Pain &Pain Management in a Medicaid Waiver Program

Byma, Beth

Abstract

Changes made to the previously submitted abstract are bracketed in the following. Poor, older adults are a vulnerable population at increased risk for [cancer], pain, poor pain management and pain management outcomes. Older adults are more likely to develop cancer and have it diagnosed at a later stage, when pain is more likely. Research has not examined the differences in pain, pain management and [pain management] outcomes between persons with and without a diagnosis of cancer among Medicaid-enrolled, older adults participating in Home and Community-Based Waiver programs (HCBWP). Additionally, no research has explored the negative effect that pain and cancer may have on the transfer of HCBWP participants to nursing homes. As HCBWP are used as an alternative to nursing home care, research that examines [cancer, pain, pain management and pain management outcomes] is vitally important in order to determine if waiver programs are truly effective in meeting the needs of participants while allowing them to remain in the community. The overall objective of the proposed research is to increase knowledge regarding pain, pain management, and pain management outcomes in HCBWP, while comparing those with and without a diagnosis of cancer. [A secondary, exploratory objective is to examine if pain, pain management, and pain management outcomes among older adult HCBWP participants with and without cancer is associated with the transition of older adult HCBWP participants to a nursing home]. The proposed research will be a secondary analysis of data from the Minimum Data Set Home Care (MDS-HC), the State of Michigan Cancer Surveillance Data and Michigan Medicaid paid claims files, and will be of a longitudinal design. Generalized Estimating Equations, logistic regression and survival analysis methods will be used to test hypotheses generated from study aims.
Aim 1 is to explore differences, overtime, in pain between HCBWP participants with and without a diagnosis of cancer among waiver participants.
Aim 2 is to compare, overtime, how pain relates to pain management strategies, pain control and physical function among HCBWP participants and how this relationship differs among those with and without a diagnosis of cancer. [An exploratory analysis will be done to determine if differences exist in the transition of HCBWP participants to nursing homes between HCBWP participants with and without a diagnosis of cancer and what effect pain, pain management and pain management outcomes have on this transition]. The proposed research builds on the applicant's doctoral program foci and will provide a foundation for her future as a nurse researcher, focusing on pain and pain management and pain management outcomes.

Public Health Relevance

Issues related to long-term care for older-adults will become increasingly important as the percentage of the population above 65 continues to rise. The proposed research addresses two National Nursing Research Agenda (NNRA) research priorities: long-term care for older adults and symptom management for pain.