The National Institute on Aging has awarded $10 million to Brown University’s Center for Gerontology and Health Care Research to create a major national database that allows researchers to study the impact of state policies and market forces on long-term care.
The five-year project will be spearheaded by Vincent Mor, chairman of the Department of Community Health at Brown and a nationally recognized expert in this field.
Mor and his team will build a database that combines existing federal data on Medicare reimbursement claims, patient hospitalization rates and other data, then adds new information they gather on the health status of residents, how services are paid for, organized and delivered, etc., drawing from a random sample of 2,600 nursing homes across the country.
In addition, the team will collect information on relevant policies from all 50 states – laws that govern reimbursements and patients’ rights, for example.
The goal is twofold, Mor said: To build on the Brown center’s own extensive research on long-term care, best practices and public policy, and to provide a resource for other researchers to conduct their own analyses.
“At the end of this project, we’ll have the single-most comprehensive data set on long-term care in the United States,” Mor said in a news release. “This storehouse of data will be used, ultimately, to shape policies that improve the health of older Americans.”
The foundation for the database already exists, Mor said in an interview. He and his team have pulled together Medicare data from 1999 to 2004, and with the grant, they will be able to add data through 2009, he said, “so we’ll have 11 years of information.”
Much of the nursing home information that will complement the Medicare data is highly confidential, Mor said, but the Brown team will aggregate it so it can be used to conduct analyses at the facility level, the area-market level, and the state level, as well as nationally.
“In three years or so, anybody will be able to go to our Web site and begin downloading data to ask their own questions,” he said.
The stakes are high in this research. More than 1.4 million Americans live in nursing homes today, and by 2020, an estimated 12 million elderly people in the United States will need some form of long-term care – whether it’s in a nursing home, an assisted-living facility, a chronic-care hospital, or at home, through a visiting nurse or aide service.
Mor’s team will work on four projects:
• A look at how state policies and regional differences in treatment affect the frequency with which residents in long-term care settings are hospitalized.
• A look at the effects of racial segregation on nursing home quality of care.
• A look at the policy and market forces that dictate the organization of medical staff support in nursing homes.
• A look at how state policies change over a 10-year period and how those changes affect the use of hospice and other forms of palliative care.
Some of the issues to be looked at are concrete. For example, Mor noted that some states require nursing homes to hold a bed for any resident who is hospitalized, and they will even pay the homes to hold the beds. Mor has done analyses using 2000 data, and he found a correlation between such policies and substantially higher hospitalization rates.
“That has big implications, because it looks like even people who don’t stay for a long time in a nursing home are affected by these policies,” he said. “And there are literally a dozen other policies that you could do that [analysis] for.”
“We want to be sure that the elderly are getting the best care possible,” said Terrie “Fox” Wetle, associate dean of medicine for public health and public policy at Brown and a lead investigator on the project, in a statement. “One way to do that is to craft sound state policies, policies based on real, reliable data on reimbursement rates, staffing patterns and other factors that directly affect long-term care quality.”
In a Brown news release, John Haaga, deputy director of the Behavioral and Social Research Program at the National Institute on Aging, said that when Brown’s database is complete in 2012, it will be the first to track nursing home performance and policy on a state level for all 50 states. The project’s ambitious nature is just one reason it was funded, Haaga said.
“This is strong science led by first-class researchers,” Haaga said, “and the public should see the benefits from this project not in 20 years, but in five. This policy-relevant research goes directly to the institute’s mission to support science that can inform our decisions about an aging society.” •
