About

Rebecca T. Brown, MD, MPH, is an Associate Professor of Medicine (Geriatrics) at the Perelman School of Medicine at the University of Pennsylvania. She serves as a Senior Fellow at the Leonard Davis Institute of Health Economics, a Research Associate at the Population Aging Research Center, and a Senior Fellow at the Penn Center for Public Health. Dr. Brown is also the Vice Chief for Research in the Division of Geriatric Medicine. Her clinical expertise includes practicing in inpatient geriatrics consults, Acute Care for Elders units, and outpatient primary care geriatrics, currently practicing at the Corporal Crescenz VA Medical Center in Philadelphia. Her research focuses on improving functional status and quality of life for socioeconomically vulnerable older adults. She has extensively studied the epidemiology and outcomes of functional impairment and other geriatric conditions among vulnerable populations. Her recent work involves developing and testing interventions to optimize function for older adults in both clinical and community settings. Dr. Brown holds a K76 Beeson Advanced Career Development Award from the NIA and a VA QUERI grant aimed at enhancing the identification and management of functional impairment among older adults in primary care.

Research topics

• Medicine
• Gerontology
• Psychology
• Demography
• Family medicine

Selected publications

• Costs associated with delirium among older patients undergoing complex spine surgeries

  Journal of Neurosurgery Spine · 2026-04-10

  article

  OBJECTIVE: As the number of older adults undergoing spine surgery grows, it is important to better understand the risks of this procedure, including associated costs. The authors recently reported that undergoing more complex spine surgeries is strongly associated with postoperative delirium (POD). The goal of this study was to examine the costs associated with POD among patients undergoing spine surgeries of varying complexity. METHODS: Data from a prospective observational cohort study of 256 adults aged ≥ 65 years who underwent spine surgery were analyzed. Preoperative, intraoperative, and postoperative variables were collected. The primary outcome of POD was defined as a positive score on any of three measures (Confusion Assessment Method for the Intensive Care Unit, Nursing Delirium Screening Scale, and chart review). The authors conducted univariable and multivariable analyses to examine factors associated with POD and estimated costs of POD stratified by tier of surgery. RESULTS: Risk factors associated with POD included age, lower education level, baseline cognitive impairment, American Society of Anesthesiologists class ≥ III, tier 4 surgery, high estimated blood loss, intensive care unit admission, postoperative complications, and hospital length of stay. In multivariable analyses, age, baseline cognitive impairment, postoperative complications, and length of hospitalization remained significantly associated with POD. The mean total costs were significantly higher in the group with delirium versus without delirium ($99,543 vs $67,892). Additionally, more patients who developed delirium required discharge to an acute rehabilitation facility (47.0% vs 21.5%, p < 0.001). In analyses stratified by tier of surgery, the greatest difference in mean costs between those with delirium versus without delirium was observed in tier 4 ($164,902 vs $116,579, p < 0.001). CONCLUSIONS: Spine surgeries with greater complexity are associated with an increased risk of POD, with higher costs and rates of intensive care unit admissions, more postoperative complications, and discharge to acute rehabilitation facilities. Delirium prevention interventions targeted to older adults at high risk for POD have the potential to optimize outcomes and decrease healthcare costs.

  PublisherDOI

• Relationship Between Baseline and Longitudinal Self-Reported Physical Function and Cardiorenal Outcomes in CKD: Findings From the CRIC Study

  American Journal of Kidney Diseases · 2026-02-18

  articleOpen access
  PublisherOA PDFDOI

• Evaluating the acceptability and feasibility of a rapid housing program for veterans experiencing chronic illness and homelessness

  Journal of Social Distress and the Homeless · 2026-04-30

  article
  PublisherDOI

• Measurement of functional status in primary care: the role of the interprofessional team

  Journal of Interprofessional Care · 2025-07-28

  article

  Measuring functional status allows clinicians to deliver evidence-based interventions to prevent or delay associated adverse outcomes. Functional status is seldom routinely measured in primary care settings where most older adults receive care. Interprofessional team-based care is increasingly regarded as an important feature of high quality and efficient health care systems. Yet despite growing evidence of the benefits of team-based care, in primary care there are not yet standards for how to operationalize interprofessional practice. In this study we explored interprofessional perspectives on assessing functional status among older adults in team-based VA primary care clinics. We conducted qualitative interviews with 57 primary care team members (nursing staff, primary care providers, and social workers) from six geographically diverse VA medical centers. We drew from implementation science frameworks and sociotechnical theories to ground our thematic analysis in dynamic, real-world contexts. Interviews revealed the view that all primary care team members play a role in measuring and addressing functional status. Participants also described a perceived hierarchy of accuracy of assessment based on role and outlined strategies for validating the accuracy of functional status assessments. These results can inform guidelines for functional status measurement in primary care that improve interprofessional assessment and team-based communication.

  PublisherDOI

• Real-world quantification of implementation dose across twenty-five implementation instances

  Implementation Science Communications · 2025-11-29

  articleOpen access

  BACKGROUND: There are many approaches in implementation science research and practice to prospectively and pragmatically measure the amount of effort required to implement a particular evidence-based practice (EBP). We sought to 1) demonstrate how to prospectively and pragmatically document implementation activities in a real-world implementation trial; 2) quantify implementation dose (frequency and time spent) across the implementation of four EBPs; and 3) explore potential drivers of variation in implementation dose across EBP, sites, implementation progress, and wave. METHODS: We built on the existing literature to develop a prospective and pragmatic way to track implementation activities during a type III hybrid effectiveness-implementation stepped wedge trial. We then quantified both total implementation dose (defined as total time spent by the implementer team) and how much of this dose was synchronous (defined as time spent working directly with local implementers at the sites receiving the intervention). We used multiple linear regression to understand what factors may influence differences in total implementation dose delivered (such as which evidence-based practice was being implemented, in which wave of the stepped wedge, at which medical centers), as well as how dose was related to implementation progress, categorized by 1) decision to participate, 2) training, 3) implementation with support, and 4) independent implementation. RESULTS: From 2022 to 2023, we prospectively captured implementation dose across 25 implementation instances related to four EBPs that were implemented at seven VA medical centers. We implemented Surgical Pause seven times, TAP six times, CAPABLE six times, and EMPOWER six times. We captured and categorized 1,271 h of implementation activities. Asynchronous administrative activities were most common across implementation phases. Other common synchronous activities include engaging collaborators, problem solving, providing updates, and ongoing action/implementation planning. The EBP was the largest driver of variation in implementation dose overall. Site, implementation progress, and wave did not independently explain variations in implementation dose. CONCLUSIONS: The EBP being implemented was a much stronger predictor of the implementation dose required than were other factors, such as experience implementing the EBP or characteristics of the medical center where the intervention was being implemented.

  PublisherDOI

• Polygenic scores and baseline cognitive function in midlife

  Alzheimer s & Dementia · 2025-12-01

  articleOpen access

  BACKGROUND: Midlife is a key life-course period for understanding risk factors of cognitive decline. Despite growing evidence demonstrating polygenic contributions to age-related disease risk, less is understood about how polygenic scores (PGS) may relate to cognitive traits in middle age. In a cross-sectional analysis, we investigated how PGS for Alzheimer's disease (AD), longevity, subjective-wellbeing (based on life satisfaction and positive affect), and cognitive-function may relate to cognition in a cohort of middle-aged adults with normal cognition. METHODS: The Health and Retirement Study (HRS) is an ongoing survey in Americans aged 50 years or older. We studied a cohort of 6615 individuals from the HRS (5359 European-ancestry, 1256 African-ancestry) aged 50-56 years with normal cognition at baseline, as determined by the HRS cognitive test battery. PGS derived from genetic variants associated with traits through genome-wide association studies in independent cohorts were available for all individuals. Linear regressions adjusted for baseline age, gender, and years of education were performed separately by genetically-defined ancestral group. RESULTS: Higher baseline cognition was observed in females (European-ancestry β=0.72±0.08,p<0.001; African-ancestry β=0.46±0.18,p=0.009) and individuals with more years of education (European-ancestry β=0.39±0.02,p<0.001; African-ancestry β=0.29±0.04,p<0.001). Higher cognitive-function PGS related to higher cognition (European-ancestry β=0.19±0.04,p<0.001; African-ancestry β=0.20±0.09,p=0.024). In the European-ancestry group, the cognitive-function PGS partially mediated the relationship between education and cognition (proportion mediated in European-ancestry=0.019, CI=0.010-0.030,p<0.001; proportion mediated in African-ancestry=0.016, CI=-0.002-0.050,p=0.072). The cognitive-function PGS still partially mediated the relationship between education and cognition in a subset of the European-ancestry group matched to the African-ancestry group based on age, gender, education, and cognition (n =1256 European-ancestry, proportion mediated=0.016, CI=0.002-0.040,p=0.016). Therefore, the lack of mediation in the African-ancestry group is likely not due to smaller sample size. We did not observe associations between cognition and PGS for AD, longevity, and subjective-wellbeing in either midlife ancestral group. CONCLUSIONS: In this HRS cohort, more years of education were related to higher baseline cognition, and in individuals with European-ancestry, this relationship was partially mediated by a PGS for cognitive-function. Future directions include assessing the contribution of PGS to cognition over time, and investigating how environmental and life-course factors may moderate the association between PGS and cognition.

  PublisherOA PDFDOI

• Challenges and Opportunities in Implementing a Multicomponent Dementia Caregiver Program in a Complex Healthcare System

  INQUIRY The Journal of Health Care Organization Provision and Financing · 2025-03-12 · 2 citations

  articleOpen accessSenior author

  The Tailored Activity Program (TAP), an intervention for people living with dementia (PLWD) and their caregivers, has been shown to reduce behavioral symptoms for PLWD and caregiver burden. While TAP is proven as an evidence-based practice (EBP), it has yet to be implemented at scale. The Department of Veterans Affairs (VA) has prioritized the Age-Friendly Health System (AFHS) initiative, providing an opportunity to test implementation of TAP in a complex healthcare system. We conducted semi-structured pre-implementation interviews with leaders and clinicians at 6 VA Medical Centers (VAMCs) to engage key implementation partners and understand their unique implementation contexts. We utilized team-based rapid qualitative analysis to identify themes related to implementation determinants. We interviewed 65 unique informants in 58 interviews (5 VAMC leaders, 36 department leaders, and 17 frontline clinical staff). Informants identified 4 key factors critical to consider prior to implementing TAP: (1) alignment with organizational priorities; (2) perceived value and fit with existing clinical workflows; (3) competition with existing organizational and clinical priorities; and (4) considerations about the effect of caregiver burden on participation. We identified key factors to consider for successful implementation of a multicomponent intervention for PLWD and their caregivers within a complex healthcare system. As the AFHS initiative expands, there is a growing need for EBPs focused on the care of PLWD and their caregivers. These factors can guide clinicians, leaders, and implementation scientists in planning for implementation and sustainment of EBPs to bolster AFHS initiatives.Trial RegistrationRegistered 05 May 2021, at ISRCTN #60,657,985.Reporting GuidelinesThe COnsolidated criteria for REporting Qualitative research (COREQ) checklist was used to ensure proper standards for reporting qualitative studies (see attached).

  PublisherDOI

• Graft-Versus-Host Disease (GVHD) and Senescence-Associated Biomarkers Correlate with Frailty and Survival in Older Adults Undergoing Hematopoietic Cell Transplantation (HCT)

  Transplantation and Cellular Therapy · 2025-02-01

  article
  PublisherDOI

• On the same (evaluation) page: a novel approach to enhance mixed-methods implementation evaluation

  BMJ Open Quality · 2025-07-01

  articleOpen access

  Quality improvement and implementation science evaluations are often complex mixed methods approaches conducted by interdisciplinary teams. These efforts are challenging in normal circumstances; the COVID-19 pandemic and subsequent shift to remote work have posed additional challenges to this type of work. Novel approaches, tools, and processes may be needed to improve the rigor and cohesion of mixed methods evaluations, especially with a team working remotely.Quality improvement and implementation science evaluations are often complex mixed methods approaches conducted by interdisciplinary teams. These efforts are challenging in normal circumstances; the COVID-19 pandemic and subsequent shift to remote work have posed additional challenges to this type of work. Novel approaches, tools, and processes may be needed to improve the rigor and cohesion of mixed methods evaluations, especially with a team working remotely.Our aim was to create a rigorous evaluation plan for a large hybrid type III implementation-evaluation trial implementing new evidence-based processes at nine medical centers. Given the trial's complexity and a geographically-distributed remotely-working interdisciplinary team, we found that existing tools did not meet our needs. We thus created a novel process for developing a rigorous evaluation plan that others could replicate.This process has seven steps: 1) select a template and identify point person; 2) complete initial development; 3) obtain targeted asynchronous feedback; 4) identify and analyze gaps; 5) conduct targeted virtual synchronous discussion; 6) finalize working document; and 7) apply the plan and solicit ongoing feedback.Interdisciplinary quality improvement and implementation science project teams need tools and processes to ensure clear communication, well-ordered workflow, and rigorous operationalization of evaluation aims. The seven-step evaluation plan tool not only helped to enhance the rigor and execution of a large program evaluation, but the process also served an important convening function to enhance coordination between remote team members. Our work builds on existing processes for evaluation plan development while incorporating team science approaches.

  PublisherOA PDFDOI

• Cognitive Care Planning for Persons Living With Dementia and Their Care Partners: Challenges, Needs, and Questions

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Dementia care partners face high levels of stress, burden, and health risks related to the complex care demands of Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD). They also struggle with coordinating care, locating AD/ADRD resources and support, and managing AD/ADRD behavioral symptoms. Cognitive care planning (CCP) is a dementia care resource that provides care recommendations based on AD/ADRD needs assessments. CCP improves quality of life and overall care management, yet care partners lack ongoing support in implementing these CCPs at home. As dementia progresses and care challenges may escalate, ongoing support, resources, and innovative solutions for older adults living with AD/ADRD and care partners are needed. We aim to develop a tailored AI-based chatbot to support dyads by first exploring potential challenges, needs, and questions dyads encounter when implementing their CCPs in daily life. We recruited older adults living at home with mild cognitive impairment or mild AD/ADRD and their care partners (N = 20 dyads) and dementia care experts (N = 10) from U.S. medical centers and clinics in the Pacific Northwest and the University of Pennsylvania. We conducted semi-structured interviews and will use content analysis to analyze data and report qualitative categories and subcategories denoting common and individualized questions gathered from participants. Findings will be used to inform development of an AI chatbot designed to provide continuous and real-time care support for dyads to improve quality of life, decrease care partner burden, and improve care management.

  PublisherOA PDFDOI

Recent grants

• Epidemiology and Outcomes of Premature Geriatrics Syndromes

  NIH · $882k · 2014–2019

• Measurement Science QUERI Program

  NIH · 2015–2020

• Improving aging in place for older adults living in subsidized housing

  NIH · $853k · 2018–2022

Frequent coauthors

• Gregory Y.H. Lip

  Liverpool Heart and Chest Hospital

  64 shared

• Giuseppe Boriani

  University of Modena and Reggio Emilia

  50 shared

• Michael A. Steinman

  University of California, San Francisco

  50 shared

• Marco Proietti

  Istituti Clinici Scientifici Maugeri

  46 shared

• I. Soldatova

  Liverpool Heart and Chest Hospital

  45 shared

• Francisco Marı́n

  Centro de Investigación Biomédica en Red

  36 shared

• L Rodionova

  University of Liverpool

  34 shared

• Lidija Poposka

  PHI University Psychiatric Clinic - Skopje

  33 shared

Awards & honors

• K76 Beeson Advanced Career Development Award from the NIA
• VA Quality Enhancement Research Initiative (QUERI) grant