Joan M. Teno Professor of Health Services, Policy and Practice, Professor of Medicine

Joan M. Teno, M.D., M.S. is a Adjunct Professor of Health Services, Policy, and Practice and currently, Professor of Medicine at the Division of Gerontology and Geriatrics at the University of Washington.  She is a health services researcher, former  hospice medical director, and board-certified internist with added qualification in Geriatrics and Palliative Medicine. Dr. Teno has served on numerous advisory panels including the Institute of Medicine, World Health Organization and American Bar Association and as grant peer reviewer for the National Institutes of Health. She has been the recipient of funding from the National Institute of Health (NIH) and the Robert Wood Johnson Foundation. Dr. Teno's focus has been on measuring and evaluating interventions to improve the quality of medical care for seriously ill and dying patients. Dr. Teno led the effort in the design of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) intervention analysis and was lead author in twelve publications from that research effort, which ranged from the role of advance directives to describing the dying experience of seriously ill and older adults. Both as a researcher and clinician, Dr. Teno has devoted her career to understanding how to measure and improve the quality of end of life care for vulnerable populations. She was the lead investigator in a research effort to create a Toolkit of Instruments to Measure Care at the End of Life (TIME). In this grant effort, she created the Brown University Family Evaluation of Hospice Care, that is currently being used by hospice across the nation and internationally to examine the quality of hospice care. She has led a state wide effort to improve pain management in nursing homes, for which she has received an award from the American Cancer Society. Over 210 research articles have been published in leading medical journals focusing on examining medical care for dying persons and frail persons residing in nursing homes. Information about some of Dr. Teno's research efforts can be viewed by visiting her websites at:

www.chcr.brown.edu/pcoc/toolkit.htm

www.chcr.brown.edu/dying/factsondying.htm

Brown Affiliations

Research Areas

scholarly work

4. Teno JM, Gozalo PL, Mitchell SL, et al. Does Feeding Tube Insertion and Its Timing Improve Survival? J Am Geriatr Soc. Sep 24 2012.

3. Teno JM, Gozalo PL, Lee IC, et al. Does hospice improve quality of care for persons dying from dementia? Journal of the American Geriatrics Society. Aug 2011;59(8):1531-1536.

1. Teno JM, Gozalo P, Mitchell SL, Bynum JP, Dosa D, Mor V. Terminal hospitalizations of nursing home residents: does facility increasing the rate of do not resuscitate orders reduce them? Journal of pain and symptom management. Jun 2011;41(6):1040-1047.

7. Teno JM, Connor SR. 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". JAMA. Feb 11 2009;301(6):651-659.

6. Welch LC, Teno JM, Mor V. End-of-life care in black and white: race matters for medical care of dying patients and their families. J Am Geriatr Soc. 2005 Jul 2005;53(7):1145-1153.

5. Teno JM, Kabumoto G, Wetle T, Roy J, Mor V. Daily pain that was excruciating at some time in the previous week: prevalence, characteristics, and outcomes in nursing home residents. J Am Geriatr Soc. 2004 May 2004;52(5):762-767.

8. Teno JM, Fisher ES, Mor V, Roy J, Clarridge B, Wennberg JE. Dying in HSA with higher ICU utilization: is more better? J Am Geriatr Soc. April 2003 2003;51(S4):S39-40.

9. Teno JM, Weitzen S, Wetle T, Mor V. Persistent pain in nursing home residents. JAMA. 2001 Apr 25 2001;285(16):2081.

2. Teno JM, Gozalo PL, Bynum JP, et al. Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. Feb 6 2013;309(5):470-477.

research overview

Dr. Teno's focus has been on measuring and evaluating interventions to improve the quality of medical care for seriously ill and dying patients. Both as a researcher and clinician, Dr. Teno has devoted her career to understanding how to measure and improve the quality of frail, older and dying persons. She has led a statewide effort to improve pain management in nursing homes, for which she has received an award from the American Cancer Society.

research statement

Joan M. Teno, M.D., M.S. is a Professor of Health Systems, Policy, and Practice and Medicine and Associate Director of the Center for Gerontology and Health Care Research at the Brown Medical School. She is a health services researcher, hospice medical director, and board-certified internist with added qualification in Geriatrics and Palliative Medicine. Dr. Teno has served on numerous advisory panels including the Institute of Medicine, World Health Organization, American Bar Association and as grant peer reviewer for the National Institutes of Health. Both as a researcher and clinician, Dr. Teno has devoted her career to understanding how to measure and improve the quality of end of life care for vulnerable populations. She is an Associate Medical Director at Home and Hospice Care of Rhode Island. Her current research is focused on the quality of care for persons with serious illnesses, especially those residing in the nursing home setting:
 
  1. Development of actionable measurement tools to guide both quality improvement and public accountability for seriously ill and dying persons.
    Dr. Teno is the recipient of National Institute of Aging and National Cancer Institute research grants to develop measurement tools based on her work in creating measurement tools to evaluate hospice care. She was the lead developer of the Brown Family Evaluation of Hospice Care that is currently being used by hospice programs across the USA and internationally to examine the quality of end of life care.



  2.  
  3. Improving pain management in the nursing home setting.
    Dr. Teno, with funding from the Robert Wood Johnson Foundation, conducted a successful 21 Nursing home quality improvement collaborative that resulted in 41% reduction in pain. For this work, Dr. Teno received recognition from the RI American Cancer Society Cancer Pain Initiative and the Meritorious Award from the Rhode Island Public Health Association. Her work continues in this area with an R21 from the National Institute of Aging that is developing a computer decision support system to assist nursing homes in care planning, decisions regarding pain management, and ongoing quality monitoring.

  4. Describing the role of public policy and local health care market on the quality of care for seriously ill and dying nursing home residents.
    In collaboration with colleagues at the Center for Gerontology and at Harvard Medical School, Dr. Teno has an R01 from the National Institute of Aging to examine the influence of public policy, the local health care market, and individual characteristics with the decisions to insert a feeding tube in nursing home residents with advanced dementia.

Over 100 research articles have been published in leading medical journals focusing on examining medical care for dying persons and frail persons residing in nursing homes. Information about some of Dr. Teno's research efforts can be viewed by visiting her websites at:

Toolkit to Measure End-of-Life Care— www.chcr.brown.edu/pcoc/toolkit.htm

Facts on Dying— www.chcr.brown.edu/dying/factsondying.htm

funded research

ACTIVE

RO1 AG024265(Teno) 6/15/05-5/31/10
DHHS
Feeding Tube Use Among Persons with Advanced Dementia
This multi-method study will analyze administrative data from 50 states, along with structured and in-depth interviews with family members of decedents with advance dementia in 6 states to address the following specific aims: 1) Describe the natural history of FT use in nursing home residents with advanced dementia; 2) Examine individual, facility and market factors associated with the initial insertion of FTs; 3) Examine individual, facility, and market factors associated with the changing rates of FT use over time in US nursing homes; 4) Assess the role of shared decision making in 6 states with high and low rate of FT utilization; and 5) Examine bereaved family member perceptions and satisfaction with end of life care in geographic regions that vary in the use of FTs. Minimum Data Set, Medicare claims, and facility data from the On-Line Survey Certification of Automated Records will be merged into a residential history file to examine the pattern and predictors of initial FT insertion, re-insertion and removal and in longitudinal analyses.

RRF-(Teno) 11/1/06-12/31/08 (cont. pending)
Development of the Patient Evaluation of Hospice and Palliative Care Measure
Brown University Center of Gerontology and Health Care Research will provide the following technical assistance to National and Hospice Palliative Care Organization to create a survey tool to measure patient's perception of the quality of hospice care: 1. Participate in drafting of potential survey items, 2. Assist in site recruitment, and 3. Provide consultation and technical assistance in conducting the analysis to examine the psychometric properties of the instrument and descriptive data analysis.

ACS- (Teno) 7/1/07-6/30/09
Hospices Organized to Promote Excellence (HOPE)
The overall objective is to improve the quality of care for cancer patients referred to hospice in the last weeks of life.

07-1446 (Teno) 8/22/07-10/31/09
California Healthcare Foundation
Evaluation of the "Reducing Potentially Preventable Transfers at End of Life" Project
The proposed project will evaluate an innovative program that represents partnership between acute care hospitals and local nursing homes to improve advance care planning and the delivery of palliative care services.

Mor (PI) 9/01/06-8/31/08 (cont. pending)
Sub with Miriam Hospital
Transdisciplinary Cancer Control Research Training Center
Brown University Center for Gerontology investigators will participate in the training and development of a uniform training curriculum, campus based public health faculty meetings, mentor junior faculty and offer feedback and commitment, and participate in bi-weekly seminars.

P01AG027296 Mor (PI) 9/15/07-6/30/12
Shaping Long-Term Care in America
The overall objectives of the program project are: To build a long term care data and policy repository and analysis infrastructure as the basis for future projects examining the nation's long term care "system"; 2. To implement the proposed research projects and to integrate similar existing, pending and future developmental projects into an overall administrative structure; 3. To integrate economic and organizational theory to develop measures and to propose testable hypotheses about long term care providers' responses to market and policy changes; 4. To systematically catalogue and broadly disseminate to numerous audiences project findings.

P01AG019783-06 (Teno) 4/15/07-2/29/08
Sub w/ Dartmouth
Causes and Consequences of Health Care Efficiency
Specific aim for this project is: to conduct an analysis of the MAX database to examine the modifiable facility factors that are associated with the variation in the use of antimicrobials in persons with advanced cognitive impairment.