America faces a crisis with the impending demand for long term care services by the """"""""Baby Boom"""""""" generation that will overwhelm current financing and delivery mechanisms. Although largely governmentally funded via Medicaid/Medicare, the privately operated component of the long term care industry is responsive to competitive market forces. The long term care industry -- nursing homes, home health agencies, assisted living and various forms of day care programming - has evolved in response to rising consumer demand, financing and regulatory policy changes. The proposed Program Project will examine the policies and market forces that influence the strategic choices of long term care providers as well as the outcomes the target population experiences. Building on two decades of research examining outcomes experienced by nursing home residents, faculty from the Brown University Center for Gerontology and Health Care Research in conjunction with colleagues at Dartmouth College and the University of Rochester propose to study the effects state and federal policies, as well as local market forces, have on the long term care industry. The proposed LTC P01 represents the """"""""culmination"""""""" of years of research establishing the viability of working with secondary data, merged with various sources of primary data, to test the impact of changing state policies and market forces. We will build a data infrastructure to serve the four (4) projects proposed that characterizes the structure, functioning and quality of care of nursing homes and will make the resulting data available to the research community. The overall objectives of the program project are to: 1. Build a long term care data and policy repository and analysis infrastructure as the basis for currently proposed and future projects examining the nation's long term care """"""""system"""""""";2. Implement a survey of states'policies and a national sample of nursing homes, integrating them with secondary data to serve the proposed research projects;3. Integrate economic and organizational theory to develop measures and to propose testable hypotheses in the proposed projects focusing on providers'responses to market and policy changes;4. Systematically catalogue and broadly disseminate to numerous audiences project findings by academic publications, promoting (via a web-site providing access to state policy, market and """"""""de-identified"""""""" provider data for use by researchers and policy analysts. Lay Summary: This program project will examine the influence state policies have on the behavior and functioning of US nursing homes and the outcomes their patients experience.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZAG1-ZIJ-9 (O2))
Program Officer
Baker, Colin S
Project Start
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Support Year
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Brown University
Public Health & Prev Medicine
Schools of Public Health
United States
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Keohane, Laura M; Trivedi, Amal N; Mor, Vincent (2017) Recent Health Care Use and Medicaid Entry of Medicare Beneficiaries. Gerontologist 57:977-986
Thomas, Kali S; Baier, Rosa; Kosar, Cyrus et al. (2017) Individualized Music Program is Associated with Improved Outcomes for U.S. Nursing Home Residents with Dementia. Am J Geriatr Psychiatry 25:931-938
Keohane, Laura M; Grebla, Regina C; Rahman, Momotazur et al. (2017) First-dollar cost-sharing for skilled nursing facility care in medicare advantage plans. BMC Health Serv Res 17:611
Kosar, Cyrus M; Thomas, Kali S; Inouye, Sharon K et al. (2017) Delirium During Postacute Nursing Home Admission and Risk for Adverse Outcomes. J Am Geriatr Soc 65:1470-1475
Dore, David D; Zullo, Andrew R; Mor, Vincent et al. (2017) Age, Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents. J Am Med Dir Assoc :
Li, Qijuan; Keohane, Laura M; Thomas, Kali et al. (2017) Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees. JAMA Intern Med 177:1012-1018
Ankuda, Claire K; Mitchell, Susan L; Gozalo, Pedro et al. (2017) Association of Physician Specialty with Hospice Referral for Hospitalized Nursing Home Patients with Advanced Dementia. J Am Geriatr Soc 65:1784-1788
Berry, Sarah D; Zullo, Andrew R; Lee, Yoojin et al. (2017) Fracture Risk Assessment in Long-term Care (FRAiL): Development and Validation of a Prediction Model. J Gerontol A Biol Sci Med Sci :
Teno, Joan M; Gozalo, Pedro L; Trivedi, Amal N et al. (2017) Temporal Trends in the Numbers of Skilled Nursing Facility Specialists From 2007 Through 2014. JAMA Intern Med 177:1376-1378
Winblad, Ulrika; Mor, Vincent; McHugh, John P et al. (2017) ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals. Health Aff (Millwood) 36:67-73

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