As medical care increasingly occurs outside the hospital, nursing homes serve more and more patients previously treated in hospitals. While pain management for cancer in hospitals is known to be poor, we have almost no information about how pain is managed in nursing homes. This is particularly problematic in light of quality problems that have plagued the nursing home industry for decades. We created a data base to address this important problem by merging several different existing data sources (the 300 item, Minimum Data Set ([MDS] resident assessment; HCFA Medicare claims; HCFA provider files and detailed drug use data included with MDS data in 5 states participating in a HCFA demonstration). The proposed study is the first of its kind to characterize the pharmacologic treatment of cancer pain in US nursing homes. In addition to examining the types of analgesics used, their frequency and mode of administration as well as whether they are prescribed on a prn basis, all analgesics will be converted into oral morphine equivalents to permit quantitative analysis of the level of analgesia provided. Descriptive analyses of over 17,000 cancer patients admitted from hospital to 1537 facilities between 1992 and 1996 will examine both patient and facility level factors affecting analgesia use and pain control. We will examine the """"""""consequences"""""""" or untreated pain on hospitalization rates. Since the prevalence of cancer patients varies as a function of facility size and other factors, we will be applying """"""""state of the art"""""""" Bayesian hierarchical models to estimate the effect of selected facility characteristics on the style and level of analgesia administration as well as the prevalence of daily pain in the patient population. Finally, profiles of facilities that prescribe higher levels of analgesics for advanced cancer patients will be constructed. The results of this study will make an important contribution to the current national debate concerning care for dying patients since over 20 percent of all deaths in the US now occur in nursing homes and will have direct influence on the development of pain management protocols for clinical staff working in nursing home settings.
| Miller, Susan C; Mor, Vincent; Wu, Ning et al. (2002) Does receipt of hospice care in nursing homes improve the management of pain at the end of life? J Am Geriatr Soc 50:507-15 |
