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)
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Study Section
Special Emphasis Panel (ZAG1-ZIJ-9 (O2))
Program Officer
Baker, Colin S
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Brown University
Public Health & Prev Medicine
Schools of Public Health
United States
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Zhang, Tingting; Zullo, Andrew R; Shireman, Theresa I et al. (2018) Epidemiology of hip fracture in nursing home residents with multiple sclerosis. Disabil Health J 11:591-597
Rahman, Momotazur; Gadbois, Emily A; Tyler, Denise A et al. (2018) Hospital-Skilled Nursing Facility Collaboration: A Mixed-Methods Approach to Understanding the Effect of Linkage Strategies. Health Serv Res 53:4808-4828
McHugh, John P; Zinn, Jacqueline; Shield, Renee R et al. (2018) Strategy and risk sharing in hospital-postacute care integration. Health Care Manage Rev :
Trivedi, Amal N; Leyva, Bryan; Lee, Yoojin et al. (2018) Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans. N Engl J Med 378:262-269
Silver, Benjamin C; Rahman, Momotazur; Wright, Brad et al. (2018) Effects of Medicare Medical Reviews on Ambiguous Short-Stay Hospital Admissions. Health Serv Res 53:4747-4766
Li, Qijuan; Rahman, Momotazur; Gozalo, Pedro et al. (2018) Regional Variations: The Use Of Hospitals, Home Health, And Skilled Nursing In Traditional Medicare And Medicare Advantage. Health Aff (Millwood) 37:1274-1281
Tyler, Denise A; McHugh, John P; Shield, Renée R et al. (2018) Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay. Health Serv Res 53:4848-4862
Dore, David D; Zullo, Andrew R; Mor, Vincent et al. (2018) Age, Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents. J Am Med Dir Assoc 19:328-332.e2
Berridge, Clara; Tyler, Denise A; Miller, Susan C (2018) Staff Empowerment Practices and CNA Retention: Findings From a Nationally Representative Nursing Home Culture Change Survey. J Appl Gerontol 37:419-434
Thomas, Kali S; Ogarek, Jessica A; Teno, Joan M et al. (2018) Development and Validation of the Nursing Home Minimum Data Set 3.0 Mortality Risk Score (MRS3). J Gerontol A Biol Sci Med Sci :

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