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Pain Impacting Quality of Life in Persons with Dementia Dying in the Nursing Home by Alternative Medicare Payment Model
Jennifer Bunker, Susan L. Mitchell, Emmanuelle Bélanger, Pedro L. Gozalo, Joan M. Teno. Journal of Palliative Medicine, 2022-06-08
Topic: Risk, prevention and care in population studies
There were 115,757 NH residents with dementia who self-reported pain in the last 30 days of life. Of those, 17.8% (n = 20,585) reported having pain the last five days from assessment, which varied by Medicare payment model (17.7% in TM, 17.5% in MA, and 19.1% in ACOs; p < 0.001). Among decedents reporting pain, 23.6% of ACO decedents reported pain affecting QoL compared to 22.1% in MA and 21.6% in TM (p = 0.09). After adjustment, decedents in ACOs compared to TM had greater predicted probability of pain affecting QoL (absolute marginal difference 0.017, 95% CI 0.00–0.035, p = 0.05), and persons in MA did not differ from persons in TM (absolute marginal difference 0.005, 95% CI −0.008 to 0.019, p = 0.41). Conclusions and Among dementia decedents dying with pain, pain impacted QoL in more than one in five persons. All payment models can improve pain management.
Key findings
- There were 115,757 NH residents with dementia who self-reported pain in the last 30 days of life.
- Of those, 17.8% (n = 20,585) reported having pain the last five days from assessment, which varied by Medicare payment model (17.7% in TM, 17.5% in MA, and 19.1% in ACOs; p < 0.001).
- Among decedents reporting pain, 23.6% of ACO decedents reported pain affecting QoL compared to 22.1% in MA and 21.6% in TM (p = 0.09).
- After adjustment, decedents in ACOs compared to TM had greater predicted probability of pain affecting QoL (absolute marginal difference 0.017, 95% CI 0.00–0.035, p = 0.05), and persons in MA did not differ from persons in TM (absolute marginal difference 0.005, 95% CI −0.008 to 0.019, p = 0.41).
- Conclusions and Among dementia decedents dying with pain, pain impacted QoL in more than one in five persons.
Why it matters
This study found that among nursing home residents with dementia who died with pain, pain affected quality of life in more than one in five, with small differences by Medicare payment model. It does not test any treatment, cure, or prevention for Alzheimer's disease.
Study details
- Participants20,585
- Effect size17.8%; 17.7%; 17.5%
- Evidence strengthLow
How this study scored 46/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of Palliative Medicine) |
| Journal's citation record | 1 / 4 | Journal of Palliative Medicine: journal h-index 134 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2022 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 20,585 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 5 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.8 citations a year over 6 year(s) since 2022 |
| Impact for its field and year | 2 / 6 | Cited 1.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 1 / 4 | Cited 3 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Joan M. Teno: h-index 90 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Brown University: institution h-index 1,120 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 35675641) |
| Free to read | 2 / 2 | Free to read |
| Total | 46 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Bunker, J., Mitchell, S. L., Bélanger, E., Gozalo, P. L., & Teno, J. M. (2022). Pain Impacting Quality of Life in Persons with Dementia Dying in the Nursing Home by Alternative Medicare Payment Model. Journal of Palliative Medicine. https://doi.org/10.1089/jpm.2022.0047
Vancouver
Bunker J, Mitchell SL, Bélanger E, Gozalo PL, Teno JM. Pain Impacting Quality of Life in Persons with Dementia Dying in the Nursing Home by Alternative Medicare Payment Model. Journal of Palliative Medicine. 2022. doi:10.1089/jpm.2022.0047. PMID: 35675641.
BibTeX
@article{bunker2022-35675641,
author = {Bunker, Jennifer and Mitchell, Susan L. and Bélanger, Emmanuelle and Gozalo, Pedro L. and Teno, Joan M.},
title = {{Pain Impacting Quality of Life in Persons with Dementia Dying in the Nursing Home by Alternative Medicare Payment Model}},
journal = {Journal of Palliative Medicine},
year = {2022},
doi = {10.1089/jpm.2022.0047},
pmid = {35675641},
url = {https://doi.org/10.1089/jpm.2022.0047}
}
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