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Case Western Reserve University, Cleveland OH

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Abstract

The proposed Self-Management Advancement through Research and Translation (SMART) Center is supported by a strong interprofessional group of researchers with programs of research and expertise in selfmanagement science across several levels of systems: individual, family, organization, and community. The aims of the SMART Center are: (1) Expand knowledge related to self-management through coordinated, interdisciplinary investigations of self-management in the context of the individual, family, organization, and community; (2) Serve as a national leader in research and dissemination of research findings to the scientific community to expand knowledge related to self-management and provide new directions for research; (3) Diffuse knowledge into clinical practice and policy to enhance the use of self-management strategies to improve the health, function and quality of life of individuals. The SMART Center will prepare a critical mass of researchers to extend and diffuse this knowledge, contribute to the development of emerging biobehavioral research methods, focus on critical issues related to health disparities, and incorporate economic considerations as part of their research. A clear need exists for a center of excellence in self-management. Although there is increasing support for the effectiveness of self-management interventions,13"17 a number of recent Cochrane reviews indicate that that evidence is still insufficient. 1 The SMART Center is innovative in several ways. First, moving beyond the traditional model of selfmanagement intervention research that focuses on the individual or family level, the SMART Center will emphasize the development of self-management knowledge at four system levels: individual, family, organization, community. This perspective will promote added focus on the organization and community factors that influence the practice of self-management activities by individuals and families. Our view is that knowledge developed taking into account these broader contexts will have easier and faster translation into practice due to increased external validity.22'23 Examples of these intervention-testing contexts are setting-level and community factors that provide information about the influence of amount of available resources, level of expertise required, time available, competing demands and commitment to the intervention. Another innovative feature of the SMART Center is our conscious decision not to replicate infrastructure support services provided in other funded Centers in the University. Thus, we have formed targeted strategic alliances with key existing Centers within the University that have research and translation services to support the mission of the SMART Center. Our colleagues in these centers have embraced this philosophy of freely sharing resources across centers. As a result, we have included unique services in the SMART Center that will be shared with the other campus centers, such as offering consultation in item response theory (IRT) and its applications to support the national NIH PROMIS initiative and a research mentor training program. Lastly, the SMART Center will provide ample access to the services of a health economist to encourage every Center investigator to include health economic considerations at the development phase of every project.