Joan M. Teno
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View article: Predicting Mortality and Costs After Emergency Department Visits by People With Dementia: Timing and Location Matter
Predicting Mortality and Costs After Emergency Department Visits by People With Dementia: Timing and Location Matter Open
Background People with dementia have high rates of emergency department (ED) and hospital utilization, high mortality and costs, and other poor outcomes. To successfully impact the care trajectories of these patients, health care systems m…
View article: A Multilevel Analysis of Determinants of Dying in Place among Assisted Living Residents
A Multilevel Analysis of Determinants of Dying in Place among Assisted Living Residents Open
Many older adults residing in assisted living (AL) consider this setting their home; yet, there is limited evidence about determinants of their ability to die in place, with state regulations explaining only some variation in this outcome.…
View article: Association of Reported Collaboration Quality with Hospice Providers and Hospice Utilization in Assisted Living
Association of Reported Collaboration Quality with Hospice Providers and Hospice Utilization in Assisted Living Open
Hospice is crucial in meeting the increasing care needs of dying residents in assisted living (AL) and supporting dying in place. We know little about how AL-hospice collaboration relates to staying in AL at the end of life. We conducted a…
View article: Bereaved Next-of-Kin Narratives about Hospice Care in Assisted Living
Bereaved Next-of-Kin Narratives about Hospice Care in Assisted Living Open
There is limited evidence about the quality of end-of-life care provided in assisted living (AL), especially as related to various community-level care processes supporting dying in place. This study aimed to explore narratives of bereaved…
View article: Benzodiazepine or Antipsychotic Use and Mortality Risk Among Patients With Dementia in Hospice Care
Benzodiazepine or Antipsychotic Use and Mortality Risk Among Patients With Dementia in Hospice Care Open
Importance Benzodiazepines and antipsychotics are frequently prescribed for symptom management in patients with Alzheimer disease and related dementias (ADRD) receiving hospice care, yet evidence guiding their safety and effectiveness is l…
View article: Identifying Gaps in Care Quality for Seriously Ill Medicare Advantage Enrollees
Identifying Gaps in Care Quality for Seriously Ill Medicare Advantage Enrollees Open
Objectives: Increasingly, seriously ill Americans are ensured by Medicare Advantage (MA). However, standardized assessments of MA care quality do not highlight their unique experiences and needs. We adapted a previously validated survey to…
View article: Psychometric Properties of Patient‐Reported Quality Measures for Community‐Based Serious Illness Care
Psychometric Properties of Patient‐Reported Quality Measures for Community‐Based Serious Illness Care Open
Objective Quality measures from the Serious Illness Survey for Home‐based Programs have been endorsed by the Centers for Medicare & Medicaid Services's consensus‐based entity for use in initiatives to promote quality improvement and accoun…
View article: END-OF-LIFE CARE PROCESSES IN ASSISTED LIVING COMMUNITIES SPECIALIZING IN MEMORY CARE
END-OF-LIFE CARE PROCESSES IN ASSISTED LIVING COMMUNITIES SPECIALIZING IN MEMORY CARE Open
Assisted living (AL) is a common site of death. Many AL communities offer specialized memory care (MC), yet we know little about how their end-of-life (EoL) care practices might differ. We conducted a nationally representative survey of 2,…
View article: Top Ten Tips Palliative Care Clinicians Should Know About Hospice Live Discharge
Top Ten Tips Palliative Care Clinicians Should Know About Hospice Live Discharge Open
Hospice care is designed to support the medical and psychosocial needs of individuals with serious illness and their caregivers through the dying process. Some individuals, though, leave hospice prior to death, generally referred to as dis…
View article: Hospice Enrollment and Central Nervous System–Active Medication Prescribing to Medicare Decedents with Dementia
Hospice Enrollment and Central Nervous System–Active Medication Prescribing to Medicare Decedents with Dementia Open
This study explores the extent to which hospice enrollment is associated with CNS–active medication exposure among Medicare decedents with Alzheimer disease and related dementias.
View article: Patterns of national emergency department utilization by fee‐for‐service Medicare beneficiaries with dementia
Patterns of national emergency department utilization by fee‐for‐service Medicare beneficiaries with dementia Open
Background Individuals with Alzheimer's disease and related dementias (ADRD) often face high acute care clinical utilization and costs with unclear benefits in survival or quality of life. The emergency department (ED) is frequently the si…
View article: <scp>Pre‐hospitalization</scp> dysphagia and feeding tube placement in nursing home residents with advanced dementia
<span>Pre‐hospitalization</span> dysphagia and feeding tube placement in nursing home residents with advanced dementia Open
Background Despite research demonstrating the risks of using feeding tubes in persons with advanced dementia, they continue to be placed. The natural history of dysphagia among patients with advanced dementia has not been examined. We cond…
View article: Characteristics and End-of-Life Care Pathways of Decedents From a National Cohort of Assisted Living Residents
Characteristics and End-of-Life Care Pathways of Decedents From a National Cohort of Assisted Living Residents Open
Background: Assisted living (AL) is an increasingly common, place of care for dying persons. However, it remains unclear to what extent residents are able to age in place or if AL represents an additional transition before death. Objective…
View article: Perspectives on advance care planning needs of persons with advanced dementia from their surrogates and clinicians
Perspectives on advance care planning needs of persons with advanced dementia from their surrogates and clinicians Open
This study assessed both clinicians and surrogate decision-makers' perspectives on communication and decision-making concerning care preferences, goals, and ACP. The study findings from a national cohort can inform decision-support interve…
View article: Changes in hospice care experiences during the <scp>COVID</scp> ‐19 pandemic
Changes in hospice care experiences during the <span>COVID</span> ‐19 pandemic Open
Demand for hospice and palliative care services increased during the COVID-19 pandemic.1 Hospices strove to meet this demand despite staffing shortages2 and visitation restrictions that sometimes prevented family members and hospice staff …
View article: Reforming the Medicare Hospice Benefit—Unintended Consequences
Reforming the Medicare Hospice Benefit—Unintended Consequences Open
This JAMA Forum discusses the reasons for changing the Medicare hospice benefit program, the potential serious unintended consequences, and provides recommendations for the testing of new alternative payment models.
View article: Likelihood of assisted living residents aging in place as a factor of dual <scp>Medicare–Medicaid</scp> eligibility at the end of life
Likelihood of assisted living residents aging in place as a factor of dual <span>Medicare–Medicaid</span> eligibility at the end of life Open
The authors declare no conflicts of interest. Data S1: Supplemental methods. Table S1: Underlying numbers for Figure 1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied b…
View article: Hospice—The Time Is Now for Additional Integrity Oversight
Hospice—The Time Is Now for Additional Integrity Oversight Open
This JAMA Forum discusses the concerning trend of for-profit hospice programs in the US, the current issues and problems with hospice care, and the need for increased oversight to ensure and improve quality for patients.
View article: Addressing Serious Illness Care in Medicare Advantage
Addressing Serious Illness Care in Medicare Advantage Open
Interview with Claire Ankuda on ensuring access to high-quality and equitable care in Medicare Advantage. (10:15)Download A comprehensive approach that prioritizes improving data transparency and quality measurement could help ensure that …
View article: Private Investment, Ownership and Management of Health and LTSS: Making Medicare and Medicaid Great Again
Private Investment, Ownership and Management of Health and LTSS: Making Medicare and Medicaid Great Again Open
Journal Article Private Investment, Ownership and Management of Health and LTSS: Making Medicare and Medicaid Great Again Get access Public Policy & Aging Report, Volume 33, Issue 2, 2023, Pages 1–40, https://doi.org/10.1093/ppar/prad010 P…
View article: Hospice agency characteristics associated with benzodiazepine and antipsychotic prescribing
Hospice agency characteristics associated with benzodiazepine and antipsychotic prescribing Open
Background Benzodiazepine and antipsychotic medications are routinely prescribed for symptom management in hospice patients, but have significant risks for older adults. We explored the extent to which patient and hospice agency characteri…
View article: Protecting seriously ill populations during pragmatic clinical trials
Protecting seriously ill populations during pragmatic clinical trials Open
Pragmatic clinical trials (PCTs) emphasize real‐world effectiveness methodology to address the limitations of results from explanatory randomized clinical trials (RCTs), which often fail to translate to real‐world medical practice. An inhe…
View article: Association of Hospice Profit Status With Family Caregivers’ Reported Care Experiences
Association of Hospice Profit Status With Family Caregivers’ Reported Care Experiences Open
Importance Expansive growth in the US hospice market has been driven almost exclusively by an increase in for-profit hospices. Prior research found that, in contrast to not-for-profit hospices, for-profit hospices focus on delivering care …
View article: Comparison of the Pathway to Hospice Enrollment Between Medicare Advantage and Traditional Medicare
Comparison of the Pathway to Hospice Enrollment Between Medicare Advantage and Traditional Medicare Open
Importance Older adults in Medicare Advantage (MA) enroll in hospice at higher rates than those in traditional Medicare (TM), but it is unclear whether the pathway of care prior to hospice use differs between MA and TM. Objective To examin…
View article: Garbage in, Garbage out—Words of Caution on Big Data and Machine Learning in Medical Practice
Garbage in, Garbage out—Words of Caution on Big Data and Machine Learning in Medical Practice Open
This JAMA Forum discusses developments with machine learning and artificial intelligence and provides examples showing how humans are required in these processes to avoid errors in classification.