Grant Details
Grant Number: |
1R01CA076551-01 Interpret this number |
Primary Investigator: |
Mor, Vincent |
Organization: |
Brown University |
Project Title: |
Clinical Management of Cancer Pain in Us Nursing Homes |
Fiscal Year: |
1998 |
Abstract
As medical care increasingly occurs outside the hospital, nursing homes
serve more and more patients previously treated in hospitals. While
pain management for cancer in hospitals is known to be poor, we have
almost no information about how pain is managed in nursing homes. This
is particularly problematic in light of quality problems that have
plagued the nursing home industry for decades.
We created a data base to address this important problem by merging
several different existing data sources (the 300 item, Minimum Data Set
([MDS] resident assessment; HCFA Medicare claims; HCFA provider files
and detailed drug use data included with MDS data in 5 states
participating in a HCFA demonstration). The proposed study is the first
of its kind to characterize the pharmacologic treatment of cancer pain
in US nursing homes. In addition to examining the types of analgesics
used, their frequency and mode of administration as well as whether they
are prescribed on a prn basis, all analgesics will be converted into
oral morphine equivalents to permit quantitative analysis of the level
of analgesia provided. Descriptive analyses of over 17,000 cancer
patients admitted from hospital to 1537 facilities between 1992 and 1996
will examine both patient and facility level factors affecting analgesia
use and pain control. We will examine the "consequences" or untreated
pain on hospitalization rates. Since the prevalence of cancer patients
varies as a function of facility size and other factors, we will be
applying "state of the art" Bayesian hierarchical models to estimate the
effect of selected facility characteristics on the style and level of
analgesia administration as well as the prevalence of daily pain in the
patient population. Finally, profiles of facilities that prescribe
higher levels of analgesics for advanced cancer patients will be
constructed. The results of this study will make an important
contribution to the current national debate concerning care for dying
patients since over 20 percent of all deaths in the US now occur in
nursing homes and will have direct influence on the development of pain
management protocols for clinical staff working in nursing home
settings.
Publications
Does receipt of hospice care in nursing homes improve the management of pain at the end of life?
Authors: Miller S.C.
, Mor V.
, Wu N.
, Gozalo P.
, Lapane K.
.
Source: Journal of the American Geriatrics Society, 2002 Mar; 50(3), p. 507-15.
PMID: 11943048
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