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Deb Mack, Ph.D., receives TL-1 Postdoctoral Fellowship Training Grant

Newly completed doctoral student, Deborah Mack PhD, received a TL-1 Postdoctoral Fellowship Training Grant for her study entitled “Use of medications with questionable benefits and known risks among US nursing home residents with life-limiting Illness.”
With an aging population, nursing homes are an increasingly important part of the health care system. Four of ten US adults who reach age 65 years will enter a nursing home at least once during their lifetime.13 Overuse of healthcare services including polypharmacy may be more likely among those near the end-of-life. Operational definitions for life-limiting illness to identify those near the end-of-life have not been defined nor validated for the nursing home population. Furthermore, we do not know the true prevalence of those with life-limiting illness in the nursing home nor do we know the association between life-limiting illness and potential overuse of healthcare treatment including polypharmacy.
The goal of this study is to develop understanding of life-limiting illness in US nursing homes residents and skilled nursing facilities (SNF). Administrative data from the US Centers for Medicare and Medicaid Services (CMS) will be employed to evaluate Medicare Fee-For-Service Beneficiaries living in US nursing homes from 2011-2016.
The specific aims are to:
1. Define, validate, and estimate the prevalence of life-limiting illness for nursing home residents and older adults with a Skilled Nursing Facility (SNF) stay
2. Evaluate the association between potentially unnecessary medications and health outcomes among long stay nursing home residents with life-limiting illness and for those immediately prior to death
3. Examine the prevalence of medication use with questionable benefits and known risks after a SNF stay for those with life-limiting illness

CMS databases used in this study include: individual-level data on health information and clinical functioning (the Minimum Data Set (MDS) 3.0), inpatient and drug Medicare claims (Medicare Parts A and D), and facility-level characteristics (CASPER). Advanced statistical methods are employed to evaluate life-limiting illness among nursing home residents and those with a recent SNF stay.
The MDS 3.0 will be merged to Medicare Part A claims, Medicare Part D claims, and facility-level data. Descriptive statistics will guide our analytic decisions including informing the parameterization of variables, model appropriateness via evaluating violations of model assumptions, and interpreting results. This statistical approach includes the implementation of prediction modeling analytic techniques (Aim 1), causal inference modeling (Aim 2), and longitudinal analyses of medication use (Aim 3).
We hypothesize that life-limiting illness will not preclude polypharmacy or excessive medical treatment.