Examples include HIV-related research, including measuring, monitoring, and improving adherence with HIV antiretroviral therapy (ART), and understanding the illness process from the patient perspective. Faculty are also involved in testing interventions to improve ART compliance through economic incentives and to improve physician-patient ART communication.
We have a long history of research influencing end-of-life and palliative care policy and clinical practice, beginning with the original hospice study in the 1980s, which documented the clinical and cost benefits of hospice and led to making hospice a Medicare benefit.
More than a decade of our work documented the futility of feeding tube insertion for nursing home residents with advanced dementia, culminating in a major reduction in their use nationwide. We also documented that palliative care consultation for nursing home residents reduced invasive treatments and improved quality of life and articulated the concept of burdensome transitions at end of life, which is now a metric in evaluating care quality.
We have a particular focus on pragmatic interventional research, with an embedded research center that partners with healthcare providers and others to identify, test, and disseminate innovative practices. The Long-Term Care Quality & Innovation Lab (Q&I) is unique in the nation as a result of its close collaborative relationship with a network of more than 14,000 assisted living communities and nursing homes and its mission to establish the evidence base for promising interventions to improve care for older adults. Q&I studies frequently involve cluster-randomized trials in the nursing home setting.
We are studying disabled and older adults living in the community, their unmet service needs, and health-related consequences. Examples include examining the benefits of long-term support services, meals on wheels, assistive technology, and home modifications as efficient home care resources in promoting independence.
We study organizational behaviors of nursing homes, market demands and incentives, and state and federal policies affecting the provision of nursing home care and its quality. This includes a 10-year (to date) National Institute on Aging program project grant to better understand the impact of changing state Medicaid policies on long-term-care providers and the people they serve. Research under this grant has included documenting large regional variation in hospitalization rates, including end-of-life transitions and the use of hospice and palliative care. We also documented substantial disparities in the care and outcomes that minority nursing home residents experience, largely attributable to the fact that blacks and Hispanic residents are more likely to reside in poor-quality facilities.
A new study linking pharmacy and Medicare data sheds light on pain management regimens for hip fracture patients in rehabilitation, and raises concerns about potentially dangerous drug-drug interactions.