David G. Stevenson, PhD. is an Associate Professor in the Department of Health Care Policy at Harvard Medical School with interdisciplinary training in ethics and health policy and a strong commitment to research in aging and long-term care. His previous work has focused on a broad range of topics in long-term care, including long-term-care financing options for the future, the influence of corporate structure on nursing home care, and the rising use of hospice care among nursing home residents. In the attached resubmission, Dr. Stevenson seeks training and research support through the National Institute on Aging Mentored Research Scientist Development Award (K01) mechanism. In collaboration with his mentors for this award - Drs. Michael Chernew (primary), Rob Huckman, Susan Mitchell, and David Grabowski - Dr. Stevenson has developed a training and research plan to address important gaps in his current knowledge base and to pursue newly- focused research. In particular, the broad goal of his K01 proposal is to gain the theoretical and methodological skills needed to become a national leader on how organizational factors influence the delivery of nursing home care and, importantly, to investigate how these insights might be used to assure, improve, and achieve high quality care. Specific to those goals, in the course of the K01 award, he will obtain further training in organizational analysis and management principles of health care organizations and in more applied dimensions such as the organization and delivery of care in the nursing home, particularly for residents at the end of life. The career development activities consist of a strategy and management component supervised by Dr. Huckman, a clinical and end of life component supervised by Dr. Mitchell, and an overarching data and methods component supervised by Drs. Chernew and Grabowski. As detailed in the proposal, Dr. Stevenson would address some of his deficits in knowledge in the context of formal coursework (e.g., coursework in organizational theory and related research methods) and would address others in the context of more informal, practically-oriented activities (e.g., observing care planning activities at a local nursing home and participating in palliative care grand rounds). The career development award includes a research plan that will enable Dr. Stevenson to apply the knowledge gained in the training activities. As outlined in the proposal, he will rely on a mixed-methods approach to pursue studies in three areas that have particular relevance for the role of organizational factors in shaping nursing home care in the United States: i) the scope and relevance of nursing home chain ownership in the United States; ii) the delivery of hospice care in nursing homes; and iii) the growing role of post-acute care in nursing homes.
Research aims i ncluded in the first, generally-focused area are largely descriptive and will inform research into the other, more applied topics.

Public Health Relevance

With the attached resubmission, I am applying for a National Institute on Aging Mentored Research Scientist Development (K01) Award. The 5-year project is entitled 'Organizational Factors and the Delivery of Nursing Home Care' and focuses on the mechanisms by which organizational or 'chain' factors shape the care delivered to nursing home residents nationally. The research plan focuses on this topic in the context of the increased role of Medicare- financed hospice and post-acute care in the nursing home and is supported by an intensive training plan that has components focused on organizational analyses, clinical care delivery in nursing homes, and data and research methods.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Scientist Development Award - Research & Training (K01)
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Neuroscience of Aging Review Committee (NIA)
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Bhattacharyya, Partha
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Vanderbilt University Medical Center
United States
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Grabowski, David C; Stevenson, David G; Caudry, Daryl J et al. (2017) The Impact of Nursing Home Pay-for-Performance on Quality and Medicare Spending: Results from the Nursing Home Value-Based Purchasing Demonstration. Health Serv Res 52:1387-1408
You, Kai; Li, Yue; Intrator, Orna et al. (2016) Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care? Med Care 54:229-34
Cornell, Portia Y; Grabowski, David C; Cohen, Marc et al. (2016) Medical Underwriting In Long-Term Care Insurance: Market Conditions Limit Options For Higher-Risk Consumers. Health Aff (Millwood) 35:1494-503
Stevenson, David G; Grabowski, David C; Keating, Nancy L et al. (2016) Effect of Ownership on Hospice Service Use: 2005-2011. J Am Geriatr Soc 64:1024-31
Grabowski, David C; Caudry, Daryl J; Dean, Katie M et al. (2015) Integrated Payment And Delivery Models Offer Opportunities And Challenges For Residential Care Facilities. Health Aff (Millwood) 34:1650-6
Orfaly Cadigan, Rebecca; Stevenson, David G; Caudry, Daryl J et al. (2015) Private investment purchase and nursing home financial health. Health Serv Res 50:180-96
Stevenson, David G; Dalton, Jesse B; Grabowski, David C et al. (2015) Nearly half of all Medicare hospice enrollees received care from agencies owned by regional or national chains. Health Aff (Millwood) 34:30-8
Stevenson, David G (2015) The Role of Ownership in Hospice Care: Commentary on Teno et al. J Pain Symptom Manage 50:435
Stevenson, David G; Dusetzina, Stacie B; O'Malley, A James et al. (2014) High-risk medication use by nursing home residents before and after hospitalization. Med Care 52:884-90
Stevenson, David G; O'Malley, A James; Dusetzina, Stacie B et al. (2014) Effect of Part D coverage restrictions for antidepressants, antipsychotics, and cholinesterase inhibitors on related nursing home resident outcomes. J Am Geriatr Soc 62:1666-74

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