Faculty Profile: Vincent Mor, PHD, MED

Vincent Mor
Vincent Mor, PHD, MED
Professor of Medical Science
Health Services, Policy & Practice
Work: +1 401-863-2959
Dr. Mor's research focuses on the organizational and health care delivery system factors associated with variation in use of health services, and outcomes experienced by frail and chronically ill persons. Areas of study include: the quality of nursing home care, Medicare funding for post-acute care, the determinants of hospitalization, disease management for cancer patients and age and racial discrimination in health care treatments.

Biography

Dr. Vincent Mor is the Florence Pirce Grant Professor of Community Health in the Public Health Program of the Brown University School of Medicine. Dr. Mor has been on the faculty of the Department of Community Health since 1981 until it became the Department of Health Services, Policy and Practice. He was tenured in 1987 and promoted to Professor in 1990. Dr. Mor was one of the founders of the Department's graduate program in 1986 and directed the Center for Gerontology and Health Care Research for 10 years. He served as Chair of the Department of Community Health from 1996 until 2010.

Dr. Mor has been Principal Investigator of nearly 30 NIH funded grants focusing on the organizational and health care delivery system factors associated with variation in use of health services and the outcomes frail and chronically ill persons experience. He has had multiple grants from the Robert Wood Johnson Foundation, the Commonwealth Fund and the Retirement Research Foundation as well as contracts from the Health Care Financing Administration and the Office of the Assistant Secretary for Planning and Evaluation to evaluate the impact of programs and policies in aging and long term care including Medicare funding of hospice, the costs and benefits of day hospital treatment of cancer, patient outcomes in nursing homes, the impact of short term case management for cancer patients, several studies documenting age discrimination in cancer treatment and use of home care services, and a national study of residential care facilities.

Dr. Mor was one of the authors of the Congressionally mandated Minimum Data Set (MDS) for Nursing Home Resident Assessment and evaluated its implementation, focusing particularly on the manner it was implemented. Dr. Mor has developed several summary measures based upon MDS data to characterize residents' physical, cognitive and psycho-social functioning, all of which have been used in resident and facility level analyses of the quality of nursing home care in US and international populations. Dr. Mor was part of a team of researchers that developed and validate risk adjusted quality indicators for nursing homes versions of which are currently being used in public reporting throughout the country.


He held a MERIT award from NIA for his research on organizational factors related to nursing home quality and residents' outcomes for 10 years and was a recipient of a Robert Wood Johnson Foundation Health Policy Investigator award to examine the influence of managed care and integrated delivery systems on the strategic decisions of nursing homes and their quality consequences for residents. He examined the effect of state policies on the quality of care provided nursing home residents, including hospitalization, merging primary and secondary data from all nursing facilities throughout the United States.

Dr. Mor is now funded by the NIA to undertake a large Program Project Grant, "Shaping Long Term Care in America". This program involves 3 research and administration cores and 4 separate projects all of which seek to better understand the impact of changing state Medicaid policies on long term care providers and the patients that they serve. Collaborating with colleagues from Dartmouth, Dr. Mor and his Brown colleagues have documented large regional variation in hospitalization rates, including end of life transitions and the use of hospice and palliative care. Additionally, this research has documented substantial disparities in the care and outcomes white and minority nursing home residents receive, largely attributable to the fact that Blacks and Hispanics are more likely to reside in sub-standard facilities.


Dr. Mor was a member of the Secretary of HHS's National Committee on Vital and Health Statistics and the recently completed Institute of Medicine Committee on Long Term Care Quality. He is on the Board of AcademyHealth, the premier health services research association in the US and chairs the Independent Quality Committee for hcr-Manorcare, a US nursing home group. He has published over 300 peer reviewed articles and numerous books and book chapters on hospice, physical functioning, long term care and cancer treatment patterns among the elderly as well as the organization of AIDS health services. He is on several editorial boards including Health Services Research. In 2011 Dr. Mor was given the Distinguished Investigator Award From AcademyHealth, the premier health services research organization in the country.

Institutions

Bu

Research Description

Dr. Mor has been Principal Investigator of nearly 30 NIH funded grants focusing on the organizational and health care delivery system factors associated with variation in use of health services and the outcomes frail and chronically ill persons experience. He has had multiple grants from the Robert Wood Johnson Foundation, the Commonwealth Fund, Pew Memorial Trust, the Retirement Research Foundation and the Commonwealth Fund, as well as contracts from the Centers for Medicare and Medicaid Services (CMS) and the Office of the Assistant Secretary for Planning and Evaluation to evaluate the impact of programs and policies in aging and long term care including Medicare funding of hospice, the costs and benefits of day hospital treatment of cancer, patient outcomes in nursing homes, the impact of short term case management for cancer patients, several studies documenting age discrimination in cancer treatment and use of home care services, and a national study of residential care facilities. Over the past 30 years Dr. Mor's research has frequently integrated quantitative and qualitative data, particularly in program evaluations examining the approaches communities, organizations, and specific providers use to adjust to health policy changes, such as financing and reimbursement, or to the emergence of integrated delivery systems.

Dr. Mor was one of the authors of the Congressionally mandated Minimum Data Set (MDS) for Nursing Home Resident Assessment and evaluated its implementation. Dr. Mor has conducted extensive research on the reliability and validity of the MDS data as used in the field and has pioneered the use of these data to characterize nursing home residents' physical, cognitive, and psycho-social functioning, all of which have been used in resident and facility level analyses of the quality of nursing home care in US and international populations. Dr. Mor directed the Brown University component of a CMS contract to develop and validate risk adjusted quality indicators for nursing homes that are now being used for public reporting of nursing home quality throughout the country.

He recently completed the second 5 years of a MERIT award from NIA for his research on nursing home organizational factors related to facility quality and residents' outcomes and has subsequently received multiple NIA grants to examine the policy and organizational determinants of hospitalization of nursing home residents and other indicators of the quality of care provided. Dr. Mor was the recipient of a Robert Wood Johnson Foundation Health Policy Investigator award to examine the influence of managed care and integrated delivery systems on the strategic decisions of nursing homes and their quality consequences for residents. Presently, he is examining the effect of state policies and market factors on the quality of care provided nursing home residents, including rehospitalization, merging primary and secondary data from all nursing facilities in the United States. Dr. Mor is seeking to determine whether quality is worse in the states with consistently poor and disjointed long term care policies.

Dr. Mor was a member of the Secretary of HHS's National Committee on Vital and Health Statistics and the Institute of Medicine Committee on Long Term Care Quality. He is a member of the Secretary's Advisory Committee on Health Services Research for the Department of Veteran Affairs. He was Chair of the Long Term Care Interest group of AcademyHealth, seeking to expand that organization's interest in and fostering of research on long term care and is currently Program Chair for the Annual Research Meeting of AcademyHealth in Washington, DC in 2008. He has published over 300 peer reviewed articles and numerous books and book chapters on nursing home quality, hospice, physical functioning, long term care, and cancer treatment patterns among the elderly as well as the organization of AIDS health services. Dr. Mor has published widely on the measurement of quality of life and physical functioning in various chronically ill populations using both previously standardized as well as novel measures of functioning. He has published models pertaining to the measurement of quality in long term care facilities and lectures widely on this topic. He is a fellow of the American Gerontological Society and is on the editorial board of Health Services Research.

Grants and Awards

MERIT Award, grant #AG11624 for 1992-2002 from National Institute on Aging

Health Policy Investigator Award, 1996-1999, from the Robert Wood Johnson Foundation

Henderson lecturer; Plenary address on the future of geriatics at the 2003 annual meeting of the American Geriatrics Society

The 2006 Bennet J. Cohen Memorial Lecture at the University of Michigan Institute of Gerontology

Florence Pirce Grant Professor of Community Health

Distinguished Investigator Award from AcademyHealth

John Eisenberg Mentoring Award from the Agency for HealthCare Research and Quality

Affiliations

Fellow, Gerontological Society of America
Board, AcademyHealth
Fellow, interRAI
Member, American Public Health Association

Funded Research

Principal Investigator. National Institutes of Health. "The Emergence of Elder
Care in China" A team of experienced LTC researchers from the U.S. and
China will study recent developments in the institutional elder care sector In China, then will develop a nursing home data collection instrument that Can be readily used by others throughout the country.

Principal Investigator. AHRQ "The Impact of Flu and Flu Vaccine on NH
Resident Morbidity" Build a model to estimate the impact of localized influenza severity and annual vaccination coverage in each resident's nursing home on the rate of functional decline, infection, weight loss and both influenza related and all cause hospitalizations.

Principal Investigator. "Performance Excellence in Kidney Care". Creating Baseline one year Mortality benchmarks for the population of patients initiating kidney dialysis with the goal of monitoring the extent to which mortality rates can be reduced by 20% in 3 years.

Principal Investigator. National Institutes of Health. "SAFEHAVEN: Decision Support for Nursing Home Resident Disaster Evacuations" This study will seek To understand the consequences of hurricanes and evacuation decisions, providing the first evidence base to inform the creation of evacuation guidelines.

Principal Investigator. Grant # 64435 Robert Wood Johnson Foundation. "Impact of State Policy Changes on Nursing Home Hospitalizations" To assess the impact of states' Medicaid bed-hold and reimbursement policies on the hospitalization rate on nursing home residents.

Principal Investigator. Sub with Johns Hopkins. "National Study of Disability Trends and Dynamics". Design and conduct a longitudinal and nationally representative study of the disability trends and dynamics among the U.S. older population.



Principal Investigator NIA P0-1 "Shaping Long Term Care in America" Five year program project to examine the effect of state policy variation on long term care providers' strategic behavior and the outcomes experienced by their residents.

Principal Investigator & Project Director " Evaluation of Washington State's Nursing Home Payment System". Contract to evaluate the state's payment system and to recommend changes to simplify it.

2006-2007 Principal Investigator. Commonwealth Fund. The Commonwealth Fund Long-Term Care Policy Survey: Assessing Experts' Views.

2005-2007 Principal Investigator. Commonwealth Fund. "Assessing the Segregation in Nursing Homes in the United States". Grant to examine the prevalence and quality consequences of segregation in US nursing homes.

2005-2006 Principal Investigator. Contract from the National Quality Forum to serve as the Executive Director and Academic Partner for the National Commission on Quality Long Term Care.

2004-2007 Principal Investigator. National Institutes of Health Grant# R01 AG23622. To examine the effect that changing state Medicaid policies have on nursing home residents' experiences and outcomes.

2004-2007 Co-Investigator. National Institutes of Health Grant #22073 to Susan Allen, Ph.D. (PI). To examine the consequences of inadequate care at home.

2004-2005 Co-Investigator. Sub-contract from Rhode Island Quality Partners from CMS contract. "Improving Nursing Home Culture: Two Pronged Pilot Special Study".

2002-2005 Principal Investigator, National Institute of Health. Grant # R01 AG20557-01. To examine state policies and hospitalizations from nursing homes.

2002-2005 Investigator, Department of Health and Human Services grant # AG1398. To examine the Post-BBA Changes in Rural Hospital LTC Strategies.

2002-2004 Co-Investigator, "Post BBA Changes in Rural Hospital Linkages to Long Term Care Facilities", Grant #AG13987-05A1 2R01.

2001-2004 Investigator, Agency for Health Care Policy and Research. To examine information technology designed specifically to alert prescribers and nursing facility staff to information that can reduce the threat to patient safety associated with ADE's.

2001-2004 Investigator, Commonwealth Fund, Grant #20010695. To examine the Fleetwood Model of Long-Term Care Pharmacy Improve Pharmacotherapy.

2000-2010 Co-Principal Investigator, Miriam Hospital, Brown University, Research Training grant #R25CA 87972-01 to develop scientists in control research.

2000-2004 Co-Principal Investigator, Brown site director, National Cancer Institute, Tamoxifen #2 to study breast cancer treatment outcomes. Grant #CA84506.

1994-2004 Principal Investigator, 2nd 5-year award, National Institute on Aging MERIT Award, to study quality of care in nursing homes. Grant #AG11624.

Teaching Experience

I teach an undergraduate as well as a graduate level course on the US Health Care System. BC0031 is an entry level undergraduate course which describes the interplay between the financing, delivery and regulatory components of the health care system as implemented in the US. BC0240 is a graduate level seminar presented in case study form to challenge students to view health care delivery issues from the perspective of numerous constituencies.

Courses Taught

  • Determinants and Consequences of Changing Health Care Systems (PHP2400)
  • The US Health Care System (PHP0310)

Selected Publications

  • Teno JM, Dosa D, Rochon T, Casey V, Mor V. Development of a Brief Survey to Measure Nursing Home Residents' Perceptions of Pain Management. J Pain Symptom Manage. 2008 Jun 16. (2008)
  • Ezeamama AE, McGarvey ST, Acosta LP, Zierler S, Manalo DL, Wu HW, Kurtis JD, Mor V, Olveda RM, Friedman JF. The Synergistic Effect of Concomitant Schistosomiasis, Hookworm, and Trichuris Infections on Children's Anemia Burden. PLoS Negl Trop Dis. 2008 Jun 4;2(6):e245. (2008)
  • Miller EA, Booth M, Mor V. Meeting the demographic challenges ahead: Toward culture change in an ageing New Zealand. Aust New Zealand Health Policy. 2008 May 22;5:5. (2008)
  • Gruneir A, Miller SC, Feng Z, Intrator O, Mor V. Relationship between state medicaid policies, nursing home racial composition, and the risk of hospitalization for black and white residents. Health Serv Res. 2008 Jun;43(3):869-81. (2008)
  • Grabowski DC, Feng Z, Intrator O, Mor V. Medicaid Nursing Home Payment and the Role of Provider Taxes. Med Care Res Rev. 2008 Mar 27. (2008)
  • Zinn J, Feng Z, Mor V, Intrator O, Grabowski D. Restructuring in response to case mix reimbursement in nursing homes: a contingency approach. Health Care Manage Rev. 2008 Apr-Jun;33(2):113-23. (2008)
  • Teno JM, Feng Z, Mitchell SL, Kuo S, Intrator O, Mor V. Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents? J Am Geriatr Soc. 2008 May;56(5):887-90. Epub 2008 Mar 5. (2008)
  • Bourbonniere M, Feng Z, Intrator O, Angelelli J, Mor V, Zinn JS. The use of contract licensed nursing staff in U.S. nursing homes. Med Care Res Rev. 2006 Feb;63(1):88-109. (2006)
  • Angelelli J, Grabowski DC, Mor V. Effect of educational level and minority status on nursing home choice after hospital discharge. Am J Public Health. 2006 Jul;96(7):1249-53. (2006)
  • Feng Z, Grabowski DC, Intrator O, Mor V. The effect of state medicaid case-mix payment on nursing home resident acuity. Health Serv Res. 2006 Aug;41(4 Pt 1):1317-36. (2006)
  • Miller SC, Papandonatos G, Fennell M, Mor V. Facility and county effects on racial differences in nursing home quality indicators. Soc Sci Med. 2006 Dec;63(12):3046-59. (2006)
  • Mor V. Defining and measuring quality outcomes in long-term care. J Am Med Dir Assoc. 2006 Oct;7(8):532-8; discussion 538-40. (2006)
  • Mitchell SL, Teno JM, Miller SC, Mor V. A national study of the location of death for older persons with dementia. J Am Geriatr Soc. 2005 Feb;53(2):299-305. (2005)
  • Liperoti R, Gambassi G, Lapane KL, Chiang C, Pedone C, Mor V, Bernabei R. Conventional and atypical antipsychotics and the risk of hospitalization for ventricular arrhythmias or cardiac arrest. Arch Intern Med. 2005 Mar 28;165(6):696-701. (2005)
  • Feng Z, Katz PR, Intrator O, Karuza J, Mor V. Physician and nurse staffing in nursing homes: the role and limitations of the Online Survey Certification and Reporting (OSCAR) system. J Am Med Dir Assoc. 2005 Jan-Feb;6(1):27-33. (2005)
  • Wu N, Miller SC, Lapane K, Roy J, Mor V. The quality of the quality indicator of pain derived from the minimum data set. Health Serv Res. 2005 Aug;40(4):1197-216. (2005)
  • Intrator O, Feng Z, Mor V, Gifford D, Bourbonniere M, Zinn J. The employment of nurse practitioners and physician assistants in U.S. nursing homes. Gerontologist. 2005 Aug;45(4):486-95. (2005)
  • 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;53(7):1145-53. (2005)
  • Wu N, Miller SC, Lapane K, Roy J, Mor V. Impact of cognitive function on assessments of nursing home residents' pain. Med Care. 2005 Sep;43(9):934-9. (2005)
  • Mor V. The compression of morbidity hypothesis: a review of research and prospects for the future. J Am Geriatr Soc. 2005 Sep;53(9 Suppl):S308-9. Review. (2005)
  • Roy J, Mor V. The effect of provider-level ascertainment bias on profiling nursing homes. Stat Med. 2005 Dec 15;24(23):3609-29. (2005)
  • Liperoti R, Gambassi G, Lapane KL, Chiang C, Pedone C, Mor V, Bernabei R. Cerebrovascular events among elderly nursing home patients treated with conventional or atypical antipsychotics. J Clin Psychiatry. 2005 Sep;66(9):1090-6. (2005)
  • Mor V. Improving the quality of long-term care with better information. Milbank Q. 2005;83(3):333-64. Review. (2005)
  • Teno JM, Mor V, Ward N, Roy J, Clarridge B, Wennberg JE, Fisher ES. Bereaved Family Member Perceptions of Quality of End-of-Life Care in U.S. Regions with High and Low Usage of Intensive Care Unit Care. J Am Geriatr Soc. 2005 Nov;53(11):1905-11. (2005)
  • Ezeamama AE, Friedman JF, Olveda RM, Acosta LP, Kurtis JD, Mor V, McGarvey ST. Functional significance of low-intensity polyparasite helminth infections in anemia. J Infect Dis. 2005 Dec 15;192(12):2160-70. Epub 2005 Nov 11. (2005)
  • Johnson VM, Teno JM, Bourbonniere M, Mor V. Palliative care needs of cancer patients in U.S. nursing homes. J Palliat Med. 2005 Apr;8(2):273-9. (2005)
  • Mor V, Papandonatos G, Miller SC. End-of-life hospitalization for African American and non-Latino white nursing home residents: variation by race and a facility's racial composition. J Palliat Med. 2005 Feb;8(1):58-68. (2005)
  • Mor V. Improving the quality of long-term care with better information. Milbank Q. 2005;83(3):333-64. Review (2005)
  • Liperoti R, Pedone C, Lapane KL, Mor V, Bernabei R, Gambassi G. Venous thromboembolism among elderly patients treated with atypical and conventional antipsychotic agents. Arch Intern Med. 2005 Dec 12-26;165(22):2677-82. (2005)
  • Wool MS, Mor V. A multidimensional model for understanding cancer pain. Cancer Invest. 2005;23(8):727-34. (2005)
  • Weech-Maldonado R, Shea D, Mor V. The relationship between quality of care and costs in nursing homes. Am J Med Qual. 2006 Jan-Feb;21(1):40-8. (2005)
  • Miller SC, Mor V. The opportunity for collaborative care provision: the presence of nursing home/hospice collaborations in the U.S. states. J Pain Symptom Manage. 2004 Dec;28(6):537-47. (2004)
  • Grabowski DC, Feng Z, Intrator O, Mor V. Recent trends in state nursing home payment policies. Health Aff (Millwood). 2004 Jan-Jun;Suppl Web Exclusives:W4-363-73. (2004)
  • Intrator O, Zinn J, Mor V. Nursing home characteristics and potentially preventable hospitalizations of long-stay residents. J Am Geriatr Soc. 2004 Oct;52(10):1730-6. (2004)
  • Weitzen S, Lapane KL, Toledano AY, Hume AL, Mor V. Principles for modeling propensity scores in medical research: a systematic literature review. Pharmacoepidemiol Drug Saf. 2004 Dec;13(12):841-53. (2004)
  • Weitzen S, Lapane KL, Toledano AY, Hume AL, Mor V. Weaknesses of goodness-of-fit tests for evaluating propensity score models: the case of the omitted confounder. Pharmacoepidemiol Drug Saf. 2005 Apr;14(4):227-38. (2004)
  • Grabowski DC, Angelelli JJ, Mor V. Medicaid payment and risk-adjusted nursing home quality measures. Health Aff (Millwood). 2004 Sep-Oct;23(5):243-52. (2004)
  • Gozalo P, Mor V, Miller S. Hospice effect on medicare expenditures. Ann Intern Med. 2004 Sep 7;141(5):409-10 (2004)
  • Miller S., Intrator O., Gozalo P., Roy J., Barber J., Mor V. (2004) "Government Expenditures at the End of Life for Short- and Long-Stay Nursing Home Residents: Differences by Hospice Enrollment Status." Journal of the American Geriatrics Society. 52(8):1-9 (2004)
  • Mor V., Zinn J., Angelelli J., Teno J., Miller S. (2004) "Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care." Milbank Quarterly 82(2) 227-256. (2004)
  • Weech-Maladonado R., Meret-Hanke L., Neff M., Mor V. (2004) "Nurse Staffing Patterns and Quality of Care in Nursing Homes." Health Care Management Review 29(2) 107-116 (2004)
  • Teno J., Kabumoto G., Wetle T., Roy J., Mor V. (2004) "Daily Pain That Was Excruciating at Some Time in the Previous Week: Prevalence, Characteristics, and Outcomes in Nursing Home Residents." Journal of the American Geriatrics Society 52:762-767 (2004)
  • Zinn J., Mor V., Intrator O., Feng Z., Angelelli J., and Davis J (2003) "The Impact of the Prospective Payment System for Skilled Nursing Facilities on Therapy Service Provision: A Transaction Cost Approach." Health Services Research 38:6 1467-1485. (2004)
  • Weitzen S, Teno JM, Fennell M, Mor V. (2003) "Factors associated with site of death: a national study of where people die. Medical Care. 41(2):323-35. (2003)
  • Mor V., Angelelli J, Jones R, Roy J, Moore T, Morris JN. (2003) "Inter-rater reliability of nursing home quality indicators in the US." BMC Health Service Research Nov 04;3(1):20. (2003)
  • Miller S., Mor V., Teno J. (2003) "Hospice Enrollment and Pain Assessment and Management in Nursing Homes." Journal of Pain and Symptom Management. 26(3) 791-799. (2003)
  • Weech-Maldonado R., Neff G., Mor V. (2003) "Does Quality of Care Lead to Better Financial Performance?: (2003)
  • Mitchell, S., Teno J., Roy J., Kabumoto G., Mor V. (2003) "Clinical and Organizational Factors Associated with Feeding Tube Use Among Nursing Home Residents with Advanced Cognitive Impairment." JAMA, 290:73-80. (2003)
  • Angelelli J, Mor V., Intrator O., Feny, Z, Zinn J. (2003) "Oversight of Nursing Homes: Prunning the Tree or Just Spotting Bad Apples?" The Gerontologist. 43:11 (FSU Special Issue). 67-75. (2003)
  • Mor V. (2003) "A Comprehensive Clinical Assessment Tool to Inform Policy and Practice: Applications of the Minimum Data Set." Medical Care, 42(4), 1-9. (2003)
  • Zinn J., Brannon D., Mor V., Barry T., (2003). "A Structure/Technology Contingency Analysis of Care Giving in Nursing Facilities." Health Care Medical Review. 28(3). (2003)
  • Mor, V., Berg K., Angelleli J., Gifford D., Morris J., and Moore T. (2003). "The Quality of Quality Measurement in U.S. Nursing Homes." The Gerontologist. Vol 43:11 (FSU Special Issue) 37-46.. (2003)
  • Weech-Maldonado, R., Neff G., Mor V., (2003): "The Relationship Between Quality of Care and Financial Performance in Nursing Homes." Journal of Health Care Finance. 29(3): 48-60. (2003)
  • Miller SC, Mor V, Coppola K, Teno J, Laliberte L, Petrisek AC. The Medicare hospice benefit's influence on dying in nursing homes. J Palliat Med. 1998 Winter;1(4):367-76. (1998)