Research Topics
| Joan TenoSummaryAffiliation: Brown University Country: USA Publications
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Publications
Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009Joan M Teno
Warren Alpert Medical School of Brown University, 121 S Main St, Providence, RI 02912, USA
JAMA 309:470-7. 2013..A recent Centers for Disease Control and Prevention report found that more persons die at home. This has been cited as evidence that persons dying in the United States are using more supportive care...
Does feeding tube insertion and its timing improve survival?Joan M Teno
Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, RI 02912, USA
J Am Geriatr Soc 60:1918-21. 2012..To examine survival with and without a percutaneous endoscopic gastrostomy (PEG) feeding tube using rigorous methods to account for selection bias and to examine whether the timing of feeding tube insertion affected survival...- Feeding tubes and the prevention or healing of pressure ulcersJoan M Teno
Center for Gerontology and Health Care Research, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
Arch Intern Med 172:697-701. 2012..Using national data, we set out to determine whether percutaneous endoscopic gastrostomy (PEG) tubes prevent or help heal pressure ulcers in nursing home (NH) residents with advanced cognitive impairment (ACI)... - It is "too late" or is it? Bereaved family member perceptions of hospice referral when their family member was on hospice for seven days or lessJoan M Teno
Warren Alpert School of Medicine at Brown University, Providence, RI, USA
J Pain Symptom Manage 43:732-8. 2012..Many family members of patients enrolled in hospice for less than seven days state that the hospice referral was made "at the right time.".. - Churning: the association between health care transitions and feeding tube insertion for nursing home residents with advanced cognitive impairmentJoan M Teno
Center for Gerontology and Health Care Research, Department of Community Health, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
J Palliat Med 12:359-62. 2009..The goal of this study was to examine whether regions with higher rates of health care transitions at the end of life are more likely to use feeding tubes in patients with severe cognitive impairment... - Referring a patient and family to high-quality palliative care at the close of life: "We met a new personality... with this level of compassion and empathy"Joan M Teno
Community Health and Medicine, Warren Alpert School of Medicine at Brown University, 2 Stimson Ave, Providence, RI 02912, USA
JAMA 301:651-9. 2009.... 
Bereaved family member perceptions of quality of end-of-life care in U.S. regions with high and low usage of intensive care unit careJoan M Teno
Center for Gerontology and Health Care Research, Brown Medical School, Providence, Rhode Island 02912, USA
J Am Geriatr Soc 53:1905-11. 2005..To compare the quality of end-of-life care of persons dying in regions of differing practice intensity...- Measuring end-of-life care outcomes retrospectivelyJoan M Teno
Brown University and Brown Medical School, Providence, Rhode Island 02912, USA
J Palliat Med 8:S42-9. 2005.... - Cancer patient assessment and reports of excellence: reliability and validity of advanced cancer patient perceptions of the quality of careJoan M Teno
Center for Gerontology and Health Care Research, Brown University School of Medicine, Providence, RI 02912, USA
J Clin Oncol 27:1621-6. 2009..This article describes the validation of new measures of the quality of cancer care at the time of diagnosis and treatment for advanced cancer with life-limiting prognosis... - "You can't always get what you want"--or can you?Joan M Teno
Center for Gerontology and Health Care Research, Brown University and Brown Medical School, Providence, RI, USA
CMAJ 174:643-4. 2006 - Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents?Joan M Teno
Center for Gerontology and Health Care Research, Department of Community Health, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
J Am Geriatr Soc 56:887-90. 2008..To determine whether adoption of Medicaid case mix reimbursement is associated with greater prevalence of feeding tube use in nursing home (NH) residents... - Timing of referral to hospice and quality of care: length of stay and bereaved family members' perceptions of the timing of hospice referralJoan M Teno
The Warren Alpert Medical School of Medicine at Brown University, Providence, Rhode Island 20912, USA
J Pain Symptom Manage 34:120-5. 2007..This perception varies substantially among the participating hospice programs. Future research is needed to understand this variation and how hospice programs are delivering high quality of care despite short length of stay... - Hospital characteristics associated with feeding tube placement in nursing home residents with advanced cognitive impairmentJoan M Teno
Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, 121 S Main St, Providence, RI 02912, USA
JAMA 303:544-50. 2010..Tube-feeding is of questionable benefit for nursing home residents with advanced dementia. Approximately two-thirds of US nursing home residents who are tube fed had their feeding tube inserted during an acute care hospitalization... - Association between advance directives and quality of end-of-life care: a national studyJoan M Teno
Center for Gerontology and Health Care Research, Brown Medical School, Providence, Rhode Island, USA
J Am Geriatr Soc 55:189-94. 2007..To examine the role of advance directives (ADs) 10 years after the Patient Self-Determination Act... - Dying trajectory in the last year of life: does cancer trajectory fit other diseases?J M Teno
Department of Community Health, Center for Gerontology and Health Care Research, Brown University School of Medicine, Providence, Rhode Island, USA
J Palliat Med 4:457-64. 2001..To examine differences in the pattern of functional decline among persons dying of cancer and other leading noncancer causes of death... - Decision-making and outcomes of feeding tube insertion: a five-state studyJoan M Teno
Health Services, Policy, and Practice, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
J Am Geriatr Soc 59:881-6. 2011..To examine family member's perceptions of decision-making and outcomes of feeding tubes... - Development of a brief survey to measure nursing home residents' perceptions of pain managementJoan M Teno
The Warren Alpert Medical School, Brown University, Providence, Rhode Island 02912, USA
J Pain Symptom Manage 36:572-83. 2008..Although there is concern with the low internal consistency, RAPM demonstrates both criterion and construct validity that suggests its potential use in quality improvement efforts... - Daily pain that was excruciating at some time in the previous week: prevalence, characteristics, and outcomes in nursing home residentsJoan M Teno
Department of Community Health, Brown Medical School, Providence, Rhode Island, New York, USA
J Am Geriatr Soc 52:762-7. 2004..To examine the prevalence, correlates, and consequences of nursing home (NH) staff reports of "excruciating" level of pain at some time in the previous week in persons with daily pain reported on the Minimum Data Set (MDS)... - Terminal hospitalizations of nursing home residents: does facility increasing the rate of do not resuscitate orders reduce them?Joan M Teno
The Warren Albert Medical School of Brown University, Providence, Rhode Island, RI 02912, USA
J Pain Symptom Manage 41:1040-7. 2011..Terminal hospitalizations are costly and often avoidable with appropriate advance care planning... - Family perspectives on end-of-life care at the last place of careJoan M Teno
Center for Gerontology and Health Care Research, Brown Medical School, Providence, RI, USA
JAMA 291:88-93. 2004..Over the past century, nursing homes and hospitals increasingly have become the site of death, yet no national studies have examined the adequacy or quality of end-of-life care in institutional settings compared with deaths at home... - Does hospice improve quality of care for persons dying from dementia?Joan M Teno
Department of Community Health, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
J Am Geriatr Soc 59:1531-6. 2011..To examine the effectiveness of hospice services for persons dying from dementia from the perspective of bereaved family members... - Family perspectives on end-of-life care experiences in nursing homesTerrie Wetle
Center for Gerontology and Health Care Research, Brown University, Providence, RI 02912, USA
Gerontologist 45:642-50. 2005..The purpose of this study is to expand knowledge regarding end-of-life care received in nursing homes through the use of narrative interviews with family members close to the decedents... - Vigilant at the end of life: family advocacy in the nursing homeRenee R Shield
Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island 02912, USA
J Palliat Med 13:573-9. 2010..Increasing numbers of Americans die in nursing homes. Little is known about the roles and experiences of family members of persons who die in nursing homes... - Physicians "missing in action": family perspectives on physician and staffing problems in end-of-life care in the nursing homeRenee R Shield
Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island 02912, USA
J Am Geriatr Soc 53:1651-7. 2005..To understand the roles of physicians and staff in nursing homes in relation to end-of-life care through narrative interviews with family members close to a decedent... - Where people die: a multilevel approach to understanding influences on site of death in AmericaAndrea Gruneir
Brown University, USA
Med Care Res Rev 64:351-78. 2007..These results reinforce the importance of both social and structural characteristics in shaping the end-of-life experience... - Home care in the last year of life: family member perceptions of unmet need associated with last place of careAman Nanda
Division of Geriatrics, Rhode Island Hospital, Brown Medical School, 593 Eddy Street, Providence, RI 02903, USA
J Am Med Dir Assoc 11:21-5. 2010..To examine the association of family members' perception about the adequacy of home health services at the last place of care before death... - Preliminary derivation of a Nursing Home Confusion Assessment Method based on data from the Minimum Data SetDavid Dosa
Department of Medicine, Brown University, Providence, Rhode Island, USA
J Am Geriatr Soc 55:1099-105. 2007.... - Hospice enrollment and pain assessment and management in nursing homesSusan C Miller
Department of Community Health, Center for Gerontology and Health Care Research, Brown University School of Medicine, 23 Stimson Street, Providence, RI 02912, USA
J Pain Symptom Manage 26:791-9. 2003..7; 95% CI 0.9, 7.7; P=0.07). Study results suggest that hospice enrollment improves pain assessment and management for nursing home residents; they also document the need for continued improvement of pain management in nursing homes... - Feeding tubes for nursing home residents with advanced dementia: how to approach feeding tube decisionsAna Tuya
Division of Geriatrics, The Warren Alpert Medical School of Brown University, USA
Med Health R I 91:33-4. 2008 - Advancing the science of hospice care: Coalition of Hospices Organized to Investigate Comparative EffectivenessDavid J Casarett
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
Curr Opin Support Palliat Care 6:459-64. 2012..Moreover, they cannot examine the implementation of therapies in real-world settings. Therefore, there is a need for novel, complementary approaches to research in this unique population... - Patient-focused, family-centered end-of-life medical care: views of the guidelines and bereaved family membersJ M Teno
Center for Gerontology and Health Care Research, Brown University, Providence, RI 02912, USA
J Pain Symptom Manage 22:738-51. 2001..A new survey instrument provides a way to incorporate the perspectives of bereaved family members in measuring the quality of end-of-life care... - Perceptions of cost constraints, resource limitations, and rationing in United States intensive care units: results of a national surveyNicholas S Ward
Division of Pulmonary Critical Care, Brown Medical School, Providence, RI, USA
Crit Care Med 36:471-6. 2008..To examine cost constraints, resource limitations, and rationing within U.S. intensive care units (ICUs) as perceived by ICU clinicians and the roles of ICU physician and nurse directors in resource allocation decisions... - Hospice care for patients with dementia: does volume make a difference?Susan C Miller
Center for Gerontology and Health Care Research, Department of Community Health, The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
J Pain Symptom Manage 35:283-91. 2008..Further study is needed to understand the nonintuitive negative association between higher volume and lower satisfaction. This study emphasizes the need for examination of quality outcomes by profit status... - Bereaved family members' evaluation of hospice care: what factors influence overall satisfaction with services?Ramona L Rhodes
The Warren Alpert Medical School of Brown University, Brown University, Providence, RI 02912, USA
J Pain Symptom Manage 35:365-71. 2008..02, CI=1.92-2.13). These four key processes of care appear to significantly influence an "excellent" rating of overall satisfaction with hospice care... - Now is the time to embrace nursing homes as a place of care for dying personsJoan M Teno
J Palliat Med 6:293-6. 2003 - Hispanic language version of the family evaluation of hospice careJason Portenoy
J Pain Symptom Manage 34:459-61. 2007 - African American bereaved family members' perceptions of the quality of hospice care: lessened disparities, but opportunities to improve remainRamona L Rhodes
Center for Gerontology and Health Care Research, Brown Medical School, Providence, RI 02912, USA
J Pain Symptom Manage 34:472-9. 2007.... - Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairmentSusan L Mitchell
Hebrew Rehabilitation Center for Aged Research and Training Institute, Department of Medicine, Beth Israel Deaconess Medical Center, and Division on Aging, Harvard Medical School, Boston, MA 02131, USA
JAMA 290:73-80. 2003..Empiric data and expert opinion suggest that use of feeding tubes is not beneficial for older persons with advanced dementia. Previous research has shown a 10-fold variation in this practice across the United States... - Use of feeding tubes in nursing home residents with severe cognitive impairmentJoan M Teno
JAMA 287:3211-2. 2002 - Driven to tiers: socioeconomic and racial disparities in the quality of nursing home careVincent Mor
Brown University, Providence, RI, USA
Milbank Q 82:227-56. 2004..This article recommends a proactive policy stance to mitigate these consequences of quality competition... - Hospice and palliative care in nursing homesSusan C Miller
Center for Gerontology and Health Care Research, Brown University School of Medicine, 2 Stimson Street, Providence, RI 02912, USA
Clin Geriatr Med 20:717-34, vii. 2004..It is suggested that a stronger physician presence and oversight of physicians knowledgeable in palliative care in nursing homes are needed to improve the quality of end-of-life care in nursing homes... - Ameliorating pain in nursing homes: a collaborative quality-improvement projectRosa R Baier
Department of Community Health, Brown University, Providence, Rhode Island, USA
J Am Geriatr Soc 52:1988-95. 2004..To evaluate a multifaceted intervention to improve pain-management processes of care and outcomes in nursing homes... - A national study of the location of death for older persons with dementiaSusan L Mitchell
Hebrew Rehabilitation Center for Aged Research and Training Institute, Boston, Massachusetts 02131, USA
J Am Geriatr Soc 53:299-305. 2005..To describe where older Americans with dementia die and to compare the state health system factors related to the location of dementia-related deaths with those of cancer and all other conditions in this population... - Medical care inconsistent with patients' treatment goals: association with 1-year Medicare resource use and survivalJoan M Teno
Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island, USA
J Am Geriatr Soc 50:496-500. 2002..Such discord was associated with higher 1-year healthcare costs and increased survival... - Palliative care needs of cancer patients in U.S. nursing homesVanessa M P Johnson
Oncology and Hematology Associates, New London, Connecticut, USA
J Palliat Med 8:273-9. 2005..5% had parenteral and/or tube feedings for nutrition. Approximately, 1 in 10 New Hampshire residents had advanced cancer. CONCLUSION: Our findings suggest important opportunities to improve the quality of cancer care for older adults... - Rules to use and rules to lose for pain management in the long-term care settingJoan M Teno
Brown Medical School, Providence, RI 02912, USA
Med Health R I 88:110-4. 2005 - End-of-life care in black and white: race matters for medical care of dying patients and their familiesLisa C Welch
Department of Community Health, Brown Medical School, Providence, Rhode Island, USA
J Am Geriatr Soc 53:1145-53. 2005..Results also suggest different home care patterns and levels of financial impact... - Late referral to hospice and bereaved family member perception of quality of end-of-life careErica R Schockett
Center for Gerontology and Health Care Research, and Department of Community Health, Brown Medical School, Providence, Rhode Island, USA
J Pain Symptom Manage 30:400-7. 2005..These results indicate a need for improved services for shorter-stay hospice patients/families and for physicians to help facilitate earlier hospice admission... - Access to hospice for African Americans: are they informed about the option of hospice?Ramona L Rhodes
Center for Gerontology and Health Care Research, Brown University, Providence, 02912, USA
J Palliat Med 9:268-72. 2006..To examine whether African Americans are informed about hospice services, and to examine demographic or disease factors that may influence receipt of information about hospice... - Transitions of care and changes in distressing painPeter C Trask
Centers for Behavioral and Preventive Medicine, Brown University Medical School The Miriam Hospital, Providence, Rhode Island 02903, USA
J Pain Symptom Manage 32:104-9. 2006..Increased attention is needed not only on how to adequately manage pain and pain-related distress but also on how to improve pain reduction measures in transitions between health care settings at the end of life... - Advanced dementia research in the nursing home: the CASCADE studySusan L Mitchell
Hebrew Senior Life Institute for Aging Research, Department of Medicine of Beth Israel Deaconess Medical Center, Boston, MA, USA
Alzheimer Dis Assoc Disord 20:166-75. 2006..The CASCADE experience establishes the feasibility of conducting rigorous, multisite dementia NH research, and the described methodology serves as a detailed reference for subsequent CASCADE publications as results from the study emerge... - Decisions to forgo hospitalization in advanced dementia: a nationwide studySusan L Mitchell
Hebrew SeniorLife, Institute for Aging Research and Beth Israel Deaconess Medical Center, Boston, Massachusetts 02131, USA
J Am Geriatr Soc 55:432-8. 2007..To examine the prevalence and factors associated with decisions to forgo hospitalization in nursing home (NH) residents with advanced dementia... - Hospice care for patients with dementiaSusan L Mitchell
Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts 02131, USA
J Pain Symptom Manage 34:7-16. 2007..These data suggest that the evaluation of hospice care for older patients is generally high, and does not vary with respect to terminal diagnoses... - Factors associated with site of death: a national study of where people dieSherry Weitzen
Center for Gerontology and Health Services Research, Providence, RI 02912, USA
Med Care 41:323-35. 2003..Recent public attention has focused on quality of care for the dying. Where one dies is an important individual and public health concern... - Do-not-resuscitate orders and hospitalization of nursing home residents: trumping, neglect, or shared decision-making at the eleventh hourJoan M Teno
J Am Geriatr Soc 52:159-60. 2004 - Resurrecting treatment histories of dead patientsJoan M Teno
JAMA 293:1591; author reply 1592. 2005 - Palliative care teams: self-reflection - past, present, and futureJoan M Teno
J Pain Symptom Manage 23:94-5. 2002
Research Grants
- Feeding Tube Use Among Persons with Advanced DementiaJoan Teno; Fiscal Year: 2007..Knowledge gained will be used to inform public policy and formulate facility interventions to ensure that FT insertion in persons with severe cognitive impairment is ethically appropriate. ..
- Multifaceted Interventions to Ameliorate Pain/SymptomsJoan Teno; Fiscal Year: 2005....
- Cancer Assessments and Reports of End-of-Life TreatmentJoan Teno; Fiscal Year: 2005..Such tools will allow institutions to measure whether cancer care is meeting patient and family members' needs and expectations. ..
- RESIDENT ASSESSMENT OF PAIN MANAGEMENT (RAPM)Joan Teno; Fiscal Year: 2001..abstract_text> ..
- Family Evaluation of Hospice CareJoan M Teno; Fiscal Year: 2010..This grant will create two surveys and modify the core surveys that will help hospices in monitoring and improving their quality of care. ..