This application proposes a 5 year career development and research plan to support the candidate's acquisition of the knowledge and research skills needed to become an independent investigator in patient- oriented aging research. The career development plan designed by the candidate and her mentors is tailored to acknowledge the special skills, experiences, and relationships needed to build a research career focused in the nursing home setting. The training plan includes formal coursework to earn a Master's Degree in Clinical Research through the Indiana University Clinical Investigation and Translational Education (CITE) program, as well as extramural training activities to obtain additional expertise in palliative care and nursing home practice. The proposed research project, "Delivering Hospice and Palliative Care Services to Nursing Home Patients," will be conducted in partnership with a large multi-state hospice and palliative care provider, Seasons Hospice. We have access to the detailed patient care records of over 50,000 hospice patients enrolled from 2006-2012, as well as about 1,000 non-hospice palliative care consult patients. Nearly 1/3 of both the hospice patients and the palliative care consult patients in this database lived in nursing homes. The hospice records are linked to the Family Evaluation of Hospice Care survey results, which provide information related to perceived quality of care in multiple domains. Despite the tremendous growth that has occurred in the use of hospice care, there have been few studies of the actual services delivered to patients, including the mix of providers involved and the intensity of services over the course of the hospice episode. The ways in which the package of services received varies among patients with differing hospice diagnoses, or who live in their homes vs. nursing homes, are not well described. Further, there is a population of nursing home patients with palliative care needs who do not meet hospice eligibility criteria. Outside palliative care consultation is available in some markets but has only been anecdotally described.
The specific aims of the project, outlined below, are designed to fill these gaps: 1) Provide a modern description of the specific hospice services received by nursing home patients, including the overall number and duration of visits by individual hospice professionals and volunteers;2) Compare the volume of services received by hospice patients living in a nursing home versus those at home and correlate services with patient outcomes;and 3) Examine the characteristics of nursing home patients who received non-hospice palliative care consults and the content of recommendations provided by consultants, including eventual referral to hospice. In summary, the Beeson Career Development Award will provide critical support for me in my transition to independent investigator, as I build expertise through practical experiences and mentorship in nursing home care, palliative care, and hospice, as well as strengthen my foundation in key research skills through a rigorous program of formal coursework. In addition to the analyses possible through access to this clinical database, partnership with a large, national hospice provider will support future patient-oriented original data collection.
Nearly 1/3 of hospice patients live in nursing homes, yet the fit of the Medicare hospice benefit for this population has been questioned. There are gaps in the evidence base surrounding current provision of hospice care to different populations and a need to explore alternative models to provide palliative care services outside of hospice. The goal of this research is to contribute to the understanding of these issues through: 1) describing specific hospice services received by nursing home patients;2) comparing volume of services received by hospice patients living in different settings and how this correlates with patient outcomes and quality;and 3) an examination of the characteristics of nursing home patients who received non-hospice palliative care consults and the content of recommendations provided by consultants.