Mark Clapp
Abstract: Chronic health conditions affect most older adults. Preventative medicine and risk management strategies, especially when applied earlier in life, are essential to altering the trajectory of a disease and ultimately improving health outcomes. Primary care providers (PCP) often provide most of these services, though younger adults are the least likely to receive primary care. This project leverages a period of high engagement and health activation during a woman’s life (pregnancy) to nudge her toward use of primary care after the pregnancy episode. With <33% of women currently receiving primary care services following a pregnancy, this randomized controlled trial will test the hypothesis that a behavioral science-informed intervention, incorporating defaults and salience, can increase the rates of PCP follow-up within 6 months following a delivery for women with hypertension, diabetes, obesity. If successful, this intervention could serve as a scalable solution to increase primary care use and preventative health services in a population that currently has low rates of engagement and utilization of these services.
Encouraging abstinence behavior in an opioid epidemic: Incentivizing inputs and outputs
Researchers: Rebecca Dizon-Ross, Ariel Zucker, Michael Fendrich, Mindy Waite, Richard Rosenthal
Abstract: Combating the epidemic of overdose deaths is a central challenge of U.S. health care policy, and substance use disorder (SUD) is increasingly harming older adults. One approach to treating SUD, incentivizing abstinence from substance use, has repeatedly proven effective but has limited evidence base in older populations. A uniquely scalable modality – of increasing interest to policymakers – for implementing this approach is with a mobile application (app) that delivers incentives for abstinence from opioids and stimulants. However, one concern about using an app for incentives is that it may hinder take-up and viability among older populations. Thus, testing the app specifically among older adults is of critical policy importance.
This project will conduct a second phase of a randomized controlled trial (RCT) to evaluate app-based incentives for abstinence from opioids and stimulants. The first phase of the RCT focused on evaluating app-based incentives among all adults and on comparing different incentive variations. The second phase will focus on the effectiveness of the app for older adults (aged 55 and over), and on understanding whether the acceptability and effectiveness of the app is decreasing with older age.
Specifically, our primary research aim is to assess whether app-based incentives are effective for older adults. Our secondary research aims are to understand whether older adults have lower take-up and engagement with the app than younger adults, and if app effectiveness is mediated by age, thus shedding light on the necessity of age-specific app design features. Effects on abstinence outcomes will be measured for all participants who engage with the app (N=59), and take-up and engagement outcomes will be measured for all participants who are eligible for the RCT even if they do not enroll (N=98). We project that 15 percent of participants will be older adults. In order to complete our research aims, we will then analyze data from the Roybal-funded study phase jointly with our previous study phase; thus, our power calculations refer to sample sizes of both study populations combined.