Faculty Profile: Joan Teno, MD, MS

Joan Teno
Joan Teno, MD, MS
Professor of Health Services, Policy, & Practice and Professor of Medicine
Community Health
Work: +1 401-863-9627
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.

Biography

Joan M. Teno, M.D., M.S. is a Professor of Community Health 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 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 120 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

Institutions

Bu

Research Description

Joan M. Teno, M.D., M.S. is a Professor of Community Health 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. 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.

  3. 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

Grants and Awards

2008 AANP State Award for Excellence for Advocate during the AANP Annual Membership Meeting on June 28, 2008 at the Gaylord National Resort and Convention Center on the Potomac, located right outside the Washington, DC area.

American Geriatrics Society Best Paper Award in Geriatrics: Ethics and Quality of Life: Teno JM, Mor V, Intrator O, Rhodes R. Health Care Transitions and Incident Feeding Tube Insertion Among Persons with Advanced Cognitive Impairment: Lost in Transition. 2007 American Geriatrics Society Annual Scientific Meeting. Seattle, WA, May 5, 2007.

American Geriatrics Society Best Paper in Health Services Research: Mitchell SL, Teno JM, Intrator O, Feng Z, Mor V. Hospitalization Decisions for Nursing Home Residents with Advanced Dementia: A Nationwide Study. 2006 American Geriatrics Society Annual Scientific Meeting. Chicago, IL, May 5, 2006.

American Geriatrics Society Best Paper Award for Geriatrics: Ethics and Quality of Life in May 2005 at the Annual American Geriatrics Society Meeting in Orlando, FL.

2005 American Academy of Hospice and Palliative Medicine (AAHPM) Award for Excellence in Scientific Research on 1/20/2005 at the Annual Assembly of AAHPM and HPNA in New Orleans, LA.

Meritorious Award from the Rhode Island Public Health Association Seventh Annual Meeting on 5/11/2004 for recognition of significant contributions to the advancement of public health in Rhode Island at the federal, state, or local level.

Award from the Rhode Island Cancer Pain Initiative and American Cancer Society on 10/29/2002 for recognition of contribution to quality pain management in Rhode Island.

Freddie Award from MediMedia USA for the entry "More Than A Failing Heart" in the category of Patient Care in the 2002 International Health & Medical Media Awards announced on 9/18/2002. Awarded 11/8/2002.

Merit Award from the American Society of Clinical Oncology and Pain Merit Award for the abstract "Cancer Patients in US Nursing Homes: Quality of End of Life Care" Johnson V, Teno JM, Mor V presented at the Opening Ceremony of the ASCO 2002 Annual Meeting on May 18-21, 2002.

Award of the 1998 Annual Session of the American College of Physicians for one of The Year's Most Important Papers in Internal Medicine Subspecialties: "Perceptions by Family Members of the Dying Experience of Older and Seriously Ill Patients." Lynn J, Teno JM, Phillips RS, Wu AW, Desbiens N, Harrold J, Claessens MT, Wenger N, Kreling B, Connors, AF. Annals of Internal Medicine, 1997:126-97-106.

National Media Owl Award: Dr. Teno was associated with video produced by Patricia Barey and Therese Burson entitled "Advance Directives: Assisting Patients with End-of-Life Decisions."

New Investigator Award, 1995 American Geriatrics Society Annual Meeting, Washington, D.C., May 1995.

Best Poster Award, 1995 American Geriatrics Society Annual Meeting, Washington, D.C., May 1995.

Affiliations

Associate Editor, Journal of Pain and Symptom Management 2009- 2013

Associate Medical Director, Home and Hospice Care of Rhode Island, 1997-present

Research Planning Committee for the National Palliative Care Research and Training Center, 2006-present

Editorial Board, Journal of Palliative Medicine, 2000-present

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.

Teaching Experience

UNIVERSITY TEACHING ROLES:

Undergraduate Education:

1. "Bearing Witness to Cancer". Lecture to Brown University Undergraduates, April 3, 2003, April 20, 2004, April 14, 2005, April 13, 2006.

Graduate Education:

1. "Legal Rights to Withdraw and Withhold Life Sustaining Treatment". Lecture to the George Washington Law School, Spring, 1996.

2. "Public Policy and Advance Directives". Lecture to the George Washington University Master of Public Health Program, Spring, 1996.

3. Survey Research Methods and Health Status Assessment. Course developed and co-taught with Dr. Floyd Fowler for Dartmouth Medical School Master of Science in the Evaluative Clinical Sciences, Winter term, 1995.


Medical School Education:


1. Community Health Clerkship on Hospice and Palliative Medicine, 2002 to present.

2. Public Health from Bedside to Public Policy. Course Leader, Spring 1998 and 1999.

3. Death and Dying. Course leader, Brown University Medical School, 1997 -1998


4. Integrating Faith and Medicine. With colleagues, I developed a four-year curriculum to integrate faith and palliative care medicine into the George Washington University Medical School, 1996 to 1997. This curriculum received a prize from the John Templeton Foundation.

5. Epidemiology and Medicine. Small group leader, Dartmouth Medical School, Spring term, 1995.

6. The Public Policy Debate Over Physician Assisted Suicide. Lecture to George Washington University Medical School, Spring, 1991.

Residency and Fellow Education:

1. Course leader for Evidence Base Medicine and the Use of Continuous Quality Improvement, 2001 to present.

2. Coordinator, Research and Hospice Month, Geriatric Fellows, 2001 to present.

3. Faculty Promotion at Brown: All You Need to Know. Faculty Development Workshop, Brown Medical School, April 2, 2003.

4. "Planning for a Career in Academic Medicine". Lecture to geriatrics fellows, Spring 1995 – present.

5. The George Washington University primary care residency program curriculum in geriatric medicine. Designed and coordinated curriculum, 1990 to 1992.

6. "Putting Advance Care Planning Into Action". Lecture for primary care residents, George Washington University, 1992.

7. Teaching Faculty, Primary Care Internal Medicine Residency Training Program, Rhode Island Hospital, 1987 to 1990. In this position, I prepared weekly lectures on a variety of topics in general internal medicine, geriatrics, and medical ethics.

8. Medical Ethics for Primary Care Residents. Faculty coordinator for this 3 year course, which provided residents with both the cognitive and behavior skills to address common ethical issues in medicine. This curriculum was recognized by the American Board of Internal Medicine as an exemplary curriculum in medical ethics. I developed core lectures, prepared the course syllabus, and co-taught medical ethics seminars. 1986 to 1990.

Selected Publications

  • 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. (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. (2011)
  • 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. (2011)
  • 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. (2009)
  • 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. (2005)
  • 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. (2004)
  • 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. (2003)
  • 9. Teno JM, Weitzen S, Wetle T, Mor V. Persistent pain in nursing home residents. JAMA. 2001 Apr 25 2001;285(16):2081. (2001)
  • 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. (2000)