"A major challenge is how to integrate hospice into regular medical care."
By Natalie Villacorta Contributing Writer
Vincent Mor, a member of Home & Hospice Care of Rhode Island’s board of directors, was recently awarded the National Hospice and Palliative Care Organization’s 2013 Distinguished Researcher Award. He has been on the board since 2009 and also is a professor of medical science, health services, policy & practice at Brown University. Home & Hospice is the major teaching affiliate for hospice and palliative medicine of The Warren Alpert Medical School of Brown University. Mor tells PBN about his research and how the field of hospice and palliative care has changed over the course of his career.
PBN: What was the National Hospice Study that you oversaw in the mid-1980s? What did you find?
MOR: We studied people from all over the country – 36 different hospices and 10 different cancer centers. Most people who were getting hospice at the time were cancer patients, so that’s who we studied.
The findings from that study were hospice patients were getting care that was comparable in terms of patients’ experience with pain and quality of life, as compared to patients that were getting treated in a caner center, but their families were more satisfied and they were more likely to die at home. Their costs were also lower, as long as patients didn’t start hospice very early. The study showed and supported the importance of allowing hospice as an option at the end of life for Medicare beneficiaries.
PBN: What research have you done more recently?
MOR: Following the National Hospice Study, I studied why it is that older patients were not getting the same level of treatment as young patients and how much of that was bias and how much was that they were not well enough to sustain the therapies. A lot of what we found was attributable to bias.
For the last 10-15 years or so I’ve been doing a lot of work looking at the quality of care in long-term care, in both nursing homes as well as home care. We’ve specifically looked at how different state Medicaid policies influence the way in which patients experience care – what kinds of services they receive and the outcomes they experience.
A lot of the policy research we’ve done strongly points to these conflicts—that Medicare and Medicaid engender different incentives in providers and those incentives are in conflict. Medicare and Medicaid might want to rationalize their polices, as opposed to each running their programs independently.
PBN: What has changed over your time in the field?
MOR: When I started there wasn’t such a field, so that’s a big, big change. So for example, hospice initially emerged as a reaction to President Nixon’s war on cancer. At the time, people were developing stronger and stronger drugs to treat cancer and they were trying them on patients who were very sick and close to death. Some staff and patients said that’s not the way to die. So hospice emerged as a reaction to that.
So now, something like 40 percent of all Medicare beneficiaries who die in the course of a given year are exposed to hospice. It’s a massive change.
PBN: What are the challenges currently facing your field?
MOR: A major challenge not is how to integrate hospice into regular medical care.
Here at Home and Hospice Care of Rhode Island, around 30 percent of the patients who enter hospice are dead within three or four days because they come so late. Same issue that we found in 1980. People don’t have these discussions early enough. Unfortunately, hospice is sort of an either or, it doesn’t have to be either or, it should be more seamless. Before the challenge was that hospice didn’t exist, now the challenge is having it formulated, used, and thought about in a different way.
PBN: What’s something exciting that’s happening in the field?
MOR: Medical students are now exposed to palliative care as an idea. For example, Brown medical school has a palliative are fellowship program. In 1978, when my mother died in Georgetown University Medical Center on the general ward, there was no knowledge of this. The nurses ran away and kept dying patients at the end of the hall.
Now training and exposure to these kinds of issues is happening much more. As the population ages, more and more doctor will be exposed to this. There are huge changes that have occurred that are very positive.