In response to changing policies and market conditions, hospitals must make decisions about how to staff the role of the attending physician since this individual plays a pivotal role in coordinating patient care, including timely and safe discharges that avoid hospital readmission. In 2013, hospitals are now penalized for higher than expected 30-day readmissions rates. In this application, we propose to study 3 paradigmatic illness trajectories among NH residents with severe functional impairment in order to understand how hospitals choose to staff the attending physician role: 1) dementia with advance cognitive;2) end organ dysfunction from CHF;and 3) hospitalized NH residents with pneumonia with pre-existing severe functional impairment. Dementia is a paradigmatic illness with prolonged severe functional impairment where medical treatment decisions must weigh quantity vs. quality of life. The latter two cohorts challenge health care providers to coordinate care across health care settings to avoid hospital readmissions and to make decisions with the patient and/or family regarding the goals of care. Using the MDS and Medicare claims data from 2000 to 2014, we propose to characterize hospitals'decisions to staff the role of the attending physician (Aim I) and examine the impact of those decisions on clinical outcome and health care utilization experienced by frail elderly, NH residents (Aim II). As of 2013, hospitals are faced with penalties for having a higher than expected 30 day re-hospitalization rates for patients with acute myocardial infarction, congestive heart failure, and pneumonia.
Our third aim i s to estimate the intended and potential unintended consequence of this new policy. A final fourth aim proposes to conduct 8 case studies to understand how hospitals with higher and lower rates of 30-day readmission organize physician services and coordinate care with the NH medical staff to provide high quality of care for each of these 3 proposed cohorts of frail, older persons. The proposed research will provide policy relevant information to examine observed dramatic changes in characteristics and hospital staffing the role of the attending physician as well as evaluate the impact of ACA penalties for hospitals with higher rates of 30 days hospital readmissions.

Public Health Relevance

Increasingly, the US Health Care system will need to provide medical care for an aging population, many now with chronic illness with progressive functional decline. The goal of this research is to study how American hospitals in response to changing policies and market conditions staff the role of the attending physician and how those choices affect clinical outcomes and health care utilization.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZAG1-ZIJ-3 (01))
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Brown University
United States
Zip Code
Rahman, Momotazur; Foster, Andrew D (2015) Racial segregation and quality of care disparity in US nursing homes. J Health Econ 39:16-Jan
Rahman, Momotazur; Tyler, Denise; Thomas, Kali S et al. (2015) Higher Medicare SNF care utilization by dual-eligible beneficiaries: can Medicaid long-term care policies be the answer? Health Serv Res 50:161-79
Teno, Joan; Meltzer, David O; Mitchell, Susan L et al. (2014) Type of attending physician influenced feeding tube insertions for hospitalized elderly people with severe dementia. Health Aff (Millwood) 33:675-82
Clark, Melissa A; Roman, Anthony; Rogers, Michelle L et al. (2014) Surveying multiple health professional team members within institutional settings: an example from the nursing home industry. Eval Health Prof 37:287-313
Miller, Susan C; Lepore, Michael; Lima, Julie C et al. (2014) Does the introduction of nursing home culture change practices improve quality? J Am Geriatr Soc 62:1675-82
Rahman, Momotazur; Grabowski, David C; Gozalo, Pedro L et al. (2014) Are dual eligibles admitted to poorer quality skilled nursing facilities? Health Serv Res 49:798-817
Thomas, Kali S; Wysocki, Andrea; Intrator, Orna et al. (2014) Finding Gertrude: The resident's voice in Minimum Data Set 3.0. J Am Med Dir Assoc 15:802-6
Schneider, Julie M; McMahon, Catherine M; Gopinath, Bamini et al. (2014) Dual sensory impairment and hearing aid use among clients attending low-vision services in Australia: the vision-hearing project. J Aging Health 26:231-49
Thomas, Kali S (2014) The relationship between older Americans act in-home services and low-care residents in nursing homes. J Aging Health 26:250-60
Fulton, Ana Tuya; Gozalo, Pedro; Mitchell, Susan L et al. (2014) Intensive care utilization among nursing home residents with advanced cognitive and severe functional impairment. J Palliat Med 17:313-7

Showing the most recent 10 out of 65 publications